Current through Register Vol. 49, No. 13, September 23, 2024
Subpart 1.
General.
A. Permanent partial impairment of fingers is
a disability of the whole body is as provided in subparts
2 to
4. The percent of whole body
disability under this part may not exceed the percent of whole body disability
for amputation of the hand or digit if the impairing condition is confined to a
digit under part
5223.0540. Each mutually exclusive
impairing condition must be rated separately and the ratings must be combined
as described in part
5223.0300, subpart
3, item E. If an impairing
condition is represented by a category designated as exclusive under subpart
2, it must be rated by that
category only and that rating may not be combined with a rating under any other
category of this part for that impairing condition.
If an impairing condition is represented by a category
designated as combinable under subpart
3, it must be rated under
that category and under the appropriate categories describing loss of function
under subpart
4. The ratings obtained must
be combined as described in part
5223.0300, subpart
3, item E.
If an impairing condition is not represented by a category
designated either exclusive or combinable, it must be rated only under the
appropriate categories describing loss of function under subpart
4.
B. For purposes of computing the percent of
disability due to injuries of the digits, each digit and each joint of each
digit is assigned a percentage representing the percent of disability of the
whole body resulting from 100 percent disability of that digit or joint. In
subparts
2, item D; 3; and 4, the
final percent disability of the whole body is computed by multiplying the
overall percent disability to the digit or joint times the values listed in
this subpart.
(1) Value of the digits:
(a) thumb, 22 percent;
(b) index finger, 11 percent;
(c) middle finger, 11 percent;
(d) ring finger, five percent;
(e) little finger, five percent.
(2) Value of the joints:
(a) thumb:
i. carpometacarpal joint, 17
percent;
ii. metacarpophalangeal
joint, seven percent;
iii.
interphalangeal joint, two percent;
(b) index and middle fingers:
i. metacarpophalangeal joint, 11
percent;
ii. proximal
interphalangeal joint, eight percent;
iii. distal interphalangeal joint, five
percent;
(c) ring and
little fingers:
i. metacarpophalangeal joint,
five percent;
ii. proximal
interphalangeal joint, four percent;
iii. distal interphalangeal joint, two
percent.
Subp. 2.
Exclusive categories.
A. Mallet deformity, loss of active extension
at distal interphalangeal joint of 30 degrees or more, substantiated by
objective clinical findings, and persisting despite therapy, or recurring and
persisting after attempted surgical correction:
(1) index finger, 0.5 percent;
(2) middle finger, 0.5 percent;
(3) ring finger, 0.2 percent;
(4) little finger, 0.2 percent.
B. Boutonniere deformity, flexion
of the proximal interphalangeal joint of 30 degrees or more and extension of
the distal interphalangeal joint, which can be reduced passively but not
actively, substantiated by objective clinical findings, and persisting despite
treatment, or recurring and persisting after attempted surgical correction:
(1) index finger, 1.1 percent;
(2) middle finger, 1.1 percent;
(3) ring finger, 0.5 percent;
(4) little finger, 0.5 percent.
C. Swan neck deformity,
hyperextension of the proximal interphalangeal joint exceeding 15 degrees or
more and flexion of the distal interphalangeal, which can be reduced passively
but not actively, substantiated by objective clinical findings; and persisting
despite treatment, or recurring and persisting after attempted surgical
correction:
(1) index finger, 1.1
percent;
(2) middle finger, 1.1
percent;
(3) ring finger, 0.5
percent;
(4) little finger, 0.5
percent.
D.
Arthroplasty, 100 percent of the value of the joint.
Subp. 3.
Combinable categories.
A. Ulnar or radial deviation at a joint:
permanent fixed deformity, measured with joint at neutral position:
(1) less than ten degrees, zero
percent;
(2) mild: ten degrees to
19 degrees, ten percent of the value of the digit;
(3) moderate: 20 degrees to 30 degrees, 20
percent of the value of the digit;
(4) severe: greater than 30 degrees, 30
percent of the value of the digit.
B. Rotational deformity: permanent fixed
deformity, measured with joint at neutral position:
(1) less than five degrees, zero
percent;
(2) mild: five degrees to
15 degrees, ten percent of the value of the digit;
(3) moderate: 16 degrees to 30 degrees, 20
percent of the value of the digit;
(4) severe: greater than 30 degrees, 30
percent of the value of the digit.
C. Instability: excessive passive ulnar or
radial motion in the joint in comparison to normal:
(1) less than five degrees, zero
percent;
(2) mild: five degrees to
ten degrees, ten percent of the value of the joint;
(3) moderate: 11 degrees to 20 degrees, 20
percent of the value of the joint;
(4) severe: greater than 20 degrees, 30
percent of the value of the joint.
D. Intrinsic tightness: measured by
hyperextending the digit at the metacarpophalangeal joint and then attempting
to flex the proximal interphalangeal joint, and persisting despite therapy, or
recurring and persisting after attempted surgical correction:
(1) flexion greater than 80 degrees at the
proximal interphalangeal joint, zero percent;
(2) mild: flexion from 60 degrees to 80
degrees, 15 percent of the value of the digit;
(3) moderate: flexion from 20 degrees to 59
degrees, 30 percent of the value of the digit;
(4) severe: flexion less than 20 degrees, 40
percent of the value of the digit.
E. Triggering: substantiated by objective
clinical findings, and persisting despite therapy, or recurring and persisting
after attempted surgical correction:
(1) mild:
inconstant during active range of motion, ten percent of the value of the
digit;
(2) moderate: constant
during active range of motion, 20 percent of the value of the digit;
(3) severe: constant during passive range of
motion, 30 percent of the value of the digit.
F. Fracture or dislocation involving
metacarpal or phalanx not otherwise ratable under subpart
3 or
4, zero percent.
Subp. 4.
Categories
describing loss of function.
Function of the hand and fingers is measured by the available
passive range of motion at each joint and by the quality and extent of tactile
sensation in the hand. For injuries involving lacerated tendons, the available
active range of motion is measured and applied to items A to H.
The passive range of motion at all joints of the digits
excluding the carpometacarpal joint of the thumb is measured in one arc:
flexion or extension. Examination with goniometer is performed to determine the
limits of passive range of motion at each of these joints. The passive range of
motion of the carpometacarpal joint of the thumb is measured by three movements
of the thumb: extension or abduction, radial abduction, and opposition.
Examination with a metric ruler is performed to determine the passive
limitations of each of the movements of the carpometacarpal joint of the
thumb.
For the thumb, all appropriate ratings for loss of motion at
the interphalangeal, metacarpal, and carpometacarpal joints are added to
determine the overall rating for loss of motion of the thumb. This overall
rating for loss of motion of the thumb is multiplied by the value of the thumb
as provided in subpart
1, item B, subitem (1), to
find the whole body disability for loss of motion of the thumb.
For the fingers, ratings for loss of motion at different
joints of the same finger are combined to determine the overall rating for loss
of motion of the finger. The overall rating for loss of motion of a finger is
multiplied by the value of the finger as provided in subpart
1, item B, subitem (1), to
find the whole body disability for loss of motion of that finger.
When there is injury to more than one digit, the disabilities
for loss of motion of each affected digit are added to determine the overall
disability for loss of motion of the hand.
The quality and extent of tactile sensation is evaluated
according to part
5223.0410, subpart 6.
Any disability for loss of sensation is combined with any
overall disability for loss of range of motion to determine the final
disability for loss of function.
A.
Extent of range of flexion or extension at metacarpophalangeal joint for
fingers excluding the thumb:
(1) extension is
greater than zero degrees and flexion is:
(a)
to greater than 70 degrees, zero percent;
(b) limited to between 51 degrees and 70
degrees, ten percent of the value of the digit;
(c) limited to between 21 degrees and 50
degrees, 25 percent of the value of the digit;
(d) limited to between zero degrees and 20
degrees, 40 percent of the value of the digit;
(e) less than zero degrees, that is, there is
an extension contracture, 60 percent of the value of the digit;
(2) extension is limited to
between zero degrees and nine degrees flexion, that is, there is a flexion
contracture, and flexion is:
(a) to greater
than 70 degrees, zero percent;
(b)
limited to between 51 degrees and 70 degrees, ten percent of the value of the
digit;
(c) limited to between 21
degrees and 50 degrees, 25 percent of the value of the digit;
(d) limited to between zero degrees and 20
degrees, 40 percent of the value of the digit;
(3) extension is limited to between ten
degrees and 30 degrees flexion, that is, there is a flexion contracture, and
flexion is:
(a) to greater than 70 degrees,
ten percent of the value of the digit;
(b) limited to between 51 degrees and 70
degrees, 20 percent of the value of the digit;
(c) limited to between 21 degrees and 50
degrees, 35 percent of the value of the digit;
(d) limited to between ten degrees and 20
degrees, 50 percent of the value of the digit;
(4) extension is limited to between 31
degrees and 60 degrees flexion, that is, there is a flexion contracture, and
flexion is:
(a) to greater than 70 degrees,
35 percent of the value of the digit;
(b) limited to between 51 degrees and 70
degrees, 45 percent of the value of the digit;
(c) limited to between 31 degrees and 50
degrees, 60 percent of the value of the digit;
(5) extension is limited to between 61
degrees and 80 degrees flexion, that is, there is a flexion contracture, and
flexion is:
(a) to greater than 70 degrees,
70 percent of the value of the digit;
(b) limited to between 61 degrees and 70
degrees, 80 percent of the value of the digit;
(6) extension is limited to greater than 80
degrees flexion, that is, there is a flexion contracture, 100 percent of the
value of the digit;
(7) ankylosis,
as defined in part
5223.0310, subpart 7, of the
metacarpophalangeal joint for the fingers excluding the thumb occurs:
(a) in extension, 60 percent of the value of
the digit;
(b) between neutral and
30 degrees of flexion, 50 percent of the value of the digit;
(c) between 31 degrees of flexion and 60
degrees of flexion, 60 percent of the value of the digit;
(d) between 61 degrees of flexion and 80
degrees of flexion, 80 percent of the value of the digit;
(e) at greater than 80 degrees of flexion,
100 percent of the value of the digit.
B. Extent of range of flexion or extension
and the proximal interphalangeal joint for fingers excluding the thumb:
(1) extension is greater than zero degrees
and flexion is:
(a) to greater than 90
degrees, zero percent;
(b) limited
to between 61 degrees and 90 degrees, ten percent of the value of the
digit;
(c) limited to between 46
degrees and 60 degrees, 25 percent of the value of the digit;
(d) limited to between zero degrees and 45
degrees, 45 percent of the value of the digit;
(e) less than zero degrees, that is, there is
an extension contracture, 80 percent of the value of the digit;
(2) extension is limited to
between zero degrees and nine degrees flexion, that is, there is a flexion
contracture, and flexion is:
(a) to greater
than 90 degrees, zero percent;
(b)
limited to between 61 degrees and 90 degrees, ten percent of the value of the
digit;
(c) limited to between 46
degrees and 60 degrees, 25 percent of the value of the digit;
(d) limited to between zero degrees and 45
degrees, 45 percent of the value of the digit;
(3) extension is limited to between ten
degrees and 45 degrees flexion, that is, there is a flexion contracture, and
flexion is:
(a) to greater than 90 degrees,
ten percent of the value of the digit;
(b) limited to between 61 degrees and 90
degrees, 20 percent of the value of the digit;
(c) limited to between 46 degrees and 60
degrees, 35 percent of the value of the digit;
(d) limited to between ten degrees and 45
degrees, 55 percent of the value of the digit;
(4) extension is limited to between 46
degrees and 60 degrees flexion, that is, there is a flexion contracture, and
flexion is:
(a) to greater than 90 degrees,
30 percent of the value of the digit;
(b) limited to between 61 degrees and 90
degrees, 40 percent of the value of the digit;
(c) limited to between 46 degrees and 60
degrees, 55 percent of the value of the digit;
(5) extension is limited to between 61
degrees and 90 degrees flexion, that is, there is a flexion contracture, and
flexion is:
(a) to greater than 90 degrees,
45 percent of the value of the digit;
(b) limited to between 61 degrees and 90
degrees, 55 percent of the value of the digit;
(6) extension is limited to greater than 90
degrees flexion, that is, there is a flexion contracture, 80 percent of the
value of the digit;
(7) ankylosis,
as defined in part
5223.0310, subpart 7, at the
proximal interphalangeal joint for the fingers excluding the thumb occurs:
(a) in extension, 80 percent of the value of
the digit;
(b) between zero degrees
and 45 degrees of flexion, 55 percent of the value of the digit;
(c) between 46 degrees of flexion and 90
degrees of flexion, 65 percent of the value of the digit;
(d) at greater than 90 degrees of flexion, 90
percent of the value of the digit.
C. Extent of range of flexion or extension at
the distal interphalangeal joint for fingers excluding the thumb:
(1) extension is greater than zero degrees
and flexion is:
(a) to greater than 45
degrees, zero percent;
(b) limited
to between zero degrees and 45 degrees, 20 percent of the value of the
digit;
(c) less than zero degrees,
that is, there is an extension contracture, 45 percent of the value of the
digit;
(2) extension is
limited to between zero degrees and nine degrees flexion, that is, there is a
flexion contracture, and flexion is:
(a) to
greater than 45 degrees, zero percent;
(b) limited to between zero degrees and 45
degrees, 20 percent of the value of the digit;
(3) extension is limited to between ten
degrees and 45 degrees flexion, that is, there is a flexion contracture, and
flexion is:
(a) to greater than 45 degrees,
ten percent of the value of the digit;
(b) limited to between ten degrees and 45
degrees, 30 percent of the value of the digit;
(4) extension is limited to greater than 45
degrees flexion, that is, there is a flexion contracture, 45 percent of the
value of the digit;
(5) ankylosis,
as defined in part
5223.0310, subpart 7, at the
interphalangeal joint for the fingers excluding the thumb occurs:
(a) in extension, 45 percent of the value of
the digit;
(b) between zero degrees
and 45 degrees of flexion, 30 percent of the value of the digit;
(c) greater than 45 degrees of flexion, 45
percent of the value of the digit.
D. Extent of range of flexion or extension at
the metacarpophalangeal joint for the thumb:
(1) extension is greater than zero degrees
and flexion is:
(a) to greater than 30
degrees, zero percent;
(b) limited
to between zero degrees and 30 degrees, six percent of the thumb;
(c) limited to less than zero degrees, that
is, there is an extension contracture, six percent of the thumb;
(2) extension is limited to
between zero degrees and 30 degrees flexion, that is, there is a flexion
contracture, and flexion is:
(a) to greater
than 30 degrees, zero percent;
(b)
limited to between zero degrees and 30 degrees, six percent of the
thumb;
(3) extension is
limited to greater than 30 degrees flexion, that is, there is a flexion
contracture, 11 percent of the thumb;
(4) ankylosis, as defined in part
5223.0310, subpart 7, at the
metacarpophalangeal joint of the thumb occurs:
(a) at less than or equal to 30 degrees of
flexion, six percent of the thumb;
(b) at greater than 30 degrees of flexion, 11
percent of the thumb.
E. Extent of range of flexion or extension at
the interphalangeal joint for the thumb:
(1)
extension is greater than zero degrees and flexion is:
(a) to greater than 40 degrees, zero
percent;
(b) limited to between
zero degrees and 40 degrees, three percent of the thumb;
(c) limited to less than zero degrees, that
is, there is an extension contracture, nine percent of the thumb;
(2) extension is limited to
between zero degrees and nine degrees flexion, that is, there is a flexion
contracture, and flexion is:
(a) to greater
than 40 degrees, zero percent;
(b)
limited to between zero degrees and 40 degrees, three percent of the
thumb;
(3) extension is
limited to between ten degrees and 40 degrees flexion, that is, there is a
flexion contracture, and flexion is:
(a) to
greater than 40 degrees, three percent of the thumb;
(b) limited to between ten degrees and 40
degrees, six percent of the thumb;
(4) extension is limited to greater than 40
degrees flexion, that is, there is a flexion contracture, nine percent of the
thumb;
(5) ankylosis, as defined in
part
5223.0310, subpart 7, at the
interphalangeal joint of the thumb occurs:
(a) in extension, nine percent of the
thumb;
(b) between zero degrees and
40 degrees of flexion, four percent of the thumb;
(c) greater than 40 degrees of flexion, nine
percent of the thumb.
F. Abduction of the thumb is the greatest
possible distance from the flexor crease of the metacarpophalangeal joint of
the fifth metacarpophalangeal joint to the palmar skin of the thumb tuft. The
limit of passive abduction is:
(1) greater
than ten centimeters, zero percent;
(2) eight to ten centimeters, five percent of
the thumb;
(3) less than eight
centimeters, 20 percent of the thumb.
G. Radial abduction of the thumb is the
greatest possible distance from the radial border of the index finger to the
ulnar border of the thumb. The limit of passive radial abduction is:
(1) greater than eight centimeters, zero
percent;
(2) between five
centimeters and eight centimeters, 20 percent of the thumb;
(3) less than five centimeters, 40 percent of
the thumb.
H. Opposition
of the thumb is the smallest possible distance between the thumb and index
fingertips. The limit of passive opposition is:
(1) less than one centimeter, zero
percent;
(2) between one centimeter
and three centimeters, 25 percent of the thumb;
(3) greater than three centimeters, 50
percent of the thumb.