Evaluation of social security disability in claimants with rheumatic disease

Article Abstract:

The General Accounting Office has attempted to limit the number of new beneficiaries of the Social Security Administration's (SSA's) disability programs. Discrepancies between the clinical condition of patients and the awarding or withholding Social Security Disability have been noted. To further investigate these areas, claimants citing rheumatic disease (chronic inflammatory disorders associated with damage to joints and other tissues) were analyzed. Fifteen percent of all applicants for SSA disability claim to suffer from musculoskeletal impairment; thus, the problem is one of considerable magnitude. New disability claimants who said they had arthritis or systemic lupus erythematosus (304 people) were included in the study; subjects were gathered from applicants at seven district offices in two states. The claimants were examined according to standard SSA protocols, then underwent two additional examinations: one by a rheumatologist, and one to determine work capacity. A discussion is presented of the SSA's definition of disability and of the methodology used in the two additional examinations. Of the 304 claimants, 58 refused to participate; 69 were not eligible for the study for other reasons; and 79 dropped out during the study. The study was completed by 98 people, 52 of whom listed musculoskeletal disease as their main diagnosis. Results showed agreement between the judgments of the SSA and the examining rheumatologists for 35 subjects (67 percent of the cases). According to the SSA, 25 were unable to work (11 for medical reasons alone); according to the rheumatologists, 30 were unable to work. Rheumatologists judged as unable 11 of the 27 judged able to work by the SSA. Results from the evaluations of subjects' work capacity did not agree with the SSA's evaluations of work ability at any more than the chance level. Overall, the findings indicate a fairly good level of agreement between SSA's decisions and decisions by clinicians. Including results from rheumatologists' examinations and work capacity evaluations could help the SSA in making decisions about who should receive disability. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Management, Complications and side effects, Disability evaluation, Rheumatic diseases, United States. Social Security Administration

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The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings

Article Abstract:

The carpal tunnel syndrome results in pain and weakness of the muscles of the thumb, and is caused by pressure on the median nerve which runs through a passage-like structure in the wrist called the carpal tunnel. The usefulness of the clinical history and physical examination findings in diagnosing carpal tunnel syndrome was evaluated. In addition, the ability of certain clinical findings to identify patients at risk for developing carpal tunnel syndrome was assessed. Out of 110 patients with upper extremity complaints of various types, 44 had carpal tunnel syndrome. The best ways to identify this disorder included the hand pain diagram rating and the Tinel sign. The hand pain diagram consists of back and palm views of both hands. Patients use the diagram to indicate where they have pain, and to describe the extent of their discomfort. The Tinel sign is carried out by tapping the square end of a reflex hammer five times on a portion of the wrist from a height of 12 centimeters. The Tinel sign is positive if the patient experiences pain or increased sensitivity in a finger innervated by the median nerve. Other physical findings or features from the clinical history were less useful in diagnosing carpal tunnel syndrome. The results show that age, the Tinel sign, and the hand pain diagram were useful in diagnosing carpal tunnel syndrome. Thus, certain groups of patients may be diagnosed without the need for complex and expensive nerve conduction studies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Carpal tunnel syndrome, Physical diagnosis, Medical examination

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A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty

Article Abstract:

Continuous passive motion (CPM) may be more effective and less expensive than traditional physical therapy for rehabilitation of patients who have undergone total knee arthroplasty, or knee replacement surgery. This method involves the use of a CPM machine set for a certain rate and arc of motion to exercise the patient's knee. Among 93 patients with arthritis who underwent total knee arthroplasty, 48 were treated with CPM plus conventional physical therapy and 45 were treated with conventional physical therapy alone. Patients in the CPM group had increased active range of motion, less swelling and less need for manipulations, compared with those in the conventional physical therapy group. Patients treated with CPM did not experience significantly less pain or fewer complications than those who were not treated with CPM. Costs associated with treatment were less for patients in the CPM group than for those in the conventional physical therapy group.

Care and treatment, Usage, Surgery, Physical therapy, Knee, Artificial knee, Knee prostheses

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