Upper limb injury
Shoulder injury after a motor accident
A shoulder claim should identify the structure injured, not stop at the word pain. Seat-belt loading, bracing, direct impact and a fall can affect the rotator cuff, labrum, capsule, AC joint, bone or nerves, and each finding may require a different CTP assessment method.
Motor accident injury
How can this injury happen?
Car or passenger collision
Seat-belt force, steering-wheel bracing or side intrusion can load the shoulder in elevation, rotation or direct compression.
Motorcycle accident
A rider may land on the point of the shoulder or brace through an outstretched arm, causing fracture, dislocation, cuff or labral injury.
Pedestrian or cyclist impact
A bumper strike or fall can drive the shoulder into the road, vehicle or an outstretched-hand position.
Injuries that can occur
- rotator cuff strain or tear
- labral injury, dislocation or instability
- AC joint sprain, clavicle or proximal humerus fracture
- capsular injury, bursitis, impingement or post-traumatic stiffness
- brachial plexus or peripheral nerve injury
Symptoms and functional problems
- pain with overhead, sideways or behind-the-back reaching
- night pain and difficulty lying on the injured side
- weakness, clicking, apprehension or a sense of instability
- difficulty dressing, washing hair, driving, lifting or carrying
Seek urgent medical assessment
A visibly deformed shoulder, absent pulse, major new numbness or weakness, or suspected fracture requires urgent assessment.
Clinical evidence
What findings matter?
The examination should separate pain-limited movement from structural instability, tendon failure, fracture and nerve injury. Imaging supports that analysis but does not replace active movement and a reasoned diagnosis.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| Active ROM with goniometer | Records flexion, extension, abduction, adduction and rotation for the shoulder figures. | Passive movement or an estimated angle does not set the upper-extremity impairment. |
| Ultrasound, MRI, CT or X-ray | May identify cuff or labral pathology, fracture, AC injury, arthritis or dislocation sequelae. | A scan label does not prove accident causation, permanence or the applicable method. |
| Orthopaedic and neurological examination | Tests stability, tendon function, sensation, reflexes and peripheral nerve distribution. | General weakness cannot be converted through prohibited upper-limb strength Table 34. |
Movement in daily life
How movement affects real activities
Shoulder function is multi-directional. A person may reach forward but remain unable to lift sideways, rotate behind the head or reach behind the back, so each active plane must be recorded rather than reduced to one general statement.
Flexion
Lifting the arm forward and overhead, including reaching a shelf or putting on a shirt.
Active flexion and extension are rated through AMA4 shoulder Figures 36 to 38 when reliable.
Abduction
Lifting the arm sideways, including reaching away from the body or fastening a seat belt.
Active abduction and adduction are addressed by Figures 39 to 41.
External rotation
Washing hair, reaching behind the head and positioning the arm to put on a jacket.
Active external rotation is read with the shoulder rotation figures, not estimated from pain severity.
Internal rotation
Reaching behind the back for dressing, hygiene or fastening clothing.
Active internal rotation is addressed with Figures 42 to 44 and must be measured consistently.
Threshold injury is a separate question: a strain, bursitis or other soft tissue condition may be threshold. A verified fracture, nerve injury, dislocation injury or partial or complete tendon or ligament rupture may be outside the soft tissue definition, but classification and WPI remain separate decisions.
Part 6 permanent impairment
How is CTP WPI assessed?
Clauses 6.47 to 6.57 adopt the AMA4 upper-extremity method as modified by Part 6. The assessor selects the method that fits the residual shoulder impairment and converts upper-extremity impairment to WPI using Table 3.
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 |
|---|---|---|---|
| Active shoulder ROM | Clause 6.50; AMA4 Figures 36 to 44 | Reliable permanent restriction in flexion, extension, abduction, adduction and rotation. | Inconsistent movement is not a valid impairment parameter. |
| Other upper-extremity disorder or analogy | Clauses 6.24 and 6.57; AMA4 pages 58 to 64 | A diagnosed condition not adequately represented by ROM, with a reasoned analogous method. | The method cannot duplicate movement, nerve or structural impairment already rated. |
| UEI to WPI conversion | Clause 6.56; AMA4 Table 3 | Converts the final upper-extremity impairment value to whole person impairment. | A shoulder diagnosis is not itself a WPI percentage. |
- The condition must be permanent or sufficiently stable under clauses 6.19 to 6.21.
- The assessor must address causation and any objectively documented pre-existing symptomatic impairment.
- Upper-limb strength testing and Table 34 are not permitted by clause 6.67.
What cannot be combined?
- peripheral nerve impairment with shoulder impairment unless they arise from separate injuries under clause 6.53
- two methods that rate the same movement or structural consequence
- upper-extremity strength Table 34 with any shoulder rating because that method is prohibited
What does not establish WPI by itself?
- shoulder pain without reliable examination
- a degenerative scan finding without accident correlation
- surgery or an injection history alone
- a treating note stating reduced ROM without actual active measurements
Motor accident examples
Side impact with loss of overhead reach
Reliable active shoulder measurements may support a ROM method, while imaging and early notes address whether the restriction is accident-related.
Motorcycle fall with dislocation and nerve symptoms
The dislocation sequelae and a separate verified nerve injury must be identified and combined only if they are genuinely separate impairments.
Claim file preparation
Evidence checklist
Assessment source
Shoulder WPI assessment source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.47-6.57 and 6.67; AMA4 section 3.1, Figures 36-44 and Table 3, only as modified by Part 6.
Threshold injury: Threshold injury and WPI are separate. The diagnosed shoulder structure and evidence of fracture, nerve injury or partial/complete rupture must be assessed before classification.
What the assessor checks
- active ROM and goniometer rules
- contralateral comparison conditions
- shoulder movement figures
- Table 3 conversion
- strength prohibition
What does not establish the result by itself
- pain
- scan wording
- surgery
- unmeasured movement
- general weakness
Official sources
Related NSW CTP guides
Free claim check
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Frequently asked questions
- Does every painful shoulder produce WPI?
- No. The assessor needs a permanent accident-related impairment and a valid Part 6 method. Pain without reliable movement, structural or nerve findings may produce no assessable percentage.
- Does passive shoulder movement count?
- Passive movement may help identify the clinical problem, but clause 6.50 says impairment is calculated from active range of motion.
- Why compare the other shoulder?
- The uninjured side may be used as a baseline only where it reasonably represents pre-accident mobility and the calculation required by clauses 6.51-6.52 is explained.
- Can shoulder strength be rated separately?
- Not by AMA4 Table 34. Clause 6.67 prohibits that method. A true nerve injury must use the permitted peripheral nerve method.
- Is shoulder WPI the same as threshold injury?
- No. Threshold classification asks what kind of injury exists. WPI measures permanent impairment under Part 6.