What Is Included in the Impairment Physical Exam

26 April 2012 / Impairment Physical Exam / Comments Off on What Is Included in the Impairment Physical Exam

In general, each orthopedic body location is examined in the same sequence order to include the following:


Inspection: scars, atrophy, right left asymmetry, deformity, joint contractures, asymmetric gross motion, joint misalignment and muscle fasciculation.


Palpation: tenderness, spasm, crepitus, masses, guarding.


Range of motion: Use the goiniometer for measurements. “Measurments of active motion take precedence in the Guides. The actual measured goiniometer readings or linear measurements are recorded”. (page 451, Chapter 16, The Upper Extremities, AMA Guides 5th Edition, AMA Press, 2004)Active motion is the motion the employee can do on his/her own.


The most common convention is to list right over left side in reporting the measurements, and a minimum of two measurements must be obtained to verify accuracy and reproducibility for rating purposes. The AMA Guides state, "Two measurements made by the same examiner using the Guides that involve an individual or an individual's functions would be consistent if they fall within 10% of each other." (page 20, Chapter 2, Practical Application of the Guides, AMA Guides 5th Edition, AMA Press, 2004).


I list the measurement set as “Valid” or “Invalid” based on the 10% reproducibility requirement. This practice helps assists the reader in identifying ratable vs. unratable findings early on in the report.

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