Subp. 4.
Categories describing loss of function.
Function of the hip is measured by the available passive
range of motion in three arcs: flexion or extension, abduction or adduction,
and rotation. Examination with goniometer is performed to determine the limits
of passive range of motion in each arc.
If there is impairment in more than one arc, the rating for
each arc is added to determine the final rating for loss of function.
A. Extent of range of flexion or extension:
(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, two percent;
(c) limited to between 31 degrees and 60
degrees, four percent;
(d) limited
to between zero degrees and 30 degrees, six percent;
(e) less than zero degrees, that is, there is
an extension contracture, seven percent;
(2) extension is limited to between zero and
19 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, two percent;
(c) limited to between 31 degrees and 60
degrees, four percent;
(d) limited
to less than 31 degrees, six percent;
(3) extension is limited to between 20
degrees and 30 degrees flexion, that is, there is a flexion contracture, and
flexion is:
(a) to greater than 90 degrees,
two percent;
(b) limited to between
61 degrees and 90 degrees, four percent;
(c) limited to between 31 degrees and 60
degrees, six percent;
(d) limited
to less than 31 degrees, eight percent;
(4) extension is limited to between 31
degrees and 45 degrees flexion, that is, there is a flexion contracture, and
flexion is:
(a) to greater than 90 degrees,
ten percent;
(b) limited to between
61 degrees and 90 degrees, 12 percent;
(c) limited to less than 61 degrees, 14
percent;
(5) 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, 20 percent;
(b) limited to between 61 degrees and 90
degrees, 22 percent;
(c) limited to
less than 61 degrees, 24 percent;
(6) extension is limited to greater than 60
degrees flexion, that is, there is a flexion contracture, 40 percent;
(7) ankylosis, as defined in part
5223.0310, subpart 7, in flexion
or extension occurs:
(a) in extension, 40
percent;
(b) between zero degrees
and 30 degrees flexion, 20 percent;
(c) between 31 degrees and 60 degrees
flexion, 24 percent;
(d) at greater
than 60 degrees flexion, 40 percent.
B. Extent of range of abduction or adduction:
(1) adduction is greater than 20 degrees and
abduction is:
(a) to greater than 20 degrees,
zero percent;
(b) limited to
between one degree and 20 degrees, one percent;
(c) limited to between zero degrees and 20
degrees adduction, that is, there is an adduction contracture, four
percent;
(d) limited to greater
than 20 degrees, that is, there is an adduction contracture, eight
percent;
(2) adduction
is limited to between zero degrees and 20 degrees and abduction is:
(a) to greater than 20 degrees, one
percent;
(b) limited to between one
degree and 20 degrees, two percent;
(c) limited to between zero degrees and 20
degrees adduction, that is, there is an adduction contracture, five
percent;
(3) adduction
is limited to between zero degrees and 20 degrees abduction, that is, there is
an abduction contracture, and abduction is:
(a) to greater than 20 degrees, four
percent;
(b) limited to between
zero degrees and 20 degrees, five percent;
(4) adduction is limited to greater than 20
degrees abduction, that is, there is an abduction contracture, eight
percent;
(5) ankylosis, as defined
in part
5223.0310, subpart 7, in abduction
or adduction occurs:
(a) in adduction, eight
percent;
(b) between zero degrees
and 20 degrees abduction, five percent;
(c) at greater than 20 degrees abduction,
eight percent.
C. Extent of range of rotation:
(1) external rotation is greater than 30
degrees and internal rotation is:
(a) to
greater than 20 degrees, zero percent;
(b) limited to between one degree and 20
degrees, two percent;
(c) limited
to between zero degrees and 20 degrees external rotation, that is, there is an
external contracture, two percent;
(d) limited to between 21 degrees and 30
degrees external rotation, that is, there is an external rotation contracture,
four percent;
(e) limited to
greater than 30 degrees external rotation, that is, there is an external
rotation contracture, eight percent;
(2) external rotation is limited to between
21 degrees and 30 degrees and internal rotation is:
(a) to greater than 20 degrees, zero
percent;
(b) limited to between one
degree and 20 degrees, two percent;
(c) limited to between zero degrees and 20
degrees external rotation, that is, there is an external rotation contracture,
two percent;
(d) limited to between
21 degrees and 30 degrees external rotation, that is, there is an external
rotation contracture, four percent;
(3) external rotation is limited to between
zero degrees and 20 degrees and internal rotation is:
(a) to greater than 20 degrees, two
percent;
(b) limited to between one
degree and 20 degrees, four percent;
(c) limited to between zero degrees and 20
degrees external rotation, that is, there is an external rotation contracture,
four percent;
(4)
external rotation is limited to between zero degrees and 20 degrees internal
rotation, that is, there is an internal rotation contracture, and internal
rotation is:
(a) to greater than 20 degrees,
two percent;
(b) limited to between
zero degrees and 20 degrees, four percent;
(5) external rotation is limited to between
21 degrees and 30 degrees internal rotation, that is, there is an internal
rotation contracture, four percent;
(6) external rotation is limited to greater
than 30 degrees internal rotation, that is, there is an internal rotation
contracture, eight percent;
(7)
ankylosis, as defined in part
5223.0310, subpart 7, in rotation
occurs:
(a) at greater than 20 degrees
internal rotation, eight percent;
(b) between 20 degrees internal rotation and
20 degrees external rotation, four percent;
(c) at greater than 20 degrees external
rotation, eight percent.