Limitation of movement refers to restrictive movement or range of motion (ROM) of a part, joint, or soft tissue, especially those imposed by disease or trauma. In this case, the limitation is in the movement of the wrist which is the joint between the hand and the forearm.

Limitation may result from conditions associated with disease, trauma, surgery, contractures or, in some instances, it may be congenital.

The degree of limitation may vary due to the underlying cause or associative conditions. For example, bending may be limited and there may be deviation of the wrist joint.

Evaluation of limitations may include: inspection of the joint; palpation; measurements of ROM; evaluation of the ligaments for stability; muscle strength testing; sensory testing; goniometers, which measure joint movements and angles; and radiology studies.

Treatments may include: physical therapy; maintenance of the joint in a functional position; and orthopedic intervention (e.g., splints, braces etc.). Medications and other therapies may be instituted to treat other conditions that contribute to the process (e.g., arthritis).

The possibility of long-term rehabilitation exists.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• To properly rate disability, accurate measurement of wrist movement range of motion is required and must be reported in degrees. The use of a goniometer in the measurement of ranges of wrist flexion, wrist extension, wrist abduction, and wrist adduction is indispensable. 38 CFR 4.46 [Accurate measurement]

• Impairments of the elbow, forearm, and wrist will be assigned separate disability evaluations.  The motions of these joints are all viewed as clinically separate and distinct.  Assign separate evaluations for impairment under the following DCs:

  • elbow: flexion under 38 CFR 4.71a, DC 5206, or extension under 38 CFR 4.71a, DC 5207

  • forearm supination and pronation under 38 CFR 4.71a, DC 5213, and

  • wrist flexion or ankylosis under 38 CFR 4.71a, DC 5214 or 38 CFR 4.71a, DC 5215.

• 38 CFR 4.59 may be applied separately to the elbow, the forearm, and the wrist to result in potentially three separate evaluations for painful motion when the evidence otherwise supports such a finding.  However, 38 CFR 4.59 may only be applied once to the elbow and may not be separately applied to both elbow flexion and elbow extension.

• When examination or other evidence denotes pain present in the joint or periarticular region but does not delineate the specific motions in which pain is present and there is a potential for a separate evaluation under 38 CFR 4.59, obtain a medical opinion to determine which motions are painful. When the examiner cannot delineate which motions are associated with pain, resolve doubt in favor of the Veteran, per 38 CFR 4.3, and consider painful motion to be present in the separate plane such as to allow assignment of the separate minimum compensable evaluation under 38 CFR 4.59.

• None.