Question:

In evaluating range of motion deficits for an extremity, when you have an unaffected extremity, what should you use to determine deviation from normal? Should you calculate this from the normal values in the Guides or should the difference be based on a comparison to the opposite normal extremity? I understand that the values are not age or sex specific.

For example, I have a patient who has a wrist injury and has only 40 degrees of flexion, yet the opposite side appears to be normal and has only 50 degrees of flexion. Do I rate the impairment as a 10 degree loss (a 2% upper extremity impairment according to Figure 26 in the fourth edition) or do I use the normal value in the Guides of 60 degrees and calculate it as a 20 degree loss (a...

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