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To Add or To
Combine? Rating Impairment of the Hand - Rating Tip of the Week
There is often confusion about
whether specific impairments are added or
combined when assessing hand injuries. Hopefully
this week’s tip will help clarify the proper
procedures and serve as a quick reference in the
future.
The Guides differentiate between the thumb and
fingers with respect to this process.
Thumb
Amputation at or proximal to the MP joint is
expressed in terms of upper extremity impairment
and is added directly to other upper extremity
impairment, if applicable
Amputation distal to the MP joint is expressed
in terms of digit impairment
All joint motion impairments are added
Additional impairing factors (sensory, motor,
vascular, etc.) are combined at the smallest
common unit (i.e. digit < hand < upper extremity
< whole person)
Digits
Amputation is expressed in terms of digit
impairment
Joint motion impairments of a common joint are
added
Multiple joint impairments of the same digit are
combined at the digit level
Additional impairing factors (sensory, motor,
vascular, etc.) are combined at the digit level
The total digit impairment is converted to hand
impairment
Hand
Hand impairment values for multiple digits are
added
The final hand impairment is then converted to
upper extremity
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