Neurology Edited by Professor Emeritus Desire' Dubounet, IMUNE

3.1 The Hand and Upper Extremity3.1a IntroductionFor accurate impairment evaluation, a complete and detailed examinationof the upper extremity is necessary and is facilitated by the use of aprinted chart that lists the various tests and measurements in an orderlyfashion (Figure 1). This chart may be reproduced without permissionfrom the AMA. Methods for evaluating upper extremity impairment canbe divided arbitrarily into anatomic, cosmetic, and functional categories.A combination of these methods is necessary to show an accurate profileof the patient's condition. Presently the most objective method ofassessment is anatomic evaluation.A system for evaluation of physical impairment in the hand andupper extremity due to amputation sensory loss, abnormal motion, andankylosis was developed and approved for international application by theInternational Federation of Societies for Surgery of the Hand. The handand upper extremity section of this chapter is divided into regionalevaluation of the thumb, I finger, wrist, elbow, and shoulder. Each sectionconsiders techniques of measurement, and includes values for impairmentfrom amputation, sensory loss, and abnormal motion. In addition, specificimpairments of the upper extremity due to peripheral nerve and plexuslesions, and vascular problems will be discussed in this section. Amethod to combine and relate various impairments to the-whole person ispresented.Nonpreferred-Upper Extremity-Since the basic tasks of everyday livingare more dependent upon the preferred upper extremity than upon thenonpreferred one, dysfunction of the nonpreferred extremity results in lessimpairment than dysfunction of the preferred. Therefore, when theimpairment of an upper extremity has been determined to be between 5%and 50%, the value should be reduced by 5% if the impairment is of thenonpreferred extremity. If the determined value is 51% to 100%, the valueshould be reduced by 10% if the impairment is of the nonpreferredextremity. For example, a 60% impairment would become 60%-(60% x10%) 54%.