EVALUATION OF ANKYLOSIS OR LIMITATION OF MOTION OF SINGLE OR MULTIPLE DIGITS OF THE HAND (1) For the index, long, ring, and little fingers (digits II, III, IV, and V), zero degrees of flexion represents the fingers fully extended, making a straight line with the rest of the hand. The position of function of the hand is with the wrist dorsiflexed 20 to 30 degrees, the metacarpophalangeal and proximal interphalangeal joints flexed to 30 degrees, and the thumb (digit 1) abducted and rotated so that the thumb pad faces the finger pads. Only joints in these positions are considered to be in favorable position. For digits II through V, the metacarpophalangeal joint has a range of zero to 90 degrees of flexion, the proximal interphalangeal joint has a range of zero to 100 degrees of flexion, and the distal (terminal) interphalangeal joint has a range of zero to 70 or 80 degrees of flex ion (2) When two or more digits of the same hand are affected by any combination of amputation, ankylosis, or limitation of motion that is not otherwise specified in the rating schedule, the evaluation level assigned will be that which best represents the overall disability (i.e., amputation, unfavorable or favorable ankylosis, or limitation of motion), assigning the higher level of evaluation when the level of disability is equally balanced between one level and the next higher level (3) Evaluation of ankylosis of the index, long, ring, and little fingers: (i) If both the metacarpophalangeal or proximal interphalangeal joint Rating Major Minor EVALUATION OF ANKYLOSIS OR LIMITATION OF MOTION OF SINGLE OR MULTIPLE DIGITS OF THE HAND-Continued (iv) If only the metacarpophalangeal or proximal interphalangeal joint is ankylosed, and there is a gap of two inches (5.1 cm.) or less between the fingertip(s) and the proximal transverse crease of the palm, with the finger(s) flexed to the extent possible, evaluate as favorable ankylosis (4) Evaluation of ankylosis of the thumb: (i) If both the carpometacarpal and interphalangeal joints are ankylosed, and either is in extension or full flexion, or there is rotation or angulation of a bone, evaluate as amputation at metacarpophalangeal joint or through proximal phalanx (ii) If both the carpometacarpal and (iii) If only the carpometacarpal or is (5) If there is limitation of motion of two or more digits, evaluate each digit separately and combine the evaluations Rating Major Minor I. Multiple Digits: Unfavorable Ankylosis 5216 Five digits of one hand, unfavorable ankylosis of Note: Also consider whether evaluation as amputation is warranted. 5217 Four digits of one hand, unfavorable Thumb and any three fingers 5218 Three digits of one hand, unfavorable Thumb and any two fingers Long, ring, and little fingers Note: Also consider whether evaluation as amputation is warranted. 5219 Two digits of one hand, unfavorable ankylosis of: Thumb and any finger 60 60 60 50 50 40 50 50 5220 Five digits of one hand, favorable ankylosis of 30 30 20 20 Rating Major Minor 20 20 20 20 Note: Also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. IV. Limitation of Motion of Individual Digits 5228 Thumb, limitation of motion: With a gap of more than two inches (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers With a gap of one to two inches (2.5 to 5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers With a gap of less than one inch (2.5 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers 5229 Index or long finger, limitation of motion: With a gap of one inch (2.5 cm.) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or, with extension limited by more than 30 degrees With a gap of less than one inch (2.5 cm.) between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, and; extension is limited by no more than 30 degrees 5230 Ring or little finger, limitation of motion: 20 20 40 40 30 Thumb and any three fingers Index, long, ring, and little fingers 5222 Three digits of one hand, favorable ankylosis of Thumb and any two fingers Index, long, and ring; index, long, and little; or index, ring, and little fingers Long. ring and little fingers 5223 Two digits of one hand, favorable an kylosis of: Thumb and any finger 40 2220 20 Index and long; index and ring; or index and little fingers 20 20 10 |