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 shoulder. 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 Shoulder Impairment
The shoulder and elbow are essential for hand positioning in space and allow for upper extremity functioning. Therefore, shoulder injury may produce significant limitations and develop work performance challenges.
We must objectively determine the appropriate degree if the patient has permanent residual physical deficits due to an injury. We will evaluate through history and physical examination or proper diagnostic testing.
Permanent Shoulder Impairment Assessment Methods
We evaluate the degree of permanent residual physical deficit when not expecting any further healing during the time of maximum medical improvement (MMI). We must determine the MMI based on the clinical treatment course outcome, expertise, and other further treatment options.
In addition, we will consider the contralateral extremity and expected values when available when assessing the level of permanent residual physical deficit. 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, we use the time of MMI, including physical bone, muscle, cartilage, tendon, nerve, blood vessel, or other tissue damage.
Shoulder Range of Motion
Shoulder range of motion includes:
Flexion (forward elevation): ROM within the sagittal plane rotating around an imaginary line through the glenoid fossae while the arm moves in front of and above the body. The normal shoulder flexion range of motion is 180 degrees.
Extension: ROM within the sagittal plane rotates around an imaginary line through the glenoid fossae while the arm moves behind the body to 60 degrees.
Abduction: ROM within the coronal plane rotating around an imaginary line through the glenohumeral joint. The normal shoulder abduction range of motion is 180 degrees, with the arm moving away from the body to the side.
Adduction: ROM within the coronal plane rotating around an imaginary line through the glenohumeral joint. The normal shoulder adduction range of motion is 30 degrees, with the arm moving across in front of the body.
External (Up) Rotation: With the arm positioned at the side, we flex the elbow to 90 degrees and rotate around an imaginary line along the humerus axis. The normal should external rotation range of motion is 90 degrees.
Internal (Down) Rotation: With the arm positioned at the side, we flex the elbow to 90 degrees and rotate around an imaginary line along the humerus axis. The normal should internal rotation range of motion is 70 degrees.
Calculating Loss of Use of the Shoulder
We will begin to assess for any special considerations to determine the overall schedule loss of shoulder use. If there are no special considerations, use the following table to determine where deficits are present with abduction and flexion, then use the higher deficit. The maximum loss of shoulder use must not exceed ankylosis when evaluating based on the range of motion.
Table: Shoulder: Percent Loss of Use of Shoulder
We use the following table, values, and notes to determine deficits. The maximum loss of the use of the elbow must not exceed ankylosis. We proportionally adjust the schedule loss of use percentages for the range of motion values.
- We only document the greater of the two deficits when evaluating flexion (forward elevation) and abduction, but not both. We add up to 10% to the overall schedule loss of use and do not exceed ankylosis if both deficit ranges of motion are at least moderate and the measures are within 100 of each other.
- We will avoid cumulative values by not adding mild internal and external rotation deficits. However, add 10-15%, not exceeding ankylosis, for marked rotation deficits and muscle atrophy.
- We use a 71⁄2-10% loss of use of an arm for mild adduction deficits.
- We utilize a 71⁄2-10% loss of use of an arm for mild posterior extension deficits.
- We use the following table for isolated internal/external ROM deficits.
Table: Shoulder: Internal and External Rotation Only
Special Considerations for the Shoulder
We utilize the special considerations when evaluating enumerated schedule loss of use values or without a provided schedule value. The maximum schedule loss of use value must not exceed the ankylosis value.
- Should dislocation become amenable for a scheduled loss of use evaluation if corrective surgery occurred at least one year ago, recurrent dislocation or permanent impairment persists longer than one year.
Therefore, we conduct an overall schedule of an appointment for pre-existent recurrent shoulder dislocations.
- Depending on the impairment degree, we use a 0-10% loss of use for a clavicle fracture.
- We utilize a 71⁄2-10% arm use loss for acromioclavicular or sternoclavicular separation.
- Depending on impairment degree, we evaluate a 15-20% arm use loss for winged scapula from serratus anterior palsy or trapezius palsy. However, we will wait until at least two years post-surgical major nerve repair to evaluate a schedule loss.
- We use a 10% for bone loss from an either-ended clavicle resection. Next, we will utilize a 15% loss of use of the arm for the entire clavicle. Then, we add mobility deficits as the single most significant functional deficit.
- We utilize a 10-15% loss of arm use for non-surgical rupture of the long head biceps muscle. Then, we use a 20% loss for a rupture at the distal insertion point of the biceps. The impairment degree may vary up to 33 1⁄3% loss for mobility and muscle weakness.
- Frozen shoulder and adhesive capsulitis, surgical and non-surgical: We will use a schedule loss of the arm if the condition is asymptomatic. We will consider using a classification after two years for severe painful conditions with exhausted all possible treatment modalities.
- We will determine a schedule focused on the highest valued extremity part. First, we will calculate the highest significant loss using a high schedule for one involved body part.
For example, we utilize a 100% loss of use of the hand for a wrist amputation or an 80% loss of arm use. Then, we add 10% to the 80% arm loss of use for other elbow or shoulder deficits. The final schedule equals a 90% loss of arm use.
- We assess total or partial shoulder arthroplasty or replacement no sooner than one-year post-surgery because clinical functions may occur before. Determine the schedule based on medical assessments of:
- Flexion or abduction ROM measurement using the most significant impairment degree
- We measure atrophy at the mid-arm level and compare it to the contralateral extremity.
- Chronic complications according to the following table unless using classification.
- Flexion or abduction ROM measurement using the most significant impairment degree
We use the following chart to determine the schedule loss of use values. An ideal outcome (Row A) is a 35% schedule loss of use. Then, we will add the value for other deficits to values that closely match the provided deficit in each column when deficits exceed those listed in Row A to the base value of 35% to calculate the total schedule loss of use award value.
Table: Shoulder Joint Replacement: Schedule Loss of Use
A patient underwent corrective shoulder replacement surgery. We determined during MMI that the patient will heal with a good outcome, full range of motion, and some atrophy.
Therefore, we assess shoulder loss of use by beginning with the initial good outcome value (35%), then we calculate the measurement of atrophy:
- 1.5 inches equals less than the contralateral side: add 5% for atrophy to the good outcome for an overall shoulder loss of use value of 40%.
- More than 2.5 inches than the contralateral side: add 10% for atrophy to the good outcome for an overall shoulder loss of use value of 45%.
We use a 100% loss of arm use for an amputation between the shoulder and the elbow.
Please refer to your state’s Workers’ Compensation Board website or speak with your Workers’ Compensation attorney for more information.