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The "Figure 16-1A Upper Extremity Impairment Evaluation Record Part" is a specialized document used primarily for evaluating impairments related to the upper extremities, particularly the hands. This record is utilized by medical professionals to assess various factors contributing to hand impairments, including sensory loss, motion or ankylosis angles, and digit impairment percentages. Its purpose is to calculate the total hand impairment and translate it into an upper extremity impairment percentage, following the standards set by the American Medical Association.
The form includes sections for noting specific disorders affecting hand functionality, offering a structured way to compile the critical information necessary for a thorough assessment. It ensures that all facets of the impairment are considered when calculating the final impairment percentage.
Patient Information: Begin by filling in basic personal information of the individual being assessed, including their name, date of birth, and medical history.
Sensory Evaluation: Use specific tools and techniques to evaluate sensory loss in the upper extremities, documenting the results in the designated sections.
Range of Motion Measurement: Measure the motion or ankylosis angles of the fingers using a goniometer. Record the angles to assess joint movement limitations.
Calculate Digit Impairment: Evaluate each digit separately, noting the impairment percentage based on established medical guidelines.
Compile Total Hand Impairment: Sum the digit impairment percentages to determine the total hand impairment percentage.
Convert to Upper Extremity Impairment: Use AMA guidelines to convert the total hand impairment into an upper extremity impairment percentage.
The Figure 16-1A is used in legal contexts to substantiate claims related to physical impairments, such as workers' compensation or disability benefits. Adhering to AMA guidelines ensures the evaluation is considered valid in legal settings, providing a standardized basis for impairment ratings which can be used by medical professionals, insurance companies, and legal entities.


Medical professionals can access the Figure 16-1A form through medical supply vendors or professional medical associations. Alternatively, hospitals and medical centers generally have copies available for their practitioners who perform extremity impairment evaluations.
A construction worker suffers an on-site hand injury. The Figure 16-1A form is utilized by a medical professional to assess the injury's extent, documenting sensory loss and range of motion. The ensuing report is used in the worker's compensation claim to determine eligibility for benefit payouts.
A patient experiencing chronic joint disorders uses the form to quantify impairments. The evaluation supports their application for disability benefits, providing validated documentation that accompanies the benefit claim submission.
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