Epicondylitis: To Rate or Not to Rate?

Saturday, July 28, 2007 | 0

By Leslie Dilbeck

The Guides are very specific in how to address the issue of epicondylitis.

They have broken down the methodology into two scenarios: surgical versus non-surgical.

Non-Surgical:

Section 16.7d Tendinitis (5th ed., 507) states "Several syndromes involving the upper extremity are variously attributed to tendonitis, fasciitis, or epicondylitis... Although these conditions may be persistent for some time, they are not given a permanent impairment rating unless there is some other factor that must be considered." Generally, there is no ratable impairment. If the examinee's condition has been chronic then it may be appropriate to rate for loss of motion in the elbow. However, be cautious in that there must be consistency in the measurements by which you are basing the impairment rating.

Surgical:

Section 16.7d goes on to state, "If an individual has had tendon rupture or has undergone surgical release of the flexor or extensor origins or medial or lateral epicondylitis, or has had excision of the epicondyle, there may be some permanent weakness of grip as a result of the tendon rupture or the surgery. In this case, impairment can be given on the basis of weakness of grip strength according to Section 16.8b. Although there is no good data on the time required to regain maximum strength after surgery, the data on strength loss after carpal tunnel release suggests that impairment rating according to Section 16.8b should not be determined less than 1 year after surgery." Yes, you read correctly, in surgical cases you are allowed to rate based on grip strength. Again be cautious in that there are specific protocols that must be followed during physical exam to ensure reliable, valid measurements (see 2-28-06 impairment tip).

Leslie Dilbeck, W.C.C.P., CIR, is a senior consultant for Brigham & Associates. To view more of these tips visit:

www.impairment.com/tips

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