Neurology Edited by Professor Emeritus Desire' Dubounet, IMUNE

the joint.The evaluator must use appropriate judgment to avoid duplication ofimpairments when other findings, such as synovial hypertrophy or carpalcollapse with arthritic changes, are present. The latter findings couldindicate a greater severity of the same underlying pathological process andtake precedence over joint crepitation, which should not be rated in theseinstances.Joint Crepitation Severity%Joint impairmentMild: Inconstant duringactive ROM* 10Moderate: Constant duringactive ROM 20Severe: Constant duringpassive ROM 30*ROM = Range of MotionExample: Mild joint crepitation of the carpometacarpal joint of thethumb would result in 10% x 80% = 8% impairment of the thumb, 3%impairment of the hand, 3% impairment of the upper extremity, and 2%impairment of the whole person (numbers are rounded to the nearestwhole percent).Joint Swelling Due toSynovial Hypertrophy%Joint ImpairmentMild 10Moderate 20Severe 30Digit Lateral DeviationThe longitudinal alignment of the DIP, PIP, or MP joint is measured indegrees during maximum active extension. Since lateral deviation at anylevel affects the longitudinal arch of the digit, the entire digit is consideredimpaired. If this is the sole impairment, the lateral deviation impairment ismultiplied by the relative value of the digit to the hand to calculate handimpairment. If the digit has other impairments, the lateral deviationimpairment value is combined using the Combined Values Chart.