265The impairments assessed for each region in each upper extremity are combined (that is, hand, wrist, elbow, shoulder).

265     The impairments assessed for each region in each upper extremity are combined (that is, hand, wrist, elbow, shoulder).

266     The WPI rating for one upper extremity may be combined with a WPI rating for the other upper extremity, except in the case of assessments under Table 9.14: Upper extremity function, where the notes appearing prior to Table 9.14 are to be followed.

267     WPI ratings from the following tables may not be combined with a WPI rating under Table 9.14: Upper extremity function if they assess the same condition in the same upper extremity:

a)      tables dealing with abnormal motion of digits:

i)        Table 9.8.1a: Abnormal motion/ankylosis of the thumb – IP and MP joints;

ii)      Table 9.8.1b: Radial abduction/adduction/opposition of the thumb – abnormal motion/ankylosis;

iii)     Table 9.8.1c: Abnormal motion/ankylosis of the fingers – index and middle fingers;

iv)     Table 9.8.1d: Abnormal motion/ankylosis of the fingers – ring and little fingers;

b)      tables dealing with sensory losses in thumb and fingers:

i)        Table 9.8.2a: Sensory losses in the thumb;

ii)      Table 9.8.2b: Sensory losses in the index and middle fingers;

iii)     Table 9.8.2c: Sensory losses in the little finger;

iv)     Table 9.8.2d: Sensory losses in the ring finger;

c)       tables dealing with wrists:

i)        Table 9.9.1a: Wrist flexion/extension;

ii)      Table 9.9.1b: Radial and ulnar deviation of wrist joint;

d)      tables dealing with elbows:

i)        Table 9.10.1a: Elbow – flexion/extension;

ii)      Table 9.10.1b: Pronation and supination of forearm;

e)      tables dealing with shoulders:

i)        Table 9.11.1a: Shoulder – flexion/extension;

ii)      Table 9.11.1b: Shoulder – internal/external rotation;

iii)     Table 9.11.1c: Shoulder – abduction/adduction.

268     If the assessor considers that the impairment is not adequately assessed using one of the tables in , or , and the condition involves objectively demonstrated joint instability, objectively demonstrated arthritis or where the employee has had an arthroplasty, the assessor may consider the effect of the injury on upper extremity function instead and assess the WPI rating using . Table 9.14 cannot be used unless the condition involves objectively demonstrated joint instability or arthritis or the employee has had an arthroplasty.