Upper Extremities – Hand and Wrist

We use these guidelines if you received a work-related injury and are curious about the effect of “Scheduled Loss of Use (SLU) on your hand and wrist. Then, you could be eligible for a compensation payment determined by the Workers’ Compensation Board’s regulations.

Our SLU report will conclude that you have permanently lost function in the injured body part due to your work-related accident. The determination of impairment is based on New York state Workers’ Compensation guidelines.

Objectives for Determining Impairment of the Hand and Wrist

The hand and wrist are essential for finger and thumb motion. In addition, the wrist works with the hand and forearm structure, such as complex flexion/extension and radial/ulnar movements.

We must objectively determine if the patient has permanent residual physical deficits due to an injury through a physical examination or appropriate diagnostic testing.

Permanent Impairment Assessment Methods of the Hand and Wrist

We will evaluate the degree of permanent residual physical deficit when not expecting further healing during maximum medical improvement (MMI). We must determine the MMI based on the clinical treatment course outcome, expertise, and other additional treatment options.

In addition, we’ll consider the contralateral extremity and expected values. Typically, one year from the injury or the last surgery is required to determine the time from the injury to MMI.

We must not assess the permanent residual physical deficit severity of the mechanism of injury. Instead, use the time of MMI, including physical bone, muscle, cartilage, tendon, nerve, blood vessel, or other tissue damage.

Range of Motion of the Hand and Wrist

Figure: Dorsi flexion and Palmar flexion of the Wrist: Determining the Percent Loss of Use of the Hand

Figure: Dorsi flexion and Palmar flexion of the Wrist: Determining the Percent Loss of Use of the Hand

 

Figure: Pronation: Supination of the wrist, measured by flexing the elbow to 90 degrees and adducting the arm along the chest wall.

Figure: Pronation: Supination of the wrist, measured by flexing the elbow to 90 degrees and adducting the arm along the chest wall.

 

Figure: Lateral Wrist Motion

Figure: Lateral Wrist Motion

Calculating Loss of Use of the Hand and Wrist

We begin to assess for any special considerations to determine the overall schedule loss of use of the wrist. If there are no special considerations, we calculate the schedule loss of use of the wrist by adding the palmar flexion (A) + dorsi flexion (B) + pronation/supination (C) to determine if there are any range of motion deficits. The scheduled loss of use cannot exceed 55% if marked wrist deficits are present.

Table: Wrist: Percent Loss of Use of Wrist

To determine deficits, we add A+B+C or use the values indicated within the deficit notes section. The scheduled loss of use cannot exceed 55% if marked wrist deficits are present. We proportionally adjust the schedule loss of use percentages for the range of motion values.

We use the lower figure if a single motion deficit exists, such as flexion or extension. However, we use the higher figure if both flexion and extension apply.

Notes:

  • We use 25% loss of the hand for a complete loss of palmar flexion.

     

  • We utilize a 331⁄3% loss of the hand with a complete loss of Dorsi flexion.

     

  • We provide a 35% loss of use of the hand with a complete loss of both pronation and supination.

     

  • We will individually consider other normal wrist findings when assessing for deficits in radial-lateral motion.

Special Considerations for the Hand and Wrist

We utilize the special considerations when evaluating enumerated schedule loss of use values and add other deficits when specified. However, the maximum schedule loss of use value must not exceed the ankylosis value except when applying special consideration number one.

  1. We use a 66 2⁄3% loss of use of the hand with complete wrist drop or radial nerve palsy and a reduced percentage for a partial wrist drop.

     

  2. We utilize a 10% loss of use of the hand for bone loss for a Darrach procedure (resection distal ulna) and add for mobility deficits.

     

  3. We evaluate a 20% loss of use of the hand for bone loss with resection of “proximal row” carpal bones and add for mobility deficits.

     

  4. Navicular fracture:

     

    • We hold non-union cases for two years.

       

    • We utilize a scheduled loss of use of the hand if x-ray imaging provides evidence of a clinical fibrous union without severe pain.

       

    • We consider classification with rare, severely painful conditions.

       

  5. Kienböck’s Disease (aseptic necrosis of carpal lunate):

     

    • We hold until x-ray images show a static condition.

       

    • If the condition is symptomatic, we consider classification.

       

  6. Carpal Tunnel Syndrome: If you are asymptomatic, one-year schedule post-decompression. We will consider classification if persistent symptoms are present and become severe and disabling. Then, we use Nerve Section 10.3A for values.

     

  7. We use 71⁄2-20% loss of use of the thumb depending on impairments for De Quervain’s Disease with or without surgical release. However, we will utilize a schedule loss of use of the hand if you present with residual wrist deficits and grip power impairment.

     

  8. We utilize a 0-71⁄2% of the hand with a wrist ganglion, depending on clinical findings.

Wrist Amputation

Wrist amputation equates to a 100% loss of use of the hand and an 80% loss of use of the arm.

Please refer to your state’s Workers’ Compensation Board website or speak with your Workers’ Compensation attorney for more information.

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