Impairment Evaluation Tip: Radiculopathy

Saturday, February 24, 2007 | 0

By Dr. Christopher Brigham

This impairment tip is courtesy of Kenneth Subin, MD, MPH, CIME, one of our senior physician reviewers.

The preferred methodology in the AMA Guides 5th ed. for rating impairment of the spine is the Diagnosis-Related Estimate (DRE).

Table 15-3, Criteria for Rating Impairment Due to Lumbar Spine Injury, Table 15-4, Criteria for Rating Impairment Due to Thoracic Spine Injury, and Table 15-6, Criteria for Rating Impairment Due to Cervical Disorders, outline the five applicable categories and impairment ranges based upon historical, physical examination, and other clinical findings.

Box 15-1, Definitions of Clinical Findings Used to Place an Individual in a DRE Category, on pages 382-383 contains essential definitions of clinical findings to help assess the proper placement of an examinee in a DRE category.

In our experience, after reviewing thousands of reports over the past years, the diagnosis of radiculopathy presents one of the more challenging concepts when determining the correct DRE placement.

The Guides define radiculopathy as a "significant alteration in the function of a nerve root or nerve roots and is usually caused by pressure on one or several nerve roots."

The most important clinical components required to support the diagnosis of a compressive radiculopathy include:

* Pain, numbness, and/or paresthesias in a dermatomal distribution

* An imaging study documenting correlating concordant nerve root pathology

* Associated clinical findings such as loss of relevant reflexes, muscle weakness and/or atrophy of appropriate muscle groups, loss of sensation in the corresponding dermatome(s)

Electrodiagnostic studies are helpful in supporting the diagnosis of a compressive radiculopathy but are not required, and do not substitute for imaging studies.

Brigham is the editor of the Guides Newsletter and Guides Casebook. To view more of these tips visit:

www.impairment.com/tips

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