The arm is the upper extremity from shoulder to elbow. Limitation of motion is the restriction of movement or range of motion of a part or joint, especially that brought on by disease or trauma to joints and soft tissues.

Limitation of motion may be associated with pressure on the brachial plexus, causing entrapped nerves. This may result from dislocation of the shoulder, fracture of a clavicle, a mass that presses on the nerve, or cervical rib syndrome. Other causes may be rotator cuff tendonitis, bone tumors adjacent to a joint, inflammation of the long thoracic nerve, or compression of the thoracic nerve.

Active elevation of the arm will most likely be limited in the etiological conditions listed above. In addition to limitation of motion and weakness, there could be pain with fractures; numbness with nerve entrapment; muscle wasting; and signs of paleness, coldness and extremity fatigue.

X-rays, arthrograms, and computed tomography (CT) scan may be used to evaluate limited arm motion. Magnetic resonance imaging (MRI) has demonstrated a sensitivity and specificity of 100% and 95% respectively while ultrasound may be used to diagnose rotator cuff disease. In addition, Doppler studies and evaluation of nerve function may be helpful.

Treatment will vary according to the underlying cause of the limitation of motion: fractures will be reduced; brachial plexus and cervical rib nerves will be released surgically; tumors will be excised or treated with chemotherapy; and tendonitis will be treated with local injections of corticosteroids, and rest of the involved part.

• Wasting away of muscle may occur at the site of the involved joint due to decreased activity. Rehabilitation to restore shoulder and arm motion should begin as soon as possible, and may be required from 3 to 6 months or longer. In general, after one year of a program, very little further improvement can be expected.

• When deciding expressly claimed issues, decision makers must consider entitlement to any complications that are within scope of the claim, including those identified by the rating criteria for that condition in 38 CFR Part 4. This could include but is not limited to, scars as the result of surgical intervention for an SC disability.

• 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)).

• Multiple precedential decisions have impacted the application of 38 CFR 4.59 for musculoskeletal disabilities. Refer to the table in the M21-1 for a listing of impactful precedential court holdings, a brief description of the impact, and the applicability date (date of decision) for each.

• In Sowers v. McDonald (2016), the United States Court of Appeals for Veterans Claims (CAVC) held that 38 CFR 4.59 is limited by the DC applicable to the claimant’s disability, and where that DC does not provide a compensable rating, 38 CFR 4.59 does not apply. This policy particularly affects painful motion of the shoulder evaluated under 38 CFR 4.71a, DC 5201.  Under this DC, painful motion of the shoulder warrants assignment of a 20-percent evaluation. Refer to the M21-1 for examples demonstrating painful motion of the shoulder. 

• Separate evaluations may be given for disabilities of the shoulder and arm under 38 CFR 4.71a, diagnostic codes (DCs) 5201, 5202, or 5203 if the manifestations represent separate and distinct symptomatology that are neither duplicative nor overlapping. Refer to the M21-1 for examples of separate evaluations for disabilities of the shoulder and arm.

• Multiple evaluations cannot be assigned under 38 CFR 4.71a, DC 5201 for limited flexion and abduction of the shoulder.

• It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. See 38 CFR 4.2 – Interpretation of examination reports. If the report or examination is inadequate, the rating agency may return for a supplementary report. See 38 CFR 4.70 – Inadequate examinations.

• None.