General comment for items 104 to 115
Hands are cosmetically and functionally the most important part of the upper limbs.
Comment about appropriate level of ISV for items 104 to 115
• The appropriate ISV for loss of a hand is only a little less than the appropriate ISV for the loss of the relevant arm
• An ISV at or near the top of the range will generally be appropriate if the injury is to the dominant hand.
Total or effective loss of both hands
A serious injury causing extensive damage to both hands making them little more than useless
• The level of residual capacity left in either hand
• Severity of any phantom pains if there has been an amputation or amputations
• An ISV at or near the bottom of the range will be appropriate if both hands remain attached to the forearms and are of some cosmetic importance
• An ISV at or near the top of the range will be appropriate if both hands are amputated through the wrist.
Serious injury to both hands
The injury will involve significant loss of function in both hands, for example, loss of 50% or more of the use of each hand.
Total or effective loss of 1 hand
• A crushed hand that has been surgically amputated or rendered functionally useless
• Traumatic amputation of all fingers and most of the palm
Severity of any phantom pain if there has been an amputation
• An ISV at or near the bottom of the range will be appropriate if there has been an amputation of the fingers at the metacarpophalangeal joints, but the thumb remains, and there is whole person impairment for the injury of 32%
(a) there has been amputation of the dominant hand at the wrist; and
(b) there is residual severe pain in the stump and ongoing complications, for example, chronic regional pain syndrome or neuroma formation.
Amputation of the thumb or part of the thumb
• The level of amputation, for example, at carpo metacarpal (CMC) joint, through the distal third of the thumb metacarpal, at the metacarpophalangeal (MCP) joint or thumb interphalangeal (IP) joint
• Whether the injury is to the dominant hand
• The extent of any damage to the fingers
(a) there has been an amputation through the interphalangeal joint of the thumb; and
(b) there is whole person impairment for the injury of 11%.
• An ISV at or near the middle of the range will be appropriate if there has been an amputation through the proximal phalanx
(a) there has been an amputation at the base of the thumb at the carpometacarpal (CMC) joint level of the dominant hand; and
(b) there are ongoing debilitating complications.
Amputation of index, middle and ring fingers, or any 2 of them
The amputation will cause complete loss or nearly complete loss of 2 or all of the following fingers of the hand:
• index finger
• middle finger
• ring finger
• little finger
The level of the amputation, for example, whether the hand has been made to be of very little use and any remaining grip is very weak
• An ISV at or near the bottom of the range will be appropriate if 2 fingers, whether index, middle or ring fingers, are amputated at the level of the proximal interphalangeal joints
• An ISV at or near the middle of the range will be appropriate if there is whole person impairment for the injury of 19%
(a) the index, middle and ring fingers are amputated at the level of the metacarpophalangeal joint (MCP joint) or there is whole person impairment for the injury of at least 27%; and
(b) the injury is to the dominant hand.
Amputation of individual fingers
• Whether the amputation was of the index or middle finger
• The level of the amputation
• Any damage to other fingers short of amputation
• An ISV at or near the top of the range will be applicable if there is complete loss of the index or middle finger of the dominant hand, and serious impairment of the remaining fingers causing whole person impairment of at least 15%
• An ISV of not more than 10 will be applicable if—
(a) there has been an amputation of the index or middle finger at the proximal interphalangeal joint (PIP joint); or
(b) there is whole person impairment for the injury of 8%.
• An ISV at or near the bottom of the range will be applicable if—
(a) there has been an amputation at the level of the distal interphalangeal joint of the little or ring finger; or
(b) there is whole person impairment for the injury of 3%.
Amputation of thumb and all fingers
As the injury will cause effective loss of the hand, see item 106.
Any other injury to 1 or more of the fingers or the thumb
Comment about appropriate level of ISV for items under 111
An ISV of not more than 5 will be appropriate if substantial function of the hand remains.
Examples of factors affecting ISV
• Whether the injury is to the thumb, or index or middle finger
• Any damage to other fingers
• Whether the injury is to the dominant hand
111.1
Extreme injury to 1 or more of the fingers or the thumb
Total loss of function of 1 or more of the fingers, with the joints ankylosed in non‑functional positions
• An ISV at or near the bottom of the range will be appropriate if there is whole person impairment for the injury of 14%
• An ISV at or near the top of the range will be appropriate if there is an injury to the thumb of the dominant hand causing total loss of function of the thumb
111.2
Serious injury to 1 or more of the fingers or the thumb
• A severe crush injury causing ankylosis of the fingers
• A bursting wound, or an injury causing severe finger damage, causing residual scarring and dysfunction
• An injury leaving a digit that interferes with the remaining function of the hand
• Division of 1 or more of the long flexor tendons of the finger, with unsuccessful repair
111.3
Moderate injury to 1 or more of the fingers or the thumb
There will be permanent discomfort, pain or sensitive scarring
• Moderate injury to the thumb or index finger causing loss of movement or dexterity
• A crush injury causing multiple fractures of 2 or more fingers
• Division of 1 or more of the long flexor tendons of the finger, with moderately successful repair
An ISV under this item will be appropriate if there is whole person impairment for the injury of 8% and the injury is to the dominant hand.
111.4
Minor injury to 1 or more of the fingers or the thumb
An uncomplicated fracture or soft tissue injury that has healed with minimal residual symptoms
• An ISV at or near the bottom of the range will be appropriate if there is a straight forward fracture of 1 or more of the fingers, with complete resolution within a short time
• An ISV at or near the top of the range will be appropriate if there has been—
(a) a fracture causing minor angular or rotational malunion of the thumb, or index or middle finger, of the dominant hand; or
(b) some adherence of a tendon following surgical repair, limiting full function of the digit
Extreme hand injury
• The injury will involve a severe traumatic injury to the hand that may include amputation of part of the hand, causing gross impairment of the hand
• A hand injury causing whole person impairment for the injury of 35% will generally fall within this item
• An injury reducing a hand's capacity to 50% or less
• An injury involving the amputation of several fingers that are re‑joined to the hand leaving it clawed, clumsy and unsightly
• An amputation of some fingers and part of the palm causing grossly reduced grip and dexterity and gross disfigurement
• An ISV at or near the bottom of the range will be appropriate if the injured hand has some residual usefulness for performing activities of daily living
• An ISV at or near the top of the range will be appropriate if the injured hand—
(a) has little or no residual usefulness for performing activities of daily living; and
(b) is the dominant hand
Serious hand injury
• A severe crush injury causing significantly impaired function despite surgery
• Serious permanent tendon damage
• Serious nerve damage
An ISV at or near the top of the range will be appropriate if there is whole person impairment for the injury of 20%
Moderate hand injury
• A crush injury, penetrating wound or deep laceration, requiring surgery
• Moderately serious tendon or nerve damage
• A hand injury causing whole person impairment for the injury of between 5% and 12%
Minor hand injury
A soft tissue injury, minor fracture or an injury that does not require surgery, with nearly full recovery of hand function