Hand and digit injury
Hand and finger injury after a motor accident
A hand claim may involve several digits, joints, tendons or nerves. The AMA4 upper-extremity method converts digit impairment to hand, then upper extremity and WPI, so the assessor must document each affected structure and follow the adding and combining instructions exactly.
Motor accident injury
How can this injury happen?
Car or passenger collision
Hands may be crushed by the wheel, dashboard, airbag or door, causing fracture, tendon or nerve injury.
Motorcycle accident
A fall or handlebar impact can fracture digits, dislocate joints or injure tendons and nerves.
Pedestrian or cyclist impact
A hand can strike the vehicle or road during a fall, producing crush, laceration or avulsion injury.
Injuries that can occur
- metacarpal or phalangeal fracture and malrotation
- finger dislocation, ligament or volar plate injury
- flexor or extensor tendon rupture
- digital or major peripheral nerve injury
- amputation, crush injury or post-traumatic stiffness
Symptoms and functional problems
- loss of finger flexion or extension
- difficulty pinch, opposition, fastening or fine manipulation
- altered two-point discrimination or numbness
- rotation, deformity, locking or painful joint stiffness
Seek urgent medical assessment
Open fracture, tendon laceration, threatened circulation, amputation or rapidly increasing compartment pressure requires emergency care.
Clinical evidence
What findings matter?
Each digit and joint should be examined for active movement, tendon continuity, malrotation, sensory loss and amputation level. Figure 1 controls the sequence for adding and converting values.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| Hand X-ray and clinical alignment | Shows fracture, union, joint surface and rotational deformity. | A fracture label does not describe tendon or functional loss. |
| Joint-by-joint active ROM | Records DIP, PIP, MP and thumb joint movement. | A general statement that the hand is stiff is insufficient. |
| Tendon and sensory examination | Tests isolated tendon action, two-point discrimination and nerve distribution. | Grip strength is not a permitted upper-limb rating. |
Movement in daily life
How movement affects real activities
Finger flexion closes the hand around objects; extension releases them; thumb opposition and abduction enable pinch, buttons and fine handling. Different joints must be measured separately.
Finger DIP, PIP and MP movement
Gripping, releasing, typing and manipulating objects.
Figures 18 to 23 address active finger joint movement.
Thumb IP and MP movement
Pinch, key grip and stabilising objects.
Figures 8 to 13 address thumb joint movement.
Thumb adduction, abduction and opposition
Buttons, handwriting, phone use and handling small objects.
Figures 14 to 16 and applicable Tables 5 to 7 address these functions.
Sensory function
Safe grip, object recognition and fine manipulation without visual monitoring.
Sensory loss must use the applicable digit or peripheral nerve method, not a pain estimate.
Threshold injury is a separate question: fracture, nerve injury or verified tendon/ligament/cartilage rupture may be non-threshold. A sprain or soft tissue contusion without excluded injury may remain threshold.
Part 6 permanent impairment
How is CTP WPI assessed?
AMA4 Figure 1 and Tables 1 to 3 provide the conversion pathway from digit to hand, upper extremity and WPI. Joint movement uses the relevant thumb or finger figures; nerve injury uses the separate Part 6 method.
Measurement rules that apply
- Clause 6.50 requires active, not passive, range of motion for the impairment calculation. A goniometer should be used where clinically indicated, and unreliable movement should be repeated consistently before it is accepted.
- Clauses 6.51 and 6.52 permit a contralateral baseline only where the uninjured joint is a fair estimate of pre-accident mobility. The total upper-extremity impairment for each comparable joint is subtracted before conversion to WPI.
- Clause 6.67 prohibits upper-limb strength evaluation and AMA4 Table 34. A genuine peripheral nerve or muscle-bulk injury must use another permitted method without double counting.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| Digit and thumb ROM | Figures 8-23; clause 6.54 | Permanent joint-specific active movement loss. | Follow adding/combining instructions for each joint and digit. |
| Sensory or peripheral nerve method | Tables 4, 8, 9 or clauses 6.58-6.60 | Verified digital sensory or major nerve injury. | Do not duplicate the same nerve consequence. |
| Conversion pathway | AMA4 Tables 1, 2 and 3; Figure 1 | Converts digit to hand, UEI and WPI. | Do not jump directly from a finger diagnosis to WPI. |
- Document each affected joint and digit.
- Use the precise adding or combining instruction rather than ordinary arithmetic.
- Do not use grip or pinch strength Tables 31-34 as WPI.
What cannot be combined?
- peripheral nerve and other upper-limb values unless separate injuries
- the same sensory loss under digit and nerve methods
- grip strength with hand movement impairment
What does not establish WPI by itself?
- hand pain
- fracture without residual findings
- weak grip
- a global estimate of hand function
Motor accident examples
Multiple finger fractures with stiffness
Each affected joint and digit is measured before values move through Tables 1-3; the assessor cannot assign one global hand percentage.
Tendon laceration with sensory loss
Movement and a separate nerve injury require distinct proof and careful combination to avoid double counting.
Claim file preparation
Evidence checklist
Assessment source
Hand and finger WPI source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.45 and 6.47-6.60, 6.67; AMA4 Figure 1, Figures 8-23 and Tables 1-3.
Threshold injury: Fracture, nerve injury and verified tendon/ligament/cartilage rupture may be non-threshold; uncomplicated sprain may remain threshold.
What the assessor checks
- joint-specific movement
- digit-hand-UEI-WPI conversion
- nerve separation rule
- strength prohibition
What does not establish the result by itself
- pain
- fracture label
- weak grip
- global estimate
Official sources
Related NSW CTP guides
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Frequently asked questions
- Is each injured finger assessed separately?
- The relevant joints and digits are documented separately, then converted and combined as Figure 1 and Tables 1-3 instruct.
- Can grip strength set hand WPI?
- No. Clause 6.67 prohibits upper-extremity strength Table 34.
- Does numbness count?
- It may if objective sensory loss is assessed under the applicable digit or peripheral nerve method.
- Does hand surgery create a percentage?
- No. The assessor evaluates the permanent residual movement, sensory or amputation impairment.
- Can a tendon rupture be non-threshold?
- A verified partial or complete tendon rupture is excluded from the soft tissue definition, subject to diagnosis and causation.