Minnesota Administrative Rules, Chapter 5223, Part 5223.0170 - MUSCULOSKELETAL SCHEDULE; JOINTS | Minnesota Administrative Rules

Subpart 1. General.

For permanent partial disability of joints, disability of the whole body is set forth in subparts 2 to 9.

Subp. 2. Surgical or traumatic shortening of lower extremity.

Surgical or traumatic shortening of lower extremity:

A. 1/4 inch to 3/4 inch, 3 percent;

B. 3/4 to 1-1/4 inches, 4.5 percent;

C. 1-1/4 to 1-3/4 inches, 6 percent; or

D. 1-3/4 inches and above, 9 percent.

Subp. 3. Hip.

Hip:

A. Range of motion:

(1) mild, anterior posterior movement from 0 degree to 120 degree flexion, rotation and lateral motion, abduction, adduction free to 50 percent of normal, 6 percent;

(2) moderate, anterior posterior motion from 15 degrees flexion deformity to 110 degrees further flexion, rotation, lateral motion, abduction, and adduction free to 25 percent normal, 12 percent;

(3) severe, anterior posterior motion from 30 degrees flexion deformity to 90 degrees further flexion, 22 percent.

B. Procedures or conditions:

(1) nonunion proximal femur fracture without reconstruction, 33 percent;

(2) arthroplasty, able to stand at work and walk, motion 25 percent to 50 percent of normal, 18 percent;

(3) total hip arthroplasty, normal result, 13 percent;

(4) femoral endoprosthesis:

(a) minimal pain, near normal range of motion, able to walk unsupported, 15 percent;

(b) mild to moderate pain with weight bearing, motion 50 percent of normal, 20 percent;

(5) hip pinning for fracture:

(a) minimal pain, near normal range of motion, able to walk unsupported, 5 percent;

(b) mild to moderate pain, motion 50 percent of normal, 10 percent.

Subp. 4. Femur.

Femur:

A. shaft fracture, closed, healed, 0 percent;

B. femoral shaft fracture, open reduction, loss of less than 20 degrees of movement of any one plane of either the hip or the knee, no malalignment, 2 percent.

Subp. 5. Knee.

Knee:

A. Range of motion.

(1) ankylosis and limited motion, total ankylosis optimum position, 15 degrees flexion, 22 percent;

(2) limitation of motion:

(a) mild, 0 degrees to at least 110 degrees flexion, 2 percent;

(b) moderate, 5 degrees to at least 80 degrees flexion, 7 percent;

(c) severe, 5 degrees to at least 60 degrees flexion, 15 percent;

(d) extremely severe, limited from 15 degrees flexion deformity with further flexion to 90 degree, 18 percent.

B. Procedures or conditions:

(1) surgical removal of medial or lateral semilunar cartilage, more than 50 percent of cartilage removed, no complications, 3 percent;

(2) partial meniscectomy, up to 50 percent of the meniscus removed, 2 percent;

(3) surgical removal both cartilages, 9 percent;

(4) ruptured cruciate ligament, repaired or unrepaired:

(a) mild laxity, 3 percent;

(b) moderate laxity, 7 percent;

(c) severe laxity, 10 percent;

(5) excision of patella, 9 percent;

(6) plateau fracture, depressed bone elevated, semilunar excised, 9 percent;

(7) plateau fracture, undisplaced, 2 percent;

(8) supracondylar or intercondylar fracture, displaced, 7 percent;

(9) supracondylar or intercondylar fracture, undisplaced, 2 percent;

(10) patella fracture, open reduction or partial patellectomy, displaced, 5 percent;

(11) patella fracture, open reduction or partial patellectomy, undisplaced, 2 percent;

(12) patellar shaving, 1 percent;

(13) arthroscopy, 0 percent;

(14) repair collateral ligament, mild laxity, 2 percent;

(15) repair collateral ligament, moderate laxity, 4 percent;

(16) repair patellar dislocation, 5 percent;

(17) total knee arthroplasty, flexion to 90 degrees, extension to 0 degrees, 13 percent;

(18) total knee unicondylar, 7 percent;

(19) lateral retinacular release, 1 percent;

(20) proximal tibial osteotomy, flexion to 90 degrees, extension to 0 degrees, 5 percent.

Subp. 6. Tibia.

Tibia:

A. tibial shaft fracture, undisplaced, healed, normal motion and alignment, 0 percent;

B. tibial shaft fracture, open reduction, loss of less than 20 degrees of movement in any one plane in either the knee or the ankle with full knee extension, no malalignment, 5 percent.

Subp. 7. Ankle and foot.

Ankle and foot:

A. Range of motion:

(1) total ankylosis ankle and foot, pantalar arthrodesis:

(a) in 10 degrees plantar flexion, 15 percent;

(b) malposition 30 degrees plantar flexion, 20 percent;

(2) ankylosis of foot, subtalar or triple arthrodesis tarsal bones, ankle, normal motion, 7.5 percent:

(a) decreased motion, subtalar joint, 3.5 percent;

(b) ankylosis in malposition, 8 percent;

(3) ankylosis of tibia and talus, subtalar joints free, optimum position 15 degrees plantar flexion, 12 percent;

(4) limitation of motion in the ankle:

(a) mild, motion limited from position of 90 degrees right angle to 20 degrees plantar flexion, 3 percent;

(b) moderate, motion limited from position of 10 degrees flexion to 20 degrees plantar flexion, 6 percent;

(c) severe, motion limited from position of 20 degrees plantar flexion to 30 degrees plantar flexion, 12 percent.

B. Procedures or conditions:

(1) achilles tendon rupture with treatment surgically or nonsurgically, able to stand on toes, 2 percent;

(2) achilles tendon rupture with treatment surgically or nonsurgically, unable to sustain body weight on toes, 4 percent;

(3) open reduction ankle:

(a) normal range of motion:

i. medial malleolus only, 2 percent;

ii. lateral malleolus only, 2 percent;

(b) normal to mild restriction on range of motion:

i. medial and lateral malleolus, 4 percent;

ii. trimalleolar, 4 percent;

(c) for moderate to severe restriction of range of motion in the ankle, rate as in item A, subitem (4);

(4) ankle, lateral ligament reconstruction, mild laxity, normal range of motion, 2 percent;

(5) ankle, lateral ligament reconstruction, moderate laxity, at least ten degrees greater widening on the Talar tilt stress test X-ray compared to the uninjured side, 3 percent.

Subp. 8. Foot.

Foot:

A. Range of motion:

(1) ankylosis of tarsal metatarsal or mild tarsal joints:

(a) normal position, 2.5 percent;

(b) malposition, 5 percent;

(2) limited motion in the foot:

(a) mild, limited motion with mild pain with weight bearing, no change in activities, 2.5 percent;

(b) moderate, limitation of motion with pain with weight bearing, no reduction in athletic or vigorous activities, 5 percent;

(c) severe, limitation of motion with pain with weight bearing, sedentary activities not affected, 10 percent.

B. Procedures or conditions:

(1) calcaneal fracture, extra articular, pain with weight bearing, 6 percent;

(2) calcaneal fracture, intra articular:

(a) mild limitation of motion as in item A, subitem (2), unit (a), 6 percent;

(b) moderate limitation of motion as in item A, subitem (2), unit (b), 12 percent;

(c) severe limitation of motion as in item A, subitem (2), unit (c), 18 percent;

(3) avascular necrosis talus:

(a) mild limitation of motion as in item A, subitem (2), unit (a), 6 percent;

(b) moderate limitation of motion as in item A, subitem (2), unit (b), 12 percent;

(c) severe limitation of motion as in item A, subitem (2), unit (c) 18 percent;

(4) tarsal fractures, healed, mild pain, 3 percent;

(5) metatarsal fractures, healed, 0 percent;

(6) phalangeal fractures, healed, 0 percent.

Subp. 9. Toes.

Toes:

A. complete ankylosis of metatarsophalangeal joint, any toe, 3 percent;

B. complete ankylosis any toe, interphalangeal joint, optimum position semiflexion, 1 percent.

Minnesota Administrative RulesAgency 151 - Labor and Industry DepartmentChapter 5223 - DISABILITY SCHEDULESPart 5223.0170 - MUSCULOSKELETAL SCHEDULE; JOINTS

Minnesota Administrative Rules
Agency 151 - Labor and Industry Department
Chapter 5223 - DISABILITY SCHEDULES
Part 5223.0170 - MUSCULOSKELETAL SCHEDULE; JOINTS