Minnesota Administrative Rules

5223.0450 MUSCULOSKELETAL SCHEDULE; SHOULDER AND UPPER ARM.

Subpart 1.

General.

For permanent partial impairment to the shoulder and upper arm, 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 arm at the shoulder. 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.

Subp. 2.

Exclusive categories.

A.

Acromioclavicular separation of the following severity:

(1)

grade 1, as defined in part 5223.0310, subpart 2, zero percent;

(2)

grade 2, as defined in part 5223.0310, subpart 3, one percent;

(3)

grade 3, as defined in part 5223.0310, subpart 4, three percent.

B.

Anterior or posterior shoulder dislocation, documented by examination, imaging study, or invasive investigation:

(1)

first episode or occurring less than three times in six months, three percent;

(2)

occurring at least three times in six months, no surgical repair, ten percent;

(3)

recurring after attempted surgical repair, ten percent;

(4)

if repaired surgically and there is no recurrence after surgical repair, the rating is as provided under subpart 4.

C.

Resection distal end of clavicle, three percent.

D.

Chronic bicipital tendon rupture, one percent.

E.

Resection arthroplasty of the glenohumeral joint, 36 percent.

F.

Painful organic syndrome, as defined in part 5223.0310, subpart 40, not elsewhere specified and substantiated by appropriate, consistent, and reproducible clinical or medical imaging findings which results in persistent limitation of active range of motion but no limitation of passive range of motion, zero percent.

Subp. 3.

Combinable categories.

A.

For dates of injury from July 1, 1993, through August 8, 2010, chronic rotator cuff tear, demonstrated by medical imaging study, with or without surgical repair:

(1)

partial thickness, two percent;

(2)

full thickness, six percent.

B.

Implant arthroplasty of the glenohumeral joint, 18 percent.

C.

Fracture or dislocation involving scapula, clavicle, humerus, not otherwise ratable under subpart 2 or 3, or part 5223.0460, zero percent.

D.

For dates of injury on or after August 9, 2010, acromioplasty, zero percent.

E.

For dates of injury on or after August 9, 2010, rotator cuff tear, demonstrated by medical imaging study:

(1)

healed or surgically repaired with no persistent tear, zero percent;

(2)

partial thickness tear which persists despite treatment, two percent;

(3)

full thickness tear which persists despite treatment, six percent.

Subp. 4.

Categories describing loss of function.

Function at the shoulder is measured by the available passive range of motion in three arcs at the shoulder: 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 an impairment in more than one arc, the ratings for each arc are added to determine the final impairment 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 150 degrees, zero percent;

(b)

to between 121 degrees and 150 degrees, three percent;

(c)

to between 101 degrees and 120 degrees, five percent;

(d)

to between 51 degrees and 100 degrees, eight percent;

(e)

to between zero degrees and 50 degrees, 12.5 percent;

(f)

to less than zero degrees, that is, there is an extension contracture, 18 percent;

(2)

extension is limited to between zero and nine degrees flexion, that is, there is a flexion contracture, and flexion is:

(a)

to greater than 150 degrees, zero percent;

(b)

to between 121 degrees and 150 degrees, three percent;

(c)

to between 101 degrees and 120 degrees, five percent;

(d)

to between 51 degrees and 100 degrees, eight percent;

(e)

to less than 51 degrees, 12.5 percent;

(3)

extension is limited to between ten degrees and 50 degrees flexion, that is, there is a flexion contracture, and flexion is:

(a)

to greater than 150 degrees, two percent;

(b)

to between 121 degrees and 150 degrees, five percent;

(c)

to between 101 degrees and 120 degrees, seven percent;

(d)

to between 51 degrees and 100 degrees, ten percent;

(e)

to less than 51 degrees, 14.5 percent;

(4)

extension is limited to between 51 degrees and 100 degrees flexion, that is, there is a flexion contracture, and flexion is:

(a)

to greater than 150 degrees, eight percent;

(b)

to between 121 degrees and 150 degrees, 11 percent;

(c)

to between 101 degrees and 120 degrees, 13 percent;

(d)

to less than 101 degrees, 16 percent;

(5)

extension is limited to between 101 degrees and 150 degrees flexion, that is, there is a flexion contracture, and flexion is:

(a)

to greater than 150 degrees, 14.5 percent;

(b)

to between 121 degrees and 150 degrees, 17.5 percent;

(c)

to less than 121 degrees, 18 percent;

(6)

extension is limited to greater than 150 degrees flexion, that is, there is a flexion contracture, and flexion is to greater than 150 degrees, 18 percent;

(7)

ankylosis, as defined in part 5223.0310, subpart 7, in flexion or extension occurs:

(a)

in extension, 18 percent;

(b)

between zero degrees and 50 degrees of flexion, 14.5 percent;

(c)

between 51 degrees of flexion and 100 degrees of flexion, 16 percent;

(d)

at greater than 100 degrees of flexion, 18 percent.

B.

Extent of range of abduction or adduction:

(1)

adduction is greater than zero degrees and abduction is:

(a)

to greater than 150 degrees, zero percent;

(b)

to between 121 degrees and 150 degrees, three percent;

(c)

to between 81 degrees and 120 degrees, eight percent;

(d)

to less than 81 degrees, 11 percent;

(2)

adduction is limited to between zero and nine degrees abduction, that is, there is an abduction contracture, and abduction is:

(a)

to greater than 150 degrees, zero percent;

(b)

to between 121 degrees and 150 degrees, three percent;

(c)

to between 81 degrees and 120 degrees, eight percent;

(d)

to less than 81 degrees, 11 percent;

(3)

adduction is limited to between ten degrees and 80 degrees abduction, that is, there is an abduction contracture, and abduction is:

(a)

to greater than 150 degrees, two percent;

(b)

to between 121 degrees and 150 degrees, five percent;

(c)

to between 81 degrees and 120 degrees, ten percent;

(d)

to less than 81 degrees, 11 percent;

(4)

adduction is limited to greater than 80 degrees abduction, that is, there is an abduction contracture, 11 percent;

(5)

ankylosis, as defined in part 5223.0310, subpart 7, in abduction or adduction occurs:

(a)

in adduction, 11 percent;

(b)

between zero degrees and 80 degrees of abduction, six percent;

(c)

at greater than 80 degrees, 11 percent.

C.

Extent of range of rotation:

(1)

external rotation is greater than 40 degrees and internal rotation is:

(a)

to greater than 20 degrees, zero percent;

(b)

to between zero degrees and 20 degrees, one percent;

(c)

limited to between zero degrees and nine degrees external rotation, that is, there is an external rotation contracture, one percent;

(d)

limited to between ten degrees and 40 degrees external rotation, that is, there is an external rotation contracture, three percent;

(e)

limited to greater than 40 degrees external rotation, that is, there is an external rotation contracture, seven percent;

(2)

external rotation is limited to between ten degrees and 40 degrees and internal rotation is:

(a)

to greater than 20 degrees, one percent;

(b)

to between zero degrees and 20 degrees, two percent;

(c)

limited to between zero degrees and nine degrees external rotation, that is, there is an external rotation contracture, two percent;

(d)

limited to between ten degrees and 40 degrees external rotation, that is, there is an external rotation contracture, four percent;

(3)

external rotation is limited to between zero degrees and nine degrees and internal rotation is:

(a)

to greater than 20 degrees, one percent;

(b)

to between zero degrees and 20 degrees, two percent;

(c)

limited to between one degree and nine degrees external rotation, that is, there is an external rotation contracture, two percent;

(4)

external rotation is limited to between one degree and 20 degrees internal rotation, that is, there is an internal rotation contracture, and internal rotation is:

(a)

to greater than 20 degrees, three percent;

(b)

to between one degree and 20 degrees, four percent;

(5)

external rotation is limited to greater than 20 degrees internal rotation, that is, there is an internal rotation contracture, and internal rotation is to greater than 20 degrees, seven percent;

(6)

ankylosis, as defined in part 5223.0310, subpart 7, in rotation occurs:

(a)

at greater than 20 degrees of internal rotation, seven percent;

(b)

between 20 degrees of internal rotation and 40 degrees of external rotation, four percent;

(c)

at greater than 40 degrees of external rotation, seven percent.

Statutory Authority:

MS s 176.105

History:

17 SR 3364; 35 SR 138

Published Electronically:

August 16, 2010