Guidelines for the assessment of permanent impairment Version 3

Chapter 2Upper Extremity ImpairmentIntroduction2.1 The hand and upper extremity is discussed in section 3.1 of Chapter 3 in the AMA 4 Guides (pp15 - 74). This long section provides guidelines on methods of assessing permanent impairmentinvolving these structures. It is a complex section that requires an organised approach with carefuldocumentation of findings on a worksheet.The Approach to Assessment of the Upper Extremity and Hand2.2 Assessment of the upper extremity mainly involves clinical evaluation. Cosmetic and functionalevaluations are performed in some situations. The impairment must be permanent and stable. Theworker will have a defined diagnosis that can be confirmed by examination.2.3 The assessed impairment of a part or region can never exceed the impairment due to amputation ofthat part or region. For an upper limb, therefore, the maximum assessment is 60% WPI.2.4 To achieve an accurate and comprehensive assessment of the upper extremity, findings should bedocumented on a standard form. Figure 1 of the AMA 4 Guides (pp 16 - 17) is extremely useful,both to document findings and to guide assessment.Note, however, that the final summary part of Figure 1 (pp 16 - 17, AMA 4 Guides) does notmake it clear that impairments due to peripheral nerve injuries cannot be combined with otherimpairments in the upper extremities unless they are separate injuries. This is to avoid“double-dipping”.2.5 The hand and upper extremity are divided into regions that are the thumb, fingers, wrist, elbow,and shoulder. Close attention needs to be paid to the instructions in Figure 1 (pp 16 - 17, AMA 4Guides) regarding adding or combining impairments.2.6 Table 3 (p 20, AMA 4 Guides) is used to convert upper extremity impairment to whole personimpairment. Note that 100% upper extremity impairment is equivalent to 60% WPI.2.7 If the condition is not in the AMA 4 Guides, it may be assessed using another like condition.WCT Guidelines 1 October 2011 9