5252 - Thigh, limitation of flexion of

DBQ: Link to Index of DBQ/Exams by Disability for DC 5252 

Definition

The portion of the body lying between the hip joint and the knee refers to the thigh. Thigh flexion is governed by these two joints, and the muscles that flex the knee and the hip. In this case, limitation of flexion involves the thigh.

Etiology

Causes of limitation of flexion of the thigh may include: dislocations; muscle injury; ankylosis; trauma; fractures; inflammation; spinal deformities; congenital abnormalities; tendon and ligament injuries; and muscle contractures.

Signs & Symptoms

The usual ROM for flexion of the thigh is from 0 to 125° degrees. Inability to flex the thigh within the normal range may be related to the following circumstances: pain; swelling; muscle weakness; obvious deformity; crepitus over the joint; disparity in the lengths of the two legs; advanced arthritis; tendon or ligament tears; or a locked knee.

Tests

Laboratory tests will be based on the underlying disease condition. X-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI) are used in musculoskeletal problems. Other tests that may be used include: a physical examination; bone scan; arthroscopy; electromyography (EMG); goniometer; and nerve conduction tests.

Treatment

Treatment will vary according to the underlying cause of the limitation. Measures of treatment include: physical therapy; range of motion exercises; braces; surgery to restore motion through joint replacement; spinal disc removal; tendon or ligament repair; and medications to decrease arthritic symptoms.

Residuals

If treatments are unsuccessful, the thigh is dysfunctional because of limitation of flexion.

Special Considerations

  • See VAOPGCPREC 9-2004

    • On September 17, 2004, General Counsel issued a precedent opinion concerning the rating of hip conditions under two separate diagnostic codes involving limitation of motion. Specifically, General Counsel held that separate ratings for qualifying hip movements under diagnostic codes 38 CFR 4.71a, DC 5251 (extension), 38 CFR 4.71a, DC 5252) (flexion) and 38 CFR 4.71a, DC 5253 (abduction, adduction or rotation) may be assigned for a disability of the same hip.

    • Multiple hip evaluations do not, as a matter of law, violate 38 CFR 4.14.or preclude separate evaluation of a disability of the same hip  under  DC 5251, 5252, and/or 5253.

    • Evaluation of the same manifestation under multiple diagnoses is prohibited under 38 CFR 4.14.

    • Although it is permissible to assign multiple evaluations under multiple diagnostic codes for a single hip, you must always abide by the amputation rule (38 CFR § 4.68).

    • As always, when evaluating hip function, the provisions of 38 CFR §§ 4.40, 4.45, and 4.59 must be considered.

  • When there is limited flexion not meeting the 10-percent criteria and there is no defined schedular 0-percent evaluation criteria, a 0-percent evaluation is warranted for limited flexion of the hip under 38 CFR 4.71a, DC 5252.

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

Notes

  • Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5250-5254 for the hip, whichever results in the highest evaluation.