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{{side}} Shoulder Impairment Rating – AMA Guides 5th Edition
Patient Name: {{firstname}} {{lastname}}Date of Birth: {{dob}}
Handedness: {{Handedness}}
Date of Injury: {{doi}}
Injured Body Part: {{bodyPart}} - {{side}}
Basis for data relied upon for this impairment evaluation:
Subjective
Based on the available data, this individual is determined to have {{pain_val_pub | lowercase}} pain. {{pain_freq_pub}} {{adl_affected}} activities of daily living are affected. The following activities are limited with or without pain: {{val}}{{$last ? '.' : ($index==adllimit.length-2) ? ',' : ','}} There are no limitations on any activities of daily living. The following activities cause pain/symptoms: {{painval}}{{$last ? '.' : ($index==adlpain.length-2) ? ',' : ','}} Performing activities of daily living does not cause pain/symptoms.Surgical History
{{surgery_performed_pub}}Pre-existing Shoulder Conditions
No pre-existing {{side | lowercase}} shoulder condition reported. There is a pre-existing {{side | lowercase}} shoulder condition. {{pre_pain_val_pub ? pre_pain_val_pub + ' pain' : 'Pain'}} reported due to pre-existing condition. {{pre_pain_freq_pub}}
Objective Exam
The skin exam demonstrates the presence of a scar {{skin_pub}} symptoms resultant from this injury. Based on the available data, the objective exam for this individual is unknown. Based on the available objective exam this individual is determined to have {{rom_pub | lowercase}} loss of motion. {{weakness_pub}}{{flexionweaknesspub}}
{{extensionweaknesspub}}
{{abductionweaknesspub}}
{{adductionweaknesspub}}
{{extrotationweaknesspub}}
{{introtationweaknesspub}}
Diagnostic Testing
{{diagnostic_test_pub}} Diagnostic testing {{gh_joint_pub2}} arthritis at the glenohumeral joint. Diagnostic testing {{ac_joint_pub2}} arthritis at the acromioclavicular joint.Functional Limitations
Work status: {{func_limits}}Functional status inferred based on available data. Work status is otherwise unknown.
Impairment Rating
Rating Chapter: 16 The Upper Extremities
The AMA Guides 5th Edition impairment rating results are as follows:Evaluating Abnormal Motion: {{rom_ue}}%UE
Comment: Estimated ratable loss in the plane(s) of Flexion {{rom_flexion_d}}o ({{rom_flexion}}%UE), Extension {{rom_extension_d}}o ({{rom_extension}}%UE), Abduction {{rom_abduction_d}}o ({{rom_abduction}}%UE), Adduction {{rom_adduction_d}}o ({{rom_adduction}}%UE), External Rotation {{rom_ext_rotation_d}}o ({{rom_ext_rotation}}%UE), and Internal Rotation {{rom_int_rotation_d}}o ({{rom_int_rotation}}%UE).
Calculations: Section 1.5d Page 20, Section 16.4 Page 451, Section 16.4c Page 452-454, Figure 16-40 Page 476, Figure 16-43 Page 477, Figure 16-46 Page 479.
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Arthroplasty: {{surgery_ue}}%UE
Arthroplasty: {{surgery_ue}}%UE
Comment: {{filterNshow(surgery)}}
{{surgery_citation}}
Flexion Muscle Testing: {{flexionweaknessue}}%UE
Extension Muscle Testing: {{extensionweaknessue}}%UE
Abduction Muscle Testing: {{abductionweaknessue}}%UE
Adduction Muscle Testing: {{adductionweaknessue}}%UE
External Rotation Muscle Testing: {{extrotationweaknessue}}%UE
Internal Rotation Muscle Testing: {{introtationweaknessue}}%UE
Manual Muscle Testing: (Global): {{weakness_ue}}%UE
Calculations: Table 16-11 Page 484, 16-35 Page 510.
Final Chapter 16 Shoulder Impairment {{final_ue}}%UE; {{wpi}}%WPI
Calculations: Table 16-3 Page 439, Combining Values Chart Page 604-606. Manual Muscle Testing: (Global): {{weakness_ue}}%UE
Calculations: Table 16-11 Page 484, 16-35 Page 510.
Final Chapter 16 Shoulder Impairment {{final_ue}}%UE; {{wpi}}%WPI
Calculations: Table 16-3 Page 439, Combining Values Chart Page 604-606.
Final Skin Rating (Weight Averaged): {{skin_val}}%WPI
Class Assignment: (1)
Comment: Signs present (surgery scars). Scar symptoms present. No scar symptoms.
Calculations: Rating Chapter: 8 The Skin; Rating Table/Figure: Table 1-2 Page 4, Table 8-2 Page 178. Impairment weight average applications in the AMA Guides 5th Edition: Pages 284, 289, 296 and 328.
California pain add-on (Chapters 3-17): {{pain_add_on}}%WPI
Chapter 18 Pain Rating: {{wpi}}%WPI
Section 1.2 Functional rating: {{wpi}}%WPI
Total Final Shoulder Claim: {{wpi_final}}%WPI
Calculations: Figure 16-40, 43,46 Pages 476, 477, 479. Table 16-27 Page 506. Table 16-35 Page 510. Combined Values Table Page 604-607.
Apportionment
If permanent disability (functional or administrative, i.e., a permanent disability rating calculated based on the findings of this report) is found to be present, non-industrial apportionment is not indicated. There are no prior injuries, ongoing disease processes, or subsequent injuries that apply. If permanent disability (functional or administrative, i.e., a permanent disability rating calculated based on the findings of this report) is found to be present, non-industrial apportionment is indicated. There are prior injuries, ongoing disease processes, or subsequent injuries that apply. The following discussion is provided with reasonable medical certainty and probability. Comment: The following apportionment is determined using weight averaged AMA Guides 5th Edition values where applicable. Scalars are based on objective clinical data and adjusted for industrial vs. non-industrial resultant permanent disability.Arthritis
Non-industrial arthritis causes shoulder pain.
The {{gh_joint_pub1 | lowercase}} degenerative changes at glenohumeral joint of the shoulder when weight averaged (Table 16-8 page 499) and impairment load tested in accordance with the AMA Guides 5th Edition, is statistically determined to be a {{adjusted_arthritis_pub}}% contribution for non-industrial apportionment. The {{ac_joint_pub1 | lowercase}} degenerative changes at acromioclavicular joint of the shoulder when weight averaged (Table 16-8 page 499) and impairment load tested in accordance with the AMA Guides 5th Edition, is statistically determined to be a {{adjusted_arthritis_pub}}% contribution for non-industrial apportionment. The {{ac_joint_pub1 | lowercase}} degenerative changes at acromioclavicular joint and the {{gh_joint_pub1 | lowercase}} degenerative changes at glenohumeral joint of the shoulder when weight averaged (Table 16-8 page 499) and impairment load tested in accordance with the AMA Guides 5th Edition, is statistically determined to be a {{adjusted_arthritis_pub}}% contribution for non-industrial apportionment. The {{ac_joint_pub1 | lowercase}} degenerative changes of the AC joint resultant in the claviculoplasty procedure when weight averaged (Table 16-8 page 499) and impairment load tested in accordance with the AMA Guides 5th Edition, is statistically determined to be a {{adjusted_arthritis_pub}}% contribution for non-industrial apportionment. The {{gh_joint_pub1 | lowercase}} degenerative changes of the glenohumeral joint when weight averaged (Table 16-8 page 499) and impairment load tested in accordance with the AMA Guides 5th Edition, is statistically determined to be a {{adjusted_arthritis_pub}}% contribution for non-industrial apportionment. The {{gh_joint_pub1 | lowercase}} degenerative changes of the glenohumeral joint resultant in the total shoulder replacement (Arthroplasty/Implant) procedure when weight averaged (Table 16-8 page 499) and impairment load tested in accordance with the AMA Guides 5th Edition, is statistically determined to be a {{adjusted_arthritis_pub}}% contribution for non-industrial apportionment. The {{ac_joint_pub1 | lowercase}} degenerative changes of the acromioclavicular joint when weight averaged (Table 16-8 page 499) and impairment load tested in accordance with the AMA Guides 5th Edition, is statistically determined to be a {{adjusted_arthritis_pub}}% contribution for non-industrial apportionment.Pre-existing Injury
This individual has a pre-existing condition with {{pre_pain_val_pub | lowercase }} pain. {{pre_pain_freq_pub}} The {{adjusted_preexisting_pub}}% apportion value is objectively calculated based on the unique and specific clinical data set presented in the report for this individual. The value is calculated as follows:Step 1. A scalar value is determined based on the RateFast Impairment Load Testing™ values on the available dimensions of pain, fatigue and functional limitations (inability to perform activities of daily living); where absent, data is based on the internal consistency of the data set and presence or absence pain interpolated across the definitions in Chapter 18 Pain, Table 18-3 Page 575 of the AMA Guides 5th Edition. Impairment load scalars are determined using impairment average weighting. Interpolation and impairment average weighting methods are described and illustrated in multiple sections throughout the AMA Guides 5th Edition (References: Interpolation: Pages 20, 453, 455, 456, 457, 459, 460, 461, 462, 463, 464, 466, 467, 468, 470, 471, 472, 474, 475, 476, 478, 538, and 549; Impairment average weighting: Pages 284, 289, 296 and 328).
Step 2. The scalar is then converted and assigned to a severity class with mathematical bracketing defined by the AMA Guides 5th Edition classification (eg. Chapter 18 Pain, Table 18-3 Page 575) and/or the method scoring as outlined above.
Step 3. The clinical data set that comprises the objective functional limitations in combination with the ratable symptom burden (RateFast Impairment Load Testing™) from the injury is adjusted for the non-injury state to define the variance of permanent impairment (eg. Resultant permanent disability rating) attributable to this non-industrial condition.
Step 4. The resultant variance is expressed as a ratio and converted to a numeric percentage whole value using standard statistical rounding.
Total non-industrial apportionment: {{final_apportionment}}%
Rating Chapter: 18 Pain
Impairment Classification Due to Pain Disorders (Impairment Load Weight Averaged)
Pain Severity: {{pain}}
Pain Frequency: {{pain_freq_word}}
Pain Class: {{pain_class}}
Pain WPI: {{wpi}}%WPI
Comment: This is NOT an Almaraz Guzman I-III rating as the impairment burden is determined to not be unusual or extra ordinary beyond that provided in the chapter cited of the AMA "four corner" rating.
Calculations: Figure 18-1, Page 574. Table 18-3, Page 575. Method: Impairment load scalars are determined using impairment average weighting. Interpolation and impairment average weighting methods are described and illustrated in multiple sections throughout the AMA Guides 5th Edition (References: Interpolation: Pages 20, 453, 455, 456, 457, 459, 460, 461, 462, 463, 464, 466, 467, 468, 470, 471, 472, 474, 475, 476, 478, 538, and 549; Impairment average weighting: Pages 284, 289, 296 and 328).
Comment: "A 0% whole person (WP) impairment rating is assigned to an individual with an impairment if the impairment has no significant organ or body system functional consequences and does not limit the performance of the common activities of daily living indicated in Table 1-2.” Page 5. "For example, an individual who receives a 30% whole person impairment due to pericardial heart disease is considered from a clinical standpoint to have a 30% reduction in general functioning as represented by a decrease in the ability to perform activities of daily living.” Page 5.
An ADL "functional rating” is therefore created using the accepted method of interpolation (which is also discussed in the rating) using the ADL impact (which is a 1%WPI = 1%ADL representation) with regards to endurance, pain. "An impairment can be manifested objectively, for example, by a fracture, and/or subjectively, through fatigue and pain.3". Page 2.
Method: Impairment load scalars are determined using impairment average weighting. Interpolation and impairment average weighting methods are described and illustrated in multiple sections throughout the AMA Guides 5th Edition (References: Interpolation: Pages 20, 453, 455, 456, 457, 459, 460, 461, 462, 463, 464, 466, 467, 468, 470, 471, 472, 474, 475, 476, 478, 538, and 549; Impairment average weighting: Pages 284, 289, 296 and 328).
Comment: Limited performance in the common activities of daily living are present ({{adllimit.length}}/34); adjusted pain {{pain_val}}/10. {{pain_freq_pub.split('.').join('')}} of the day. A rating other than 0% WPI is required for compliance with the AMA Guides 5th Edition. This individual does not meet ratable criteria above a Class I (0%WPI) in Chapter 18 Pain Table 18-3, Page 575.
Section 1.2 rating is indicated: {{final_ue}}%UE; {{wpi_final}}%WPI; based on the full impairment load value of the shoulder according to the AMA Guides 5th Edition Table 16-18 Page 499; 54%WPI. This is NOT an Almaraz Guzman I-III rating as the impairment burden is determined to not be unusual or extra ordinary beyond that provided in the chapter cited of the AMA "four corner" rating.
Calculations: Table 1-2, Page 4, Section 1.2, Page 5.
Future Care
{{futurecare}}RateFast Claim Metric Summary
Injury Severity: {{rrsi_pub}}Percentage Recovery Score Index Based: {{rrsi_perc}}
Data Completeness: {{data_complete_pub}}%
Data Grade: {{data_grade}}