Peripheral vascular disease involving the upper extremity can result in impairment. The AMA has developed criteria for determining the severity of the impairment.
NOTE: The scale here determines the impairment of an upper extremity rather than the level of impairment for the whole person.
NOTE: The assignment of whole person impairment needs to be clarified. According to the AMA Guides, impairment is assigned for each upper extremity, with total impairment based on combining both levels of impairment.
Parameters:
(1) intermittent claudication and pain
(2) edema
(3) Raynaud's symptoms
(4) evidence of vascular damage on physical examination
|
Intermittent Claudication and Pain |
Edema |
Raynaud's Symptoms |
Impairment of Upper Extremity |
|
neither at rest |
only transient |
with or without obstructive physiology that completely responds to lifestyle changes and/or medical therapy |
0 – 9% |
|
during severe usage |
persistent edema of moderate severity controlled by elastic supports |
with obstructive physiology that incompletely responds to lifestyle changes and/or medical therapy |
10 – 39% |
|
on mild usage |
marked edema that is only partially controlled by elastic supports |
|
40 – 69% |
|
on mild usage |
marked edema not controlled by elastic supports |
|
70 – 89% |
|
severe and constant at rest |
marked edema not controlled by elastic supports |
|
90 – 100% |
where:
• Calcification of arteries is usually detected on X-rays.
• Obstructive physiology in Raynaud's disease include finger:brachial indices < 0.8 or low digital temperatures with decreased laser Doppler signals that do not normalize with warming of affected digits.
|
Evidence of Vascular Damage on Physical Examination |
Impairment of Upper Extremity |
|
loss of pulses minimal loss subcutaneous tissue of fingertips calcification of arteries asymptomatic dilation of arteries or veins not requiring surgery or curtailing activities |
0 – 9% |
|
healed painless stump of an amputated digit showing evidence of persistent vascular disease or a healed ulcer |
10 – 39% |
|
healed amputation of 2 or more digits of one extremity with evidence of persisting vascular disease or superficial ulceration |
40 – 69% |
|
amputation at or above a wrist amputation of 2 or more digits of both extremities with evidence of persistent vascular disease persistent widespread or deep ulceration involving one extremity |
70 – 89% |
|
amputation at or above wrist of both extremities amputations of all digitis of both extremities with evidence of persistent vascular disease widespread or deep ulceration involving both upper extremities |
90 – 100% |
whole person impairment =
= 0.6 * (impairment of the upper extremity)
Specialty: Sports Medicine & Rehabilitation, Cardiology, Emergency Medicine
