Criteria: Thumb: Figure 16-12 Pie Chart of Thumb Impairments Due to Abnormal Motion at the IP joint (456), Figure 16-15 Pie Chart of Thumb Impairments Due to Abnormal Motion at the MP joint (457),Table 16-8a Thumb Impairments Due to Lack of Radial Abduction and to Ankylosis (459), Table 16-8b Thumb Impairments Due to Lack of Adduction and to Ankylosis (459), a Table 16-8b Thumb Impairments Due to Lack of Adduction and to Ankylosis (459); Fingers: Figure 16-21 Finger Impairment Due to Abnormal Motion at the DIP (461), Figure 16-23 Finger Impairment Due to Abnormal Motion at the PIP (463), Figure 16-25 Finger Impairment Due to Abnormal Motion at the MP (464); Wrist: Figure 16-28 Pie Chart of Upper Extremity Motion Impairments Due to Lack of Flexion and Extension (467), Figure 16-31 Pie Chart of Upper Extremity Motion Impairments Due to Abnormal Radial and Ulnar Deviations of the Wrist (467); Elbow: Figure 16-33 Pie Chart of Upper Extremity Motion Impairments Due to Lack of Flexion and Extension of Elbow Joint (474), Figure 16-37 Pie Chart of Upper Extremity Motion Impairments Due to Lack of Pronation and Supination (474); Shoulder: Figure 16-40, Pie Chart of Upper Extremity Motion Impairments Due to Lack of Flexion and Extension of Shoulder (476), Figure 16-43, Pie Chart of Upper Extremity Motion Impairments Due to Lack of Abduction and Adduction of Shoulder (477), and Figure 16-46, Pie Chart of Upper Extremity Impairments Due to Lack of Internal and External Rotation of Shoulder (479).
Guidance: Depending on the type of injury and the regions involved there are multiple approaches to defining impairment. Often soft tissue injuries do not result in impairment. Section 16.7d Tendinitis (507) states “Several syndromes involving the upper extremity are variously attributed to tendonitis, fasciitis, or epicondylitis Although these conditions may be persistent for some time, they are not given a permanent impairment rating unless there is some other factor that must be considered.” (508) Range of motion deficits are the most common approach and may be combined, when appropriate, with other ratable factors, such as amputation, nerve injury and other disorders. Strength loss has a very limited role in impairment evaluation; the Guides state in Section 16.8 Strength Evaluation: “Decreased strength cannot be rated in the presence of decreased motion, painful conditions, deformities, or absence of parts (eg, thumb amputation) that prevent effective application of maximal force in the region being evaluated.” (508). Most rated conditions are either painful conditions or associated with motion deficits. Figure 16-1 Upper Extremity Impairment Evaluation Record (436) should be completed, which provides a mechanism for recording the data needed in impairment evaluation. Measurements are obtained bilaterally and the opposite hand may be used as a baseline, if normal for that individual. Impairment of thumb motion is determined as explained in Section 16.4d Thumb Ray Motion Impairment (454-460). The thumb ray has three articular units: interphalangeal (IP) joint, metacarpophalangeal (MP) joint, and carpometacarpal (CMC joint). There are five functional units of motion that are added. Impairments are based are the additive values obtained from Figure 16-12 Pie Chart of Thumb Impairments Due to Abnormal Motion at the IP joint (456), Figure 16-15 Pie Chart of Thumb Impairments Due to Abnormal Motion at the MP joint (457), Table 16-8a Thumb Impairments Due to Lack of Radial Abduction and to Ankylosis (459),Table 16-8b Thumb Impairments Due to Lack of Adduction and to Ankylosis (459), and Table 16-8b Thumb Impairments Due to Lack of Adduction and to Ankylosis (459). These values are added. Impairment of finger motion is determined using Section 16.4e Finger Motion Impairment (461-466) and the provided pie charts for the DIP, PIP and MP joints. Deficits of impairment for the DIP joint are assessed using Figure 16-21 Finger Impairment Due to Abnormal Motion at the DIP (461). These are combined with deficits of impairment for the PIP joint, as illustrated in Figure 16-23 Finger Impairment Due to Abnormal Motion at the PIP (463). The result is combined with deficits of impairment for the PIP joint, as illustrated in Figure 16-25 Finger Impairment Due to Abnormal Motion at the MP (464). If there are multiple digits involved, each digit impairment is converted to hand impairment using Table 16-1 Conversion of Impairment of the Digits to Impairment of the Hand (438) and added. Hand impairment is converted to upper extremity impairment using Table 16-2 Conversion of Impairment of the Hand to Impairment of the Upper Extremity (439). Wrist motion impairment is assessed as explained in Section 16.4g Wrist Motion Impairment (466-470), and based on Figure 16-28 Pie Chart of Upper Extremity Motion Impairments Due to Lack of Flexion and Extension (467) and Figure 16-31 Pie Chart of Upper Extremity Motion Impairments Due to Abnormal Radial and Ulnar Deviations of the Wrist (467). Impairment values are added. Elbow motion impairment is assessed per Section 16.4 h Elbow Motion Impairment (470-474). Measurements of motion for flexion, extension, pronation and supination are obtained bilaterally. Figure 16-33 Pie Chart of Upper Extremity Motion Impairments Due to Lack of Flexion and Extension of Elbow Joint (474) and Figure 16-37 Pie Chart of Upper Extremity Motion Impairments Due to Lack of Pronation and Supination (474) specify the impairments associated with motion deficits. Impairment values are added. Shoulder motion impairment is assessed per Section 16.4i, Shoulder Motion Impairment (474-479). Measurements of motion for flexion, extension, abduction, adduction, internal rotation and external rotation are obtained bilaterally. Figure 16-40, Pie Chart of Upper Extremity Motion Impairments Due to Lack of Flexion and Extension of Shoulder (476), Figure 16-43, Pie Chart of Upper Extremity Motion Impairments Due to Lack of Abduction and Adduction of Shoulder (477), and Figure 16-46, Pie Chart of Upper Extremity Impairments Due to Lack of Internal and External Rotation of Shoulder (479) provide impairment values for motion deficits. Impairment values are added. Alternative approaches to assessing impairment should also be considered as explained in Section 16.7 Impairment of the Upper Extremity Due to Other Disorders (498-507). Upper extremity impairment is converted to whole person using Table 16-3 Conversion of Impairment of the Upper Extremity to Impairment of the Whole Person (439).
