Manual Single National Disability Rating to Colombia - Decree 917 of 1999 (Part I of II) - Chapter II - 2. PERIPHERAL NERVOUS SYSTEM

MANUAL SINGLE NATIONAL DISABILITY
(PART I OF II)

CHAPTER II
2. PERIPHERAL NERVOUS SYSTEM

2.1 General

These standards establish the criteria used to assess permanent impairment resulting from the alteration of peripheral spinal nerves. It is important to note that the assessment should be based on a thorough neurological examination.

To assess the deficiency is necessary to determine the degree of impairment in respect of:

2.1.1 Pain

Pain is a subjective feeling, individual and immeasurable agony, discomfort and anxiety, which affects a person in a variable. To evaluate the pain associated with spinal peripheral nerve disorders should be taken into account:

a) How pain interferes with the performance of daily activities of the individual;

b) What is the extent of pain along the involved dermatome distribution;

c) The extent to which the description suggests that pain is caused by peripheral neuropathy, and that is associated with other symptoms or signs of nerve root or compromised. Nerve pain in the extremities secondary to nerve damage, intense character, steady and considerable variation, also known as causalgia, can become so extreme that the individual can be completely disabled. Is occasionally associated with peripheral neuropathy, particularly of the median, sciatic and tibial. When causalgia persists despite appropriate treatment, loss of function can lead to 100% of the limb deficiency assessed for that nerve. If reflex sympathetic dystrophy is associated with causalgia, applies the same criteria described above.

2.1.2 Loss of muscle strength muscle tests help evaluate specific nerve injury and include strength, duration and repetition of muscle contraction. The loss of strength not simulated, measured in accordance with the full range of motion against gravity and resistance, determine the impairment of the body, in accordance with the outline of the Table below:

TABLE No. 2.1: DEFICIENCY MUSCULAR STRENGTH BY LOSING

Impaired range of motion of the body (%)

Full against gravity and strong resistance 0

Against slight resistance 7.5

Only against gravity. 19

With gravity eliminated. 33

Traces of mobility. 45

Zero mobility. 50

Where possible we must distinguish loss of strength by pain of loss of function

motor impairment, and qualify separately with the corresponding tables. This requires

take into account:

2.1.2.1 sensory disorders.

The risk assessment should consider:

a) Pain and dysesthesias;

b) Changes in the knowledge of the measures, shape and quality of objects (stereognosis)

c) Changes in position sense, and perception of two points;

d) Paresthesias of cerebral origin;

e) Changes that can be discovered with other more complex tests, such as disturbances in body image.

2.1.2.2 motor disorders.

These disorders include hemiparesis and hemiplegia that are limiting. Furthermore, it is not so limiting other symptoms, namely:

a) Involuntary movements such as tremor, athetosis, chorea or hemiballism;

b) Changes in tone and posture;

c) Various forms of akinesia and dyskinesia, in which the movement can be severely affected as in Parkinson's disease;

d) deficiency associated and cooperative movements. Complex alterations of the manual and postage, including ataxias.

2.1.3 Diagnostic tests help Within tests help in the diagnoses that can help determine nerve involvement electrodiagnostic highlights, including electromyography, nerve conduction time and evoked potentials. These tests should only be performed in specialized centers by professionals with proven expertise and technical capacity.

2.2 THE SPINAL NERVES

The recommended order and described for determining the permanent impairment caused by damage to peripheral spinal nerve is:

a) The spinal nerve roots.

b) The spinal nerve complexes.

c) specific spinal nerves.

2.2.1. Spinal nerve plexus injuries deficiency diseases or nerve plexus should be determined by evaluating the loss of their varied functions. Through anastomosis of the nerve roots are formed

main nerve trunks, whose clinical significance lies in the fact that their injuries are easily recognizable syndromes lead to accurate.

a) Brachial plexus and upper trunk.

b) the lumbosacral plexus or middle or lower trunk.

2.2.1.1 Superior trunk brachial plexus or supplies the shoulder and upper extremity and is formed by the anterior divisions of the C5 - C6 - C7 and C8 cervical roots and the first thoracic root.

Figure No. 1: Plej BRACHIAL

TABLE No.2.2 DEFICIENCY OF UNILATERAL BRACHIAL PLEXUS

Global Deficiency

Sensory deficit pain or discomfort (%) for loss of strength (%) Top value

total loss (%)

* Upper trunk (C-5, C-6) 0 -15 0-15 0 to 30

(Duchenne - Erb) 0 - 7 0 - 15.5 0 - 23.5

* Trunk medium (C-7) 0 - 1.5 0 - 10 0 - 11.5

* Lower trunk (C-8, T-1) (Klum-pke-Déjerime) 0-5 0-18 0 to 23

NOTE: The sum of the deficiencies caused by the sensory deficit, pain or discomfort, and those of

loss of strength, equivalent to the maximum value of overall deficit. Therefore, this sum can not

exceed that value.

Lumbosacral Plexus 2.2.1.2

The main nerves of the lower extremity and pelvis are born of the lumbosacral plexus. Alterations in this plexus not only involve the lower limb but also the intestine, bladder and sexual organs, the stability of the trunk.

FIGURE No. 2: Plej LUMBOSACRAL Table No. 2.3 Weaknesses OF UNILATERAL LUMBOSACRAL Plej

Global deficiency sensory deficit pain or discomfort (%) for loss of strength (%) Top value

total loss (%)

0 - 16 0 – 19 0 - 35

NOTE: The sum of the deficiencies caused by the sensory deficit, pain or discomfort and loss of power, equivalent to the maximum value of overall deficit. Therefore, this amount can not exceed that value.

2.3 ROOTS OF SPINAL NERVESTABLE No.2.4 DEFICIENCY FOR UNILATERAL SPINAL NERVE ROOT

Limb deficiency (%)

Nerve root: For pain or discomfort, sensory deficit (%) for loss of strength (%) For

Total loss (%)

C-5 0-5 0-12 0-17.0

C-6 0-5 0-15 0-20.0

C-7 0-15 0-4 0-18.5

C-8 0-4 0-20 0-24.0

T-1 0-5 0-7 0-12.0

L-3 0-5 0-7 0-12.0

L-4 0-4 0-14 0-18.5

L-5 0-4 0-16 0-20.0

S-1 0-5 0-7 0-12.0

The conversion to global deficiency must be made only when they are combined all the shortcomings of the limb studied. Where there is more committed spinal nerves must first combine the values

of limb deficiencies and weighted to the table of overall deficit.

2.3.1. SPINAL NERVE NOMINEES2.3.1.1. Head, Neck, and DiaphragmTable No.2.5: IMPAIRMENT SPECIFIC UNILATERAL SPINAL NERVE AFFECTING THE HEAD AND NECK

Global Deficiency

Deficit sensory pain or discomfort (%) for loss of strength (%) For Loss

Total (%)

Greater occipital 0 -2.5 0 0 - 2.5

Lesser occipital 0 - 1.5 0 0 - 1.5

Great headset 0 - 1.5 0 0 - 1.5

Accessories section (Sec. Espinal) 0 0 - 5 0 - 5.0

A unilateral disorder of the phrenic nerve would result in a minimum deficiency, since the person can compensate and continue with their daily activities. The overall deficit of unilateral phrenic complication person shall be 10%. On the other hand, a bilateral phrenic complication could lead to a reduction in respiratory function, which must be evaluated according to the criteria set out in Chapter of the respiratory system.

2.3.1.2 Upper ExtremityTable No.2.6: IMPAIRMENT UNILATERAL SPINAL NERVE AFFECTING THE UPPER EXTREMITY

. Limb deficiency (%)

Nerves: sensory deficit pain or discomfort (%) for loss of strength (%) For

Total loss (%)

Thoracic Previous 0 0-5 0 to 5

Axillary (circumflex) 0-5 0-33 0 to 38

Dorsal scapular 0 0-5 0 to 5

Long thoracic 0 0-15 0 to 15

First branchial cutaneous Middle 0-5 0 0-5

Brachial Cutaneous Middle 0-5 0 0-5

Medium (forearm above the average) 0-31 0-42 0-73

Medium (forearm Below average) 33 0-28 0-61

Thumb radial side branch 0-4 0 0-4

Rama ulnar side of thumb 0-8 0 0-8

Rama radial side of index 0 0-8 0-8

Ulnar side branch index 0-3 0-3 0

Radial side branch of the middle finger or middle 0-7 0-7 0

Ulnar branch of the middle finger or middle 0-2 0-2 0

Rama radial side of ring 0 0-3 0-3

Cutaneous muscle 0-5 0-29 0-24

Radial (spinal muscle) (upper arm with loss of the triceps), wrist position

0-5 0-52 0-57 functional

Radial - spinal muscle functional position 0-38 0-43 0-5

Upper and lower subscapular-0 0-5 0-5

Supra scapular 0-5 0-14 0-19

Toracicodorsal - Subscapularis 0 0-10 0-10

Cubital - above the forearm. Middle 0-7 0-26 0-33

Cubital - under the arm. Middle 0-9 0-24 0-33

Rama's ring finger ulnar side 0-2 0 0-2

Radial side of the little branch 0-2 0 0-2

Little finger ulnar side branch 0-4 0-4 0

NOTE: Refer to Table No. 2.9 to convert the upper extremity deficiency in overall deficit, only after combining all the deficiencies of the upper limb studied.

Table No.2.7: IMPAIRMENT OF CARPAL TUNNEL SYNDROME. Class Description deficiency hand criteria (%) Upper Limb Deficiency (%) Global Deficit (%)

I Light: There is a sensitivity. 5.0 5.0 3.0

II Moderate: There is motor involvement and sensitivity. 10.0 9.0 5.0

Severo III: There is motor impairment, sensitivity and denervation. 14.0 15.0 8.0

FIGURE 3. - Motor innervation UPPER EXTREMITYTABLE No. 2.8: CONVERSION OF DEFICIENCY DEFICIENCY FINGERS IN THE HAND AND UPPER LIMB DEFICIENCY DEFICIENCY

Thumb (%) Used (%) Upper Extremity (%) Finger Index (%) Used (%)

Upper Extremity (%)

0 –1 0 0 0 –1 0 0

2-3 1 1 2-5 1 1

4-6 2 2 6-9 2 2

7-8 3 3 10-13 3 3

9 – 11 4 4 14 – 17 4 4

12 – 13 5 5 18 – 21 5 5

14 – 16 6 5 22 – 25 6 5

17 – 18 7 6 26 – 29 7 6

19 – 21 8 7 30 – 33 8 7

22 – 23 9 8 34 – 37 9 8

24 - 26 10 9 38 - 41 10 9

27 – 28 11 10 42 – 45 11 10

29 - 31 12 11 46 –49 12 11

Finger Heart (%) Labour (%) Upper Extremity (%) Ring Finger (%) Labour (%)

Upper Extremity (%)

0 - 2 0 0 0 – 4 0 0

3 - 7 1 1 5 – 14 1 1

8 – 12 2 2 15 – 24 2 2

13 – 17 3 3 25 – 34 3 3

18 – 22 4 4 35 – 44 4 4

23 – 27 5 5 45 – 54 5 5

28 -32 June 5 Little Finger

33 - 37 7 6 0 – 9 0 0

38 – 42 8 7 10 – 29 1 1

43 – 47 9 8 30 – 49 2 2

48 - 52 10 9 50 – 69 3 3

70 – 89 4 4

Table No.2.9: CONVERSION OF DEFICIENCY OF UPPER LIMB DEFICIENCY IN GLOBAL SUPER Extremadura (%). 

PERSON GLOBAL (%) Extremadura SUPER (%). PERSON GLOBAL (%) Extremadura. SUPER (%) PERSON GLOBAL (%) Extremadura SUPER (%) PERSON GLOBAL (%) Extremadura SUPER (%). PERSON GLOBAL (%)

0 0.0 20 6.0 40 12.0 60 18.0 80 23.0

1 0.5 21 6.5 41 12.5 61 18.5 81 24.5

2 0.5 22 6.5 42 12.5 62 18.5 82 24.5

3 1.0 23 7.0 43 13.0 63 19.0 83 25.0

4 1.0 24 7.0 44 13.0 64 19.0 84 25.0

5 1.5 25 7.5 45 13.5 65 19.5 85 25.5

6 2.0 26 8.0 46 14.0 66 20.0 86 26.0

7 2.0 27 8.0 47 14.0 67 20.0 87 26.0

8 2.5 28 8.5 48 14.5 68 20.5 88 26.5

9 2.5 29 8.5 49 14.5 69 20.5 89 26.5

10 3.0 30 9.0 50 15.0 70 21.0 90 27.0

11 3.5 31 9.5 51 15.5 71 21.5 91 27.5

12 3.5 32 9.5 52 15.5 72 21.5 92 27.5

13 4.0 33 10.0 53 16.0 73 22.0 93 28.0

14 4.0 34 10.0 54 16.0 74 22.0 94 28.0

15 4.5 35 10.5 55 16.5 75 22.5 95 28.5

16 5.0 36 11.0 56 17.0 76 23.0 96 29.0

17 5.0 37 11.0 57 17.0 77 23.0 97 29.0

18 5.5 38 11.5 58 17.5 78 23.5 98 29.5

19 5.5 39 11.5 59 17.5 79 23.5 99 29.5

100 30.0

The percentages in this table are expressed unilaterally. When unilateral bilateral engagement deficiencies will be determined individually and made each one in overall deficit. Finally, the values ​​are combined using the combined values ​​table. In the case of the dominant limb applies the criteria outlined in Chapter 1.

2.3.1.3 Lower ExtremityTABLE No.2.10 UNILATERAL SPINAL NERVE IMPAIRMENT SPECIFIC TO AFFECT THE LOWER LIMB

Lower limb deficiency (%)

Nerves: sensory deficit pain or discomfort (%) for loss of strength (%) For

Total loss (%)

0-38 0-33.2 0-4.8 Femoral

Femoral (below the iliac nerve) 0-34 0-19.2 0-4.8

Genito - Femoral 0-5 0 0-5

Inferior gluteal 0 0-25 0-25

Femorocutaneous 0-10 0 0-10

Internal obturator nerve 0 0-10 0-10

Muscle Nerve Piriformis 0 0-10 0-10

Shutter 0 0-10 0-10

Posterior thigh skin 0-5 0 0-5

Superior gluteal 0 0-20 0-20

Sciatic (nerve supply above the popliteal fossa) 0-20.2 0-60.8 0-81

Common peroneal (lateral popliteal external) 0-38 0-33.2 0-4.8

Deep (over the middle tibia) 0 0-25 0-25

Deep (below the middle tibia 0 0-5 0-5

Surface 0-9.4 0-2.6 0-14

Tibial nerve (popliteal Middle or internal) Above knee 0 0-45 0-45

Hind tibia (half calf and knee) 0-12.4 0-20.6 0-33

Below half calf 0-14 0-14 0-28

Lateral plantar branch 0-5 0-5 0-10

Medial plantar branch 0-5 0-5 0-10

Cruris (sural) 0-5 0 0-5

Notes:

1. View No.2.11 TABLE to convert the lower limb deficiency in global impairment of the person.

2. The overall deficit conversion from partial deficiency is only done when all the deficiencies affecting the lower limb have been studied in combination.

TABLE No.2.11: DEFICIENCY OF LOWER LIMB DEFICIENCY IN RELATION TO GLOBAL Extremadura LOWER (%). PERSON GLOBAL (%) 

Extremadura LOWER (%). PERSON GLOBAL (%) Extremadura LOWER (%). PERSON GLOBAL (%) Extremadura LOWER (%). PERSON GLOBAL (%) Extremadura LOWER (%). PERSON GLOBAL (%)

0 0.0 20 4.0 40 8.0 60 12.0 80 16.0

1 0.0 21 4.0 41 8.0 61 12.0 81 16.0

2 0.5 22 4.5 42 8.5 62 12.5 82 16.5

3 0.5 23 4.5. 43 8.5 63 12.5 83 16.5

4 1.0 24 5.0 44 9.0 64 13.0 84 17.0

5 1.0 25 5.0 45 9.0 65 13.0 85 17.0

6 1.0 26 5.0 46 9.0 66 13.0 86 17.0

7 1.5 27 5.5 47 9.5 67 13.5 87 17.5

8 1.5 28 5.5 48 9.5 68 13.5 88 17.5

9 2.0 29 6.0 49 10.0 69 14.0 89 18.0

10 2.0 30 6.0 50 10.0 70 14.0 90 18.0

11 2.0 31 6.0 51 10.0 71 14.0 91 18.0

12 2.5 32 6.5 52 10.5 72 14.5 92 18.5

13 2.5 33 6.5 53 10.5 73 14.5 93 18.5

14 3.0 34 7.0 54 11.0 74 15.0 94 19.0

15 3.0 35 7.0 55 11.0 75 15.0 95 19.0

16 3.0 36 7.0 56 11.0 76 15.0 96 19.0

17 3.5 37 7.5 57 11.5 77 15.5 97 19.5

18 3.5 38 7.5 58 11.5 78 15.5 98 19.5

19 4.0 39 8 59 12.0 79 16.0 99 20.0

100 20.0

TABLE No.2.12: Poor THORACIC ROOT

Global Deficiency Unilateral thoracic roots (%) Deficiency Global Bilateral (%)

Two thoracic roots 0 - 2.4 0 - 4.9

Five thoracic roots 2.5 - 7.4 5.0 - 13.9

Any of five or more thoracic roots 7.5 - 17.5 14.0 - 29.0