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Introduction to Musculoskeletal—The Extremities
There are a few basic rules to follow when determining impairment ratings for the upper and lower extremities. When evaluating range of motion of a specific joint such as the wrist, elbow, shoulder, ankle, knee, or hip, the values are added. When multiple joints are involved (i.e., shoulder and elbow or hip and knee), the total value from each joint must be combined using the Combined Values Chart.
Specific Disorders Upper extremity—Specific disorders of the upper extremity (i.e., persistent joint subluxation, joint swelling, etc.) are converted to impairment of upper extremity and then combined with all other upper-extremity values.Lower extremity—Specific disorders of the lower extremity (i.e., hip disorders, specific disorders of the knee, etc.) are combined with all other lower- extremity values.Using the specific guidelines for motor and sensory impairment, these values will also be determined separately and combined with all other values of the involved extremity.The evaluator is cautioned to combine all the values of one extremity before conversion to whole person. (Only one conversion to whole person should be done per extremity.)When both upper and lower extremities are involved, each extremity should be evaluated separately and converted to whole person. Then the two whole-person values (both the upper and lower extremities) should be combined to produce a single whole-person rating.
Preferred or Nonpreferred
ExtremitySince the basic tasks of everyday living are more dependent upon the preferred upper extremity than the nonpreferred one, dysfunction of the nonpreferred extremity results in less impairment. Therefore, when an impairment of an upper extremity has been determined, the value should be reduced by 10% if the impairment is of the nonpreferred extremity.
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of the (upper) nonpreferred extremity
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10% 40%
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of 40% =4% minus 4% = 36% upper extremity
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