Body Part Evaluation Guides

The lumbar spine (lower back) is the most commonly evaluated body region in California workers' compensation claims. Injuries include disc herniations, degenerative disc disease, spinal stenosis, and fractures. QME evaluations assess range of motion, neurological deficits, and functional limitations.

The cervical spine (neck) is the fourth most frequently evaluated region in California workers' compensation, commonly injured in motor vehicle accidents, falls, and cumulative trauma. Conditions include disc herniations, cervical radiculopathy, cervical spondylosis, and whiplash-associated disorders. QME evaluations assess neurological status, range of motion, and upper extremity radicular symptoms.

Thoracic spine injuries in workers' compensation are less frequent than cervical or lumbar injuries but occur in falls, direct impacts, and compression fractures. Conditions include thoracic disc herniations, compression fractures, and intercostal neuralgia. Evaluations address range of motion, neurological deficits, and pain with respiratory mechanics.

Sacral and coccygeal injuries in workers' compensation typically result from falls onto the buttocks, resulting in coccyx fractures, coccydynia, and sacral fractures. While less common than lumbar injuries, these can cause significant sitting intolerance and functional limitations. Evaluations assess pain with sitting, pelvic floor function, and neurological status.

Multi-level spine evaluations address injuries involving two or more spinal regions, commonly seen in cumulative trauma claims and high-energy accidents. Under the AMA Guides 5th Edition, impairments from different spinal regions are combined using the Combined Values Chart. These complex evaluations require careful apportionment between specific and cumulative injury claims.

Shoulder injuries are the second most frequent body part evaluated in California QME examinations, commonly resulting from repetitive overhead work, lifting, and acute trauma. Conditions include rotator cuff tears, labral tears, impingement syndrome, and adhesive capsulitis. Evaluations focus on range of motion loss, strength deficits, and surgical outcomes.

Wrist and hand injuries are among the most common upper extremity conditions in workers' compensation, frequently caused by repetitive motion, cumulative trauma, and acute workplace accidents. Common conditions include carpal tunnel syndrome, de Quervain's tenosynovitis, scaphoid fractures, and TFCC tears. Evaluations assess grip and pinch strength, sensory deficits, and range of motion.

Elbow injuries in workers' compensation commonly result from repetitive motions, direct trauma, and cumulative use. Lateral and medial epicondylitis, cubital tunnel syndrome, and fracture-dislocations are frequently evaluated. QME assessments focus on range of motion, stability, grip strength, and ulnar nerve function.

Finger and thumb injuries are common in manufacturing, construction, and food processing occupations, including fractures, tendon lacerations, amputations, and trigger finger. The thumb carries significantly higher impairment values due to its functional importance. Evaluations assess range of motion of individual joints, sensory loss, and opposition function.

Forearm injuries in workers' compensation include radius and ulna fractures, compartment syndrome, and Monteggia/Galeazzi fracture-dislocations from falls and machinery accidents. Pronation and supination deficits are key impairment drivers. Evaluations focus on rotational range of motion, grip strength, and radiographic alignment.

Upper arm and humerus injuries in workers' compensation result from falls, direct blows, and overhead work. Proximal humerus fractures, humeral shaft fractures, and biceps/triceps tendon ruptures are commonly evaluated. Assessments focus on shoulder and elbow range of motion, strength deficits, and residual deformity.

Whole upper extremity evaluations address cumulative trauma disorders and multi-joint injuries affecting multiple segments of the arm. Common in keyboard workers, assembly line operators, and trades requiring repetitive hand and arm use. The AMA Guides 5th Edition provides conversion tables from digit/hand/UE impairment to whole person impairment.

The knee is the third most commonly evaluated joint in workers' compensation QME evaluations, frequently injured in slip-and-fall incidents, repetitive kneeling, and twisting motions. Common diagnoses include meniscal tears, ACL/PCL injuries, chondromalacia, and post-traumatic arthritis. Evaluations assess ligamentous stability, range of motion, and articular cartilage defects.

Ankle and foot injuries are commonly evaluated in workers' compensation claims involving falls, missteps, and crush injuries. Conditions include ankle fractures, Achilles tendon ruptures, plantar fasciitis, and tarsal tunnel syndrome. QME evaluations assess gait, stability, range of motion, and weight-bearing capacity.

Hip injuries in workers' compensation include labral tears, avascular necrosis, fractures, and post-traumatic osteoarthritis, often resulting from falls, heavy lifting, and repetitive activities. Total hip arthroplasty outcomes are a significant component of evaluations. QME assessments measure range of motion, gait abnormalities, and functional limitations.

Lower leg and tibial injuries in workers' compensation include tibial plateau fractures, compartment syndrome, stress fractures, and tibial shaft fractures from falls and struck-by incidents. Evaluations assess bony union, residual deformity, muscle atrophy, and functional gait impairment.

Thigh and femoral injuries in workers' compensation include femoral shaft fractures, quadriceps and hamstring tears, and heterotopic ossification, typically from high-energy trauma such as falls from height and motor vehicle accidents. Evaluations assess bony healing, muscle atrophy, limb length discrepancy, and gait impairment.

Toe injuries in workers' compensation include fractures, crush injuries, amputations, and hallux valgus/rigidus aggravation from repetitive walking or standing on hard surfaces. The great toe carries significantly more impairment value than lesser toes. Evaluations assess range of motion, weight-bearing tolerance, and gait impact.

Hearing loss evaluations are a significant category in California workers' compensation, particularly for workers in construction, manufacturing, entertainment, and emergency services. Noise-induced hearing loss (NIHL) and tinnitus are the most common conditions. QME evaluations require audiometric testing and assessment of monaural versus binaural hearing impairment.

Traumatic brain injury evaluations in workers' compensation address concussions, post-concussive syndrome, and moderate-to-severe TBI from workplace falls, struck-by incidents, and motor vehicle accidents. These cases often involve complex neuropsychological testing and multidisciplinary assessment. Cognitive, emotional, and physical sequelae are all evaluated for impairment rating.

Ocular injuries in workers' compensation include chemical burns, corneal abrasions, traumatic cataracts, retinal detachments, and visual field deficits from TBI. These injuries are prevalent in construction, welding, manufacturing, and chemical industries. Evaluations measure visual acuity loss, visual field defects, and binocular function impairment.

Psychiatric evaluations represent a growing segment of California workers' compensation QME examinations, addressing claims for PTSD, major depressive disorder, anxiety disorders, and adjustment disorders arising from workplace injuries or events. Under LC 4660.1, psychiatric impairment apportionment requires careful analysis. Evaluations utilize standardized psychological testing and clinical interview.

Pulmonary evaluations in workers' compensation address occupational asthma, COPD from toxic exposures, pneumoconioses (silicosis, asbestosis), and hypersensitivity pneumonitis. These claims are common in construction, mining, firefighting, and manufacturing. Evaluations rely heavily on pulmonary function testing and exposure history documentation.

Dermatological evaluations in workers' compensation address occupational contact dermatitis, chemical burns, scarring/disfigurement, and skin cancers from UV or chemical exposure. These claims are common in healthcare, cleaning, manufacturing, and outdoor occupations. Evaluations assess the extent and severity of skin involvement, functional limitations, and cosmetic disfigurement.

Cardiovascular evaluations in workers' compensation address myocardial infarctions in certain presumptive occupations (firefighters, law enforcement), hypertension, and post-traumatic chest wall injuries. California Labor Code 3212 creates a presumption of industrial causation for certain public safety employees. Evaluations involve exercise tolerance testing and cardiac functional classification.