title: Evaluation of impairment in the upper extremity.
abstract: A system for evaluation of physical impairment in the hand and upper extremity was developed and has been tested and used by many hand surgeons around the world. It was approved for international application by the International Federation of Societies for Surgery of the Hand. A method for evaluating amputation and sensory and motion impairments has been devised for the hand and upper extremity. Amputation impairment percentage values were determined for each digit or position thereof for the hand, wrist, elbow, and shoulder. By a principle of progressive multiplication of percentage values, impairment of a part can be related to the hand, upper extremity, and eventually the whole person. Sensory impairment is given 50% that of an amputation. Impairment of finger motion can result from lack of flexion (F), extension (E), or ankylosis (A). The method for evaluating flexion impairment is based on a combined angular measurement principle that was correlated with the linear measurement of Boyes. Values for flexion and ankylosis impairment were obtained from the American Medical Association guide. Values for extension impairment were derived from the formula A = E + F. Values for hyperextension were given consideration in the impairment tables. The sum of impairments as related to the whole hand equals the total impairment. The method to combine various impairments is based on the principle that each impairment acts not on the whole part (e.g., the finger) but on the remaining portion (e.g., proximal interphalangeal joint and proximally) after the preceding impairment has acted (e.g., on the distal interphalangeal joint). When there is more than one impairment to a given part, these must be combined before conversion to a larger part. The combined values determination is based on the formula "A% + B% (100% - A%) = the combined values of A% + B%." Based on this principle, the physical loss of each anatomic segment is related to the part, to the entire hand, and then to the body. The common impairment values have been placed in a table form for easier use.
mesh_terms: D000062:Accidents, Occupational; D000673:Amputation, Traumatic / Q000175:diagnosis; D001134:Arm Injuries / Q000175:diagnosis*; D004185:Disability Evaluation; D005383:Finger Injuries / Q000175:diagnosis; D006230:Hand Injuries / Q000175:diagnosis*; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis; D008487:Medical History Taking; D008501:Medical Records, Problem-Oriented; D009069:Movement Disorders / Q000175:diagnosis; D009784:Occupational Diseases / Q000175:diagnosis*