|
Musculotendinous Impairments and Intrinsic Tightness—Intrinsic tightness in the hand may be demonstrated by a test described by Bunnell. Hyperextension of the metacarpophalangeal (MP) joint in a normal hand still allows passive flexion of the proximal interphalangeal (PIP) joint. If the intrinsic muscles are tight or contracted, the available stretch of these muscles is taken up by the hyperextended position of the MPjoint, and passive flexion of the PlP joint will be difficult. If there is already restriction in active range of motion at the MP or PIP joint, then no additional rating is given for intrinsic tightness. Intrinsic tightness impairment is combined with other impairments of the same digit using the Combined Values Chart. Finger impairment is converted to hand impairment using Table 8.
|
|
Intrinsic Tightness Severity
(Passive flexlon of PIP Joint
with MP Joints hyperextended)
|
% Digit
lmpairment*
|
|
|
Mild: PIP flexion 80° to 60°
|
20
|
|
|
Moderate: PIP flexion 59° to 20°
|
40
|
|
|
Severe: PIP flexion less than 20°
|
60
|
|
|
*Use Table 18 to find the relative value of each digit.
|
Constrictive Tenosynovitis—Impairment due to constrictive tenosynovitis is combined Chart. The digit impairment is converted to hand impairment with Table 8. If there is already restriction in active range of motion, no additional rating is given for constrictive tenosynovitis.
|
|
|
Constrictive Tenosynovitis Severity
|
% Digit
lmpairment*
|
|
|
Mild: inconstant triggering during active ROM**
|
20
|
|
|
Moderate: Constant triggering during active ACM
|
40
|
|
|
Severe: Constant triggering during passive ROM
|
60
|
|
**ROM: Range of Motion
*Use Table 18 to find the relative value of each digit.
|
