Assessment and management of upper and lower extremity impairment and disability

The assessment and management of occupational and nonoccupational injuries and illnesses of the extremities require knowledge of the same concepts of impairment and disability that are used when evaluating or treating problems of other body systems. Dr. Talmage discusses the need for an accurate and objectively verifiable diagnosis and focuses on upper extremity pain in workers and the term tendinitis'. The concept of maximal medical improvement is considered, with examples of knee injuries to the menisci and localized articular cartilage defects. Causation controversies are explored using carpal tunnel syndrome as the example. The impairment rating process is illustrated by use of the AMA Guides system. A "checklist" to insure completeness of the examination of extremity problems is offered. Disability assessment and management is discussed, with an emphasis on the difference between abilities (capacities) and risk-based restrictions. The author concludes with thoughts on how to minimize disability.