Arm Schedule Loss of Use (SLU) — Elbow & Wrist

Arm = 312 weeks. Elbow and wrist injuries fall here, not at the shoulder or hand level.

TL;DR

• Elbow injuries (epicondylitis, ulnar nerve, biceps tendon, distal humerus fractures, radial head fractures) value at the arm under WCL §15(3) at 312 weeks.
• Wrist injuries (distal radius fractures, scapholunate ligament, TFCC) may schedule at the arm or the hand, depending on the level of impairment.
• 2018 Guidelines drive the percentage from ROM, surgical history, and special considerations.
• Cubital tunnel release, lateral epicondylitis release, and elbow arthroscopy carry Guidelines minimums.

What the arm value covers

The 312-week arm value covers impairment of the arm above the wrist — including the elbow, biceps, triceps, distal humerus, proximal radius and ulna, and the soft tissue and nerve structures of the upper arm and forearm. The shoulder is also part of the arm for SLU purposes but is conceptually distinct enough that it has its own page.

How elbow SLU is calculated

Range of motion. Flexion, extension, pronation, supination — each measured against normal benchmarks.

Surgical minimums.

• Cubital tunnel release (ulnar nerve at elbow) — minimum
• Lateral epicondylitis release (tennis elbow surgical release) — minimum
• Medial epicondylitis release (golfer’s elbow) — minimum
• Elbow arthroscopy — minimum varies by procedure
• Distal biceps tendon repair — minimum
• Triceps tendon repair — minimum
• ORIF of radial head, olecranon, or distal humerus fractures — minimums
• Elbow arthroplasty — significant minimum

Nerve findings. Ulnar nerve dysfunction (positive Tinel’s, weakness in ulnar distribution, intrinsic atrophy) adds to the percentage.

Hardware retention. Persistent hardware adds.

How wrist SLU is calculated

Wrist injuries value at the arm if the impairment is proximal-dominant, at the hand if it’s distal-dominant. The choice is often controlled by which calculation produces the larger total.

Range of motion. Flexion, extension, radial deviation, ulnar deviation.

Surgical minimums.

• ORIF of distal radius fracture — minimum
• Scapholunate ligament repair / reconstruction — minimum
• TFCC repair — minimum
• Wrist arthroscopy — minimum
• Carpal fusion — significant minimum

Grip strength. Dynamometer-measured grip strength deficit factors in.

Common patterns

• Construction trades — distal radius fractures from falls; biceps and triceps ruptures from heavy lifting
• Sanitation and warehouse — repetitive elbow stress, lateral epicondylitis
• Healthcare — wrist injuries from patient transfers
• Office / clerical — wrist injuries (causation typically needs specific medical foundation)
• Construction electricians, MTA electrical workers — ulnar nerve from prolonged elbow flexion

What I see go wrong

• Cubital tunnel release valued at 0% post-op, ignoring the Guidelines minimum
• ROM measured with the shoulder out of neutral, distorting elbow ROM readings
• Wrist scheduled at the hand when arm-level scheduling would produce more
• Distal radius ORIF undervalued when there’s persistent hardware and limited supination/pronation

What to do next

Contact me directly for arm SLU evaluation. The SLU Estimator is being expanded to cover elbow/wrist. Run the IME Red Flag Checker on any concerning IME report.

Frequently asked questions

What is the difference between arm SLU and hand SLU?

Elbow injuries, biceps and triceps ruptures, and distal humerus/proximal radius/ulna fractures value at the 312-week arm. Wrist injuries may value at the arm or the hand, depending on which calculation produces more. Always run both.

What’s the SLU minimum for cubital tunnel release?

Cubital tunnel release at the elbow carries a Guidelines minimum on the arm regardless of subjective outcome. IME reports rating the post-release patient at 0% are inconsistent with the Guidelines.

Related pages

• Schedule Loss of Use — shoulder
• Schedule Loss of Use — hand and finger
• Carpal tunnel and repetitive stress
• Construction-site injuries
• What is a Schedule Loss of Use award?