Flail joint is a joint with excessive mobility. In this case, it refers to the elbow joint; the joint between the upper arm and forearm.

Causes of impairment of flail joint of the elbow may include: fracture of the joint; nonunion fracture of the bone; paralysis of the muscles controlling the joint; rupture of a ligament; radial palsy; ulnar nerve palsy; compression of the 7th cervical spine nerve root; dislocations; or stroke.

Excessive joint mobility and associated pain are present. There may be elbow flexion contracture, and inability to perform range of motion.

Tests for the impairment may include: general physical examinations and examinations for nerve and muscle functions; x-ray; computed tomography (CT) scan; and magnetic resonance imaging (MRI). In addition, electromyography (EMG) may be used.

Treatments may consist of reduction of a dislocation; traction; surgery for rupture of the biceps; and physical therapy. Treatment by open reduction, internal fixation, and bone grafting may be done particularly in the young. Satisfactory results also are achieved with aggressive release of contractures and rigid internal fixation. Treatment by total elbow replacement is also successful in cases where there is extensive bone and soft tissue loss. Orthotics may be provided to support the joint and associated structures, and medications administered for pain or inflammation.

• There may be decreased extension of the joint, mild instability, impaired mobility, paresthesia, and limited activities of daily living (ADL).

• 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 applies and should be considered with existing evaluations (38 CFR 3.951(a)).

• To properly rate disability, accurate measurement of shoulder and arm ranges of motion is required and must be reported in degrees. The use of a goniometer in the measurement of ranges of motion in shoulder and arm in flexion, elevation, abduction, external rotation, and internal rotation is indispensable. 38 CFR 4.46 [Accurate measurement]

• 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. 

• 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.

• In all the forearm and wrist injuries, codes 5205 through 5213, multiple impaired finger movements due to tendon tie-up, muscle or nerve injury, are to be separately rated and combined not to exceed rating for loss of use of hand. 38 CFR 4.71 (a) [Schedule of ratings-musculoskeletal system]