What should be checked before relying on a WPI figure?
Check maximum medical improvement, the body area, objective findings, the NSW Guideline chapter and any NSW modification before relying on a percentage.
Can this page calculate your percentage?
No. WPI depends on an assessor, maximum medical improvement, objective findings and the NSW Guidelines. This page is general information only.
Permanent impairment assessment
How permanent impairment is assessed for Shoulder, elbow, wrist, hand and upper extremity nerves
Upper limb WPI is not a generic arm-pain rating. The assessment starts by identifying the affected structure - shoulder joint, rotator cuff, elbow tendon, wrist joint, finger, tendon or nerve - and then applying the NSW-modified AMA5 upper extremity method without double counting the same loss.
What injuries can happen to this body part?
- Shoulder rotator cuff, frozen shoulder, impingement, instability, AC joint, clavicle, labral or biceps tendon conditions
- Elbow epicondylitis, fracture, ligament, tendon or nerve conditions
- Wrist, hand, finger, tendon, digital nerve, carpal tunnel and other upper limb nerve conditions
Symptoms and findings that matter
- Which anatomical structure is impaired and whether the diagnosis is stable at MMI
- Reliable active ROM where the method uses motion loss
- Objective nerve, sensory, motor, two-point discrimination or nerve conduction findings where relevant
- Surgery history and whether a NSW-modified table row applies
- Conversion from digit, hand or upper extremity impairment to WPI where required
What investigations are usually relevant?
- Treating specialist report and final impairment assessment at maximum medical improvement
- Imaging, pathology, audiology, ophthalmology, respiratory, nerve or functional testing that fits the body system
- Operative reports, discharge summaries, rehabilitation records and objective clinical measurements where relevant
How WPI is assessed for this body part
- Upper limb WPI is not a generic arm-pain rating. The assessment starts by identifying the affected structure - shoulder joint, rotator cuff, elbow tendon, wrist joint, finger, tendon or nerve - and then applying the NSW-modified AMA5 upper extremity method without double counting the same loss.
- Assessment source: NSW Guidelines Chapter 2 upper extremity, AMA5 Chapter 16 where adopted by NSW, and Chapter 17 for CRPS where applicable.
- The assessor should explain maximum medical improvement, the body-system chapter, the method selected, any NSW modification, and why the objective findings fit that method.
How movement affects the assessment
- Shoulder ROM affects reaching, dressing, washing hair, lifting and overhead work.
- Elbow ROM affects eating, pushing, carrying and tool positioning. Wrist and finger ROM affect grip, typing, writing, buttons and fine motor work.
- ROM must be measured reliably. Inconsistent or pain-limited movement can become a dispute rather than a percentage.
NSW upper extremity assessment rules
Main methodAMA5 Chapter 16 applies to upper extremity WPI, subject to the NSW modifications in Chapter 2 of the SIRA Guidelines.
Stable diagnosisThe impairment must be permanent and stable, with a defined diagnosis confirmed by examination.
ROM reliabilityActive ROM is used for impairment calculation. Passive ROM can help clinical examination, but inconsistent ROM should not be used as a valid parameter.
ConversionUpper extremity impairment is converted to WPI using AMA5 Table 16-3 as adopted by NSW.
No double countingThe same loss should not be counted twice through ROM, nerve, strength, diagnosis-based or surgery methods.
Verified NSW upper limb rows and modifications
Shoulder impingement3% UEI or 2% WPI, only where there are positive provocative tests, no loss of ROM, and symptoms have been present for at least 12 months.
Ruptured long head of biceps3% UEI or 2% WPI where isolated from other rotator cuff pathology. It cannot be combined with rotator cuff impairment or ROM.
Epicondylitis2% UEI or 1% WPI where symptoms have been present for at least 18 months, localised epicondyle tenderness is present, and provocative tests are positive. If ROM loss is also present, use the higher method, not both.
Joint surface fracture fallbackIf a displaced joint-surface fracture has pain with movement and 2 mm or more displacement, but ROM loss is not sufficient to rate, allow 2% UEI or 1% WPI.
Distal clavicle resection arthroplasty, isolatedThe NSW modification changes the AMA5 Table 16-27 figure to 5% UEI.
Proximal clavicle resection arthroplasty, isolatedThe NSW modification changes the AMA5 Table 16-27 figure to 8% UEI.
Sternoclavicular jointThe NSW modification changes the figure to 25% UEI or 15% WPI.
Upper limb nerve and carpal tunnel rules
Sole peripheral nerve injuryIf the upper extremity impairment results solely from a peripheral nerve injury, do not also rate abnormal motion for that same upper extremity.
Peripheral nerve tablesUse AMA5 Table 16-15 together with Tables 16-10 and 16-11 for peripheral nerve lesions, as adopted by NSW.
Clinical judgementThe examiner must choose an appropriate percentage within the severity range. The maximum value is not applied automatically.
Carpal tunnel after surgeryPost-operative carpal tunnel syndrome is assessed in the same way as carpal tunnel without operation.
Grip strength and ROM in CTSWhere carpal tunnel is assessed as a nerve condition, grip loss and loss of ROM are usually not separately rated for CTS itself.
Digital nerve and finger sensory method
Digital nervesEach finger has radial-side and ulnar-side digital nerves. The affected side, finger, and length of sensory loss matter.
Two-point discriminationDigital nerve sensory loss is determined by static two-point discrimination: 6 mm or less is no sensory impairment; 7 mm to less than 15 mm is partial sensory loss; inability below 15 mm is total sensory loss.
Conversion pathDigital impairment is converted to hand impairment, then upper extremity impairment, then WPI using AMA5 Tables 16-1 to 16-3 as adopted.
Example onlyA full-length partial ulnar digital nerve loss in a ring finger is given in the AMA companion example as 10% ring finger impairment, converting to 1% hand, 1% UEI and 1% WPI.
Neuroma example onlyA painful digital neuroma example with 50% sensory deficit of the index radial digital nerve converts to 15% index finger impairment, 3% hand, 3% UEI and 2% WPI.
CRPS upper limb NSW method
No Chapter 18 pain ratingNSW excludes AMA5 Chapter 18. CRPS is not assessed as generic chronic pain.
Rateable diagnosisUse NSW Table 17.1 to decide whether CRPS is a rateable diagnosis and exclude other diagnoses that better explain the signs and symptoms.
CRPS 1 timing and verificationFor CRPS 1, the diagnosis must have been present for at least one year, verified by more than one examining physician, and other possible diagnoses excluded.
Upper limb conversionFor upper limb CRPS, combine eligible loss of motion and sensory/pain or motor components as the NSW method permits, then convert upper extremity impairment to WPI using AMA5 Table 16-3.
Practical WPI examples
- A rotator cuff tear may be assessed by reliable shoulder ROM unless a specific NSW rule or rare strength method is properly justified.
- A carpal tunnel claim should identify residual median nerve impairment rather than separately adding grip loss or wrist ROM for CTS itself.
- A finger digital nerve injury may need two-point discrimination and conversion from digit to hand to UEI to WPI.
Evidence checklist
- A clear diagnosis and the body area being assessed
- Records showing the condition has reached maximum medical improvement, if that is the issue
- Specialist reports, imaging reports and treating notes relied on by the assessor
- Objective findings on examination, not only symptoms described by the injured person
- A work and treatment chronology explaining the injury, treatment, surgery and recovery path
- Any previous injury, degeneration, congenital issue or non-work cause that needs apportionment considered
- Ultrasound or MRI reports, operative notes, hand therapy notes, ROM sheets, sensory testing and nerve conduction studies where relevant
What usually does not increase WPI
- Assuming a scan result automatically gives a WPI percentage
- Confusing pain, disability or inability to work with permanent impairment
- Ignoring maximum medical improvement before arranging an assessment
- Using an AMA5 table without checking whether the NSW Guidelines modify or replace it
- Double counting the same impairment through two methods when the Guidelines require one method
- Using the same generic paragraph for every arm injury
- Double counting ROM, nerve and strength for the same loss
- Using symptoms alone where objective findings are required
Assessment source
Assessment source: Assessment source: NSW Guidelines Chapter 2 upper extremity, AMA5 Chapter 16 where adopted by NSW, and Chapter 17 for CRPS where applicable.
This section is source-backed general information. It is not a WPI assessment and is not legal advice.
- SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment: Source for the NSW assessment framework, MMI, AMA5 adoption, NSW modifications and exclusions.
- SIRA upper extremity chapter: Source for NSW upper extremity assessment rules and AMA5 Chapter 16 adoption/modification points.
Related injury and claim pages
Need a practical claim check?
If an impairment percentage, medical assessment or insurer decision is affecting your NSW injury claim, send the decision or report for a practical review. This is general information only and does not guarantee any result.
Request a free claim checkAssessment scope for Upper Limb WPI Assessment
The assessment scope for Upper Limb WPI Assessment should be stated precisely before any percentage is considered. The file should identify whether that label describes the primary diagnosed condition, a symptom of another injury, a regional overview or one component of a broader impairment. Findings from another body area or diagnosis should not be transferred without explanation. The report should connect the stated condition to the correct NSW Guideline chapter, objective findings, treatment history and any permitted combination or apportionment method. This distinction is particularly important where similar page labels cover different clinical questions.
- Confirm the diagnosis and body area being assessed as Upper Limb
- Separate condition-specific findings from overlapping symptoms or injuries in another body area
- Check that the selected NSW Guideline chapter and method match the condition actually assessed
- Explain any combination, apportionment or exclusion rather than relying on the page label alone
Clinical boundary for this WPI guide
This page is an overview of the whole upper-extremity framework, from shoulder to fingers. It is most useful when several levels are injured or the correct regional method has not yet been identified. The file should map each diagnosis to its anatomical level and distinguish range of motion, nerve loss, amputation and other permitted methods. A more focused shoulder, elbow, wrist, hand or nerve guide should be used once the main impairment is clear.
- Map every accepted diagnosis to the shoulder, elbow, wrist, hand or nerve level
- Check whether findings use movement, neurological, amputation or another method
- Avoid counting the same functional loss at both regional and whole-limb levels
- Use the most specific upper-limb guide once the assessment pathway is known
Start with maximum medical improvement
Permanent impairment should generally be assessed when the condition is stable and unlikely to change substantially in the next year. Treatment, surgery and rehabilitation history may affect whether the timing is appropriate.
Use the NSW Guidelines first
The NSW Guidelines adopt AMA5 in many areas, but NSW modifications prevail. Do not assume an AMA5 table applies without checking the NSW chapter and any public SIRA clarification.
Keep the assessment practical
A useful assessment file separates diagnosis, objective findings, surgery history, work capacity issues, apportionment questions and the body-area method used by the assessor.
Ask about an impairment issueDocuments and records
Injury evidence to organise early
The useful records depend on how the injury happened, when symptoms were recorded and how treatment or work capacity changed.
- Date, location and short description of the injury event
- Medical certificates, reports, scans, treatment records or hospital documents
- Employer, insurer, police, incident or venue records where relevant
- Photos, witness details, dashcam or other supporting material if available
- Income, superannuation, work capacity or leave records where relevant
- Letters, emails, claim numbers and decisions already received
Common questions
Injury evidence questions
Short general answers only. The right next step depends on the facts, dates and documents.
Is WPI the same as being unable to work?
No. WPI is a medical impairment measure. Work capacity, weekly payments, damages, treatment disputes and TPD issues are separate questions, although the evidence may overlap.
Does pain alone create a WPI percentage?
Not by itself. NSW workers compensation excludes AMA5 Chapter 18 on pain. Chronic pain is assessed through the underlying diagnosed condition where the Guidelines permit it.
Can secondary psychological symptoms be added to physical WPI?
In NSW workers compensation, secondary psychiatric or psychological impairment is not assessed as permanent impairment. Primary psychological impairment is assessed separately and is not combined with physical WPI.
Injury pathway enquiry
Not sure which claim type matches the injury?
Start with how the injury happened, what medical records exist and how work or daily activity has changed. The same injury can sit in different pathways.