January 8^th, 2009

Law Offices of Jones and Jones
J. R. Jones
Attorney at Law
1234 South High Street
Columbus, Ohio  43215
Telephone:  (614) 555-5555
Facsimile:  (614) 555-5556

The following is in regards to your client, Jane Doe, who presented to our office on January 8, 2009, for examination in regards to the above-mentioned industrial related incident in reference to percentage of Whole Person Permanent Partial Impairment, utilizing AMA Guides, 5^th Edition.

HISTORY AND MECHANISM:

Jane Doe presented with ongoing complaints of neck pain.  She states that these complaints have been present since being involved in an industrial related accident that occurred on the above-mentioned date.  She described the mechanism of the injury as when she was lifting a large stack of claim files she felt severe pain that radiated into her right shoulder, neck, right arm and hand numbness, with weakness and tingling noticed along with pain radiating down her arm to her hand, causing a weak grip and right hand pain.  The facility she went to after the accident was OSU occupational therapy.  The next doctor she went to was Dr. Matvey, where she received chiropractic treatment.  She is currently under the care of Dr. James Hicks, where she is receiving chiropractic treatment.

CURRENT COMPLAINTS AND STATUS:

Jane Doe explained that she still works for the above-mentioned employer. The patient states that she missed a couple of days of work due to the injury.  Ms. Doe states that the pain comes and goes.  She describes the pain as a tingling, throbbing, numbness, stiffness, aching, and shooting sensation.  The patient states that she has limited mobility of her neck.  She states that this injury interferes with her work, sleep, daily routine, and recreation.  With limited use of her neck, it is difficult or impossible for her to perform the following activities:  doing laundry, running sweeper, cutting lawn, shoveling snow, raking leaves, playing with kids, hobbies, exercising, and sleeping.  Ms. Doe explains that as the weather gets damp and cold her pain increases.  Ms. Doe explains that since the injury she also has difficulty washing and curling her hair, reaching above her head for items, and she often drops things like cups and glasses. 

Deep tendon reflexes were +2 and symmetrical of the biceps, triceps, and were elicited bilaterally and equally of the brachial radialis.  Foraminal compression test was positive at C6 on the right.  Maximal foraminal compression test was positive on the right at C6.  Hypertonicity was palpated in the trapezius muscles on the right.  Thenar muscles in both hands spasm.  Grip strength was 45 lbs left and 10 lbs right.  Patient is right hand dominant. Motion palpation revealed fixations at C5/C6 during flexion and extension and left rotation.

CERVICAL RANGE OF MOTION IMPRESSION:

A.)  Flexion = 2% impairment.
B.)  Extension = 4% impairment.
C.)  Left Lateral Flexion = 2% impairment.
D.)  Right Lateral Flexion = 2% impairment.
E.)  Left Rotation = 1% impairment.
F.)  Right Rotation = 1% impairment.

Criteria for rating whole person impairment due to specific spine disorders. 

Section II.  Intervertebral disc or other soft tissue lesion; right paracentral disc protrusion, C5-C6. Item c:  Unoperated on stable, with medically documented injury, pain and rigidity associated with moderate to severe degenerative changes on structural tests, includes a herniated nucleus pulposus with or without radiculopathy is equal to a 6% WPI.

The patient was unable to discern between two sharp points of contact within 40mm (<5mm is normal) over the C6 dermatome in the right hand.  This equates to a  2% WPI.  Reference AMA Guides, 5^th Edition, Table 16-10, page 482, and Table 16-13, page 489.

DISCUSSION AND OPINION: 

The following impairment rating has been given to Jane Doe after a thorough history, orthopedics, neurological, muscle testing, and range of motion examinations were performed on January 8^th, 2009:  It is my professional opinion that Ms. Doe has sustained a 19% Whole Person Impairment.

This impairment rating falls into the Range of Motion category, November 2000, 5^th Edition AMA Guides to the Evaluation of Permanent Impairment.