Ankylosis is the immobilization or stiffness of a joint. In this case, the wrist which is the joint between the hand and the forearm is involved.

The condition may result from disease, trauma, surgery, contractures or, in some instances, it may be congenital.

Ankylosis in this area would result in immobility of the wrist joint. However, signs and symptoms, including the degree of ankylosis, 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.

Tests to determine the presence of ankylosis may include: inspection of the joint; palpation; measurements of range of motion (ROM); evaluation of the ligaments for stability; muscle-strength testing; sensory testing; and radiology studies.

Treatments may include: physical therapy, maintenance of the joint in a functional position, and orthopedic intervention. If the ankylosis was surgically created, the joint is kept immobilized in correct body alignment for 6 to 12 weeks until the bone is healed. Medications and other therapies may be instituted to treat other conditions that contribute to the process (e.g., arthritis).

Wasting away at the site of the joint may occur due to decreased activity. 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)).

• Entitled to special monthly compensation under 38 CFR 3.350. Also, consider entitlement to SMC as an issue in every case where there is a severe degree of disability involving the loss or loss of use of an extremity or sensory organ or any other functional loss providing entitlement to SMC.

• 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.

• Extremely unfavorable ankylosis will be rated as loss of use of hands under diagnostic code 5125. 38 CFR 4.71 (a) [Schedule of ratings-musculoskeletal system]