Q: A patient with a total shoulder replacement arthroplasty has limited movement with measurements of: flexion 110 degrees, extension 50 degrees, abduction 80 degrees, adduction 10 degrees, internal rotation 30 degrees, and external rotation 50 degrees. Obesity precludes evaluating atrophy. There is no evidence of neurologic deficit, instability, component malposition, loosening, or infection. What is the proper Sixth Edition rating for this case?

A: The diagnosis-based impairment (DBI) approach is used to assess impairment. Per Table 15-5, Shoulder Regional Grid: Upper Extremity Impairments (6th ed, 401-405) for shoulder arthroplasty there is a class 2 impairment for “implant with normal motion.” There is no exclusion for replacements with less than normal motion, just a minimum rating for those who have a shoulder arthroplasty.

The asterisk goes to a footnote that says “If motion loss is present, the impairment may...

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