Radius, Impairment of C&P Exam Prep

Elbow Flexion Range of Motion

What it measures: The degree of bending at the elbow joint, normally 0 to 145 degrees.

What to expect: Examiner will use a goniometer to measure how far you can bend your elbow. Normal endpoint is 145 degrees. You will perform this actively (you move it), passively (examiner moves it), and after 3 repetitions.

Pain considerations: Inform the examiner of the exact degree at which pain begins, not just the maximum degree you can reach. Pain limiting motion is a separate compensable element under DeLuca v. Brown.

Elbow Extension Range of Motion

What it measures: The degree of straightening at the elbow, normal endpoint is 0 degrees (full extension).

What to expect: Examiner measures how fully you can straighten your elbow. Any flexion contracture (inability to fully extend) will be recorded.

Pain considerations: Even if you can extend fully, report pain experienced during extension, as painful motion can be rated as functional loss.

Forearm Pronation Range of Motion

What it measures: The ability to rotate the forearm so the palm faces downward. Normal is 0 to 80 degrees.

What to expect: Examiner will measure how far you can rotate your forearm palm-down. This is critical under DC 5212 and related codes (DC 5213) because limitation of pronation has direct rating thresholds.

Pain considerations: Report pain onset during pronation and whether pain limits you before the mechanical endpoint is reached.

Forearm Supination Range of Motion

What it measures: The ability to rotate the forearm so the palm faces upward. Normal is 0 to 85 degrees.

What to expect: Examiner will measure how far you can rotate your forearm palm-up. Limitation of supination to 30 degrees or less has a specific rating threshold.

Pain considerations: Clearly distinguish between pain-limited supination and mechanically-blocked supination; both are compensable.

Bone Assessment and Deformity Examination

What it measures: Physical presence of nonunion, false movement, bone loss, malunion, and deformity of the radius.

What to expect: The examiner will palpate the radius shaft, assess for abnormal movement at the fracture site, and review any available x-rays or imaging. They will assess whether bone loss is 1 inch (2.5 cm) or more and whether marked deformity is present.

Pain considerations: Even when a nonunion or malunion is present, also describe the pain, weakness, and functional limitations that result from the structural abnormality.

Circumferential Muscle Measurement (Atrophy Assessment)

What it measures: Comparison of arm circumference between the affected and unaffected extremity to detect muscle atrophy from disuse.

What to expect: Examiner measures the circumference of both upper extremities at the same anatomical location (typically the forearm or upper arm). A difference suggests disuse atrophy.

Pain considerations: Atrophy often results from avoiding painful use of the arm; describe the specific activities you avoid and why.

Repetitive-Use Testing (DeLuca/Correia Requirement)

What it measures: Whether range of motion worsens after three repetitions of motion, simulating actual-use conditions.

What to expect: After initial ROM measurements, the examiner will ask you to repeat each motion three times and remeasure. This is legally required under Correia v. McDonald and DeLuca v. Brown. The examiner must document any additional functional loss after repetition.

Pain considerations: Increased pain, swelling, stiffness, or weakness after repetition is legally significant. Describe it in terms of degrees of worsening if possible.

40%

Nonunion in lower half of radius, with false movement: WITH loss of bone substance of 1 inch (2.5 cm) or more AND marked deformity - MAJOR extremity (dominant arm)

From 38 CFR: 38 CFR 4.71a DC 5212: Nonunion in lower half, with false movement, with loss of bone substance (1 inch or more) and marked deformity - 40% major, 30% minor

30%

Nonunion in lower half of radius, with false movement: WITHOUT loss of bone substance or deformity - MAJOR extremity; OR Nonunion in lower half WITH bone loss/deformity - MINOR extremity (non-dominant)

From 38 CFR: 38 CFR 4.71a DC 5212: Nonunion in lower half, without loss of bone substance or deformity - 30% major, 20% minor

20%

Nonunion in upper half of radius (major or minor); OR Nonunion in lower half without bone loss/deformity - MINOR extremity

From 38 CFR: 38 CFR 4.71a DC 5212: Nonunion in upper half - 20% major, 20% minor

10%

Malunion of radius with bad alignment (major or minor extremity)

From 38 CFR: 38 CFR 4.71a DC 5212: Malunion with bad alignment - 10% major, 10% minor

Pain

How to describe it: Describe pain location (e.g., middle of forearm, at fracture site, radiating to wrist or elbow), character (aching, sharp, burning), frequency (constant vs. intermittent), and what makes it worse (rotation, lifting, gripping, extended use). Rate severity on a 0-10 scale for typical days and worst days.

Example: On my worst days, I wake up with a constant 8/10 aching pain at the fracture site in my forearm. I cannot rotate my palm upward at all without sharp pain, and even resting my arm on a surface causes discomfort that wakes me at night.

Examiner listens for: Onset of pain during specific motions, pain at rest versus with activity, pain limiting functional use, and whether pain worsens with repeated use over time.

Avoid: Do not say 'it's not that bad' or 'I manage.' Describe the actual impact of the pain on what you can and cannot do. Do not average your pain - report your worst typical experience.

Weakness

How to describe it: Describe inability to grip objects, difficulty lifting, inability to resist forces (e.g., a jar lid, a wrench), and whether weakness is constant or develops after use. Note if the affected arm fatigues faster than the unaffected arm.

Example: I cannot hold a gallon of milk with my affected arm. After two or three minutes of using my forearm, my grip gives out and I drop things. My arm shakes when I try to rotate against resistance.

Examiner listens for: Objective weakness on muscle testing, description of tasks that can no longer be performed, and grip or rotational strength reduction compared to contralateral side.

Avoid: Do not say 'I'm weak but I push through it.' Quantify: how heavy an object can you hold, for how long, before you must stop.

Fatigability and Lack of Endurance

How to describe it: Explain how quickly the affected arm tires with use. Give specific examples: 'After 5 minutes of writing I have to stop,' or 'I can only carry groceries one bag at a time and must switch arms every 30 seconds.'

Example: On bad days, I cannot wash dishes for more than 2 minutes before my forearm becomes so fatigued and painful that I have to stop for 10 minutes before resuming. I used to work all day with my hands.

Examiner listens for: Evidence that functional capability degrades significantly with sustained or repeated use - this is the core of the DeLuca doctrine and must be captured in the DBQ.

Avoid: Do not say 'I get tired sometimes.' Provide specific time estimates, describe what happens when you push through fatigue, and clarify that this is different from before your injury.

Incoordination

How to describe it: Describe difficulty with fine motor tasks: buttoning a shirt, turning a key, catching objects, pouring liquids, using tools. Note any tremor, unsteadiness, or loss of precise control in the affected arm.

Example: I spill drinks when I try to pour because I cannot control the rotation of my forearm smoothly. I miss the keyhole when trying to unlock doors. I cannot thread a needle or handle small screws.

Examiner listens for: Loss of smooth, coordinated movement in the forearm and hand that was not present before the injury, particularly in tasks requiring rotation or fine control.

Avoid: Do not minimize coordination problems as 'clumsiness.' Describe specific tasks that have become unreliable and any injuries or accidents that have resulted.

Flare-Ups

How to describe it: Describe what triggers a flare (weather, activity, stress, overuse), how long flare-ups last, how severe they are, how often they occur, and what you must do when they occur (rest, ice, medication).

Example: When I do any heavy lifting or repeated twisting motions, my forearm swells, the pain spikes to 9/10, and I cannot use the arm for 2-3 days. This happens at least twice a month. During a flare I cannot drive, cook, or care for myself properly.

Examiner listens for: Frequency, severity, duration, and triggers of flare-ups. The examiner is required to document flare-up impact and must note if range of motion would be further reduced during a flare.

Avoid: Do not say 'I just rest until it gets better.' Quantify rest duration, activity restrictions during flares, and whether you have sought medical treatment for flares.

False Movement and Deformity

How to describe it: If you have nonunion with false movement, describe the sensation: abnormal bending or movement at the fracture site, a sense of the bone shifting, clicking, or instability in the forearm when you try to use it.

Example: When I try to rotate my forearm or apply any torque, I can feel the fracture site flex abnormally. It feels unstable, like the bone is not solid. I avoid any activity that loads the forearm because I fear re-injury.

Examiner listens for: Palpable or observable false movement at the fracture site, instability during forearm rotation, and patient-reported sensation of nonunion.

Avoid: Do not say 'it feels weird sometimes.' Be specific: describe when it happens, what the movement feels like, and what you are unable to do because of it.