Impairment ratings and disability issues of the upper extremity

Determination of a fair and consistent permanent impairment rating is a very important part of the injured worker's care. This rating is a medical determination and is based on objective and consistent physical findings. Conversion of these findings into a percent of impairment is greatly facilitated by the use of guidelines which enable different examiners to be consistent in their determinations. The most widely used guide is the Guides to the Evaluation of Permanent Impairment, published by the American Medical Association. Disability is a legal determination which attempts to quantitate how the impairment will affect the injured person. Disability takes into account the worker's age, education, experience, and other social and economic factors. In the United States, disability is usually determined by the courts, while in other parts of the English-speaking world, the physician who does the impairment rating may be expected to estimate the disability as well as the impairment. This article will discuss some aspects of determination of impairment of the upper extremity, using the AMA Guides as the primary guideline.