To Add or to Combine? Rating Impairment of the Hand

Saturday, February 24, 2007 | 1

By Dr. Christopher Brigham

There is often confusion about whether specific impairments are added or combined when assessing hand injuries. Hopefully this week's tip will help clarify the proper procedures and serve as a quick reference in the future.

The Guides differentiate between the thumb and fingers with respect to this process.

Thumb

* Amputation at or proximal to the MP joint is expressed in terms of upper extremity impairment and is added directly to other upper extremity impairment, if applicable

* Amputation distal to the MP joint is expressed in terms of digit impairment

* All joint motion impairments are added

* Additional impairing factors (sensory, motor, vascular, etc.) are combined at the smallest common unit (i.e. digit < hand < upper extremity < whole person)

Digits

* Amputation is expressed in terms of digit impairment

* Joint motion impairments of a common joint are added

* Multiple joint impairments of the same digit are combined at the digit level

* Additional impairing factors (sensory, motor, vascular, etc.) are combined at the digit level

* The total digit impairment is converted to hand impairment

Hand

* Hand impairment values for multiple digits are added

* The final hand impairment is then converted to upper extremity

Brigham is the editor of the Guides Newsletter and Guides Casebook. To view more of these tips visit:

www.impairment.com/tips

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