{"disclaimer":"This is my working reading of Minnesota Rule chapter 5223. I keep checking it against the official rule text and published decisions. If a category, percent, or combination looks wrong, email hello@mncompbuddy.com and say what you found. A mismatch is a reason to look again, not a reason to treat this tool or a doctor rating as automatically correct.","manifest":{"part":"5223.0450","title":"Shoulder and upper arm permanency rule 5223.0450","status":"published","publishedOn":"2026-08-18","auditDocument":"docs/audits/ppd-rule-5223-0450-attack.md"},"graph":{"part":"5223.0450","slug":"shoulder","title":"Shoulder and upper arm","summary":"Rule 5223.0450 rates the shoulder and upper arm under exclusive categories (AC separation grades, the dislocation ladder, distal clavicle resection, chronic bicipital tendon rupture, resection arthroplasty at 36 percent, painful organic syndrome), combinable categories (implant arthroplasty at 18 percent, the rotator cuff categories, acromioplasty for dates of injury on or after August 9, 2010, the unratable fracture catch-all), and loss of measured motion under subpart 4. The rotator cuff grammar changed on August 9, 2010: before, the demonstrated tear pays regardless of healing; after, only a tear persisting despite treatment pays. The whole part is capped at the amputation value for the arm at the shoulder.","generalAuthority":{"part":"5223.0450","path":"1","quote":"Subpart 1. General. For permanent partial impairment to the shoulder and upper arm, disability of the whole body is as provided in subparts 2 to 4. The percent of whole body disability under this part may not exceed the percent of whole body disability for amputation of the arm at the shoulder. Each mutually exclusive impairing condition must be rated separately and the ratings must be combined as described in part 5223.0300, subpart 3, item E. If an impairing condition is represented by a category designated as exclusive under subpart 2, it must be rated by that category only and that rating may not be combined with a rating under any other category of this part for that impairing condition. If an impairing condition is represented by a category designated as combinable under subpart 3, it must be rated under that category and under the appropriate categories describing loss of function under subpart 4. The ratings obtained must be combined as described in part 5223.0300, subpart 3, item E. If an impairing condition is not represented by a category designated either exclusive or combinable, it must be rated only under the appropriate categories describing loss of function under subpart 4.","textHash":"97200d0b","url":"https://www.revisor.mn.gov/rules/5223.0450/"},"facts":[{"id":"medical.acSeparationGrade","label":"Acromioclavicular separation, by grade (as defined at 5223.0310, subps. 2 to 4)","type":"enum","options":[{"value":"none","label":"No AC separation"},{"value":"grade1","label":"Grade 1"},{"value":"grade2","label":"Grade 2"},{"value":"grade3","label":"Grade 3"}],"evidence":["x-ray report","exam notes grading the separation"]},{"id":"medical.shoulderDislocation","label":"Anterior or posterior shoulder dislocation, documented by examination, imaging study, or invasive investigation","type":"enum","options":[{"value":"none","label":"No documented dislocation"},{"value":"first-or-infrequent","label":"First episode, or occurring less than three times in six months"},{"value":"recurrent-no-repair","label":"Occurring at least three times in six months, no surgical repair"},{"value":"recurrent-after-repair","label":"Recurring after attempted surgical repair"},{"value":"repaired-no-recurrence","label":"Surgically repaired with no recurrence (rated on measured motion under subpart 4)"}],"evidence":["imaging or reduction records for each episode","operative report"]},{"id":"surgical.distalClavicleResection","label":"Resection of the distal end of the clavicle","type":"boolean","evidence":["operative report"]},{"id":"medical.chronicBicipitalTendonRupture","label":"Chronic bicipital tendon rupture","type":"boolean","evidence":["exam notes or imaging documenting the rupture"]},{"id":"surgical.glenohumeralArthroplasty","label":"Arthroplasty of the glenohumeral joint","type":"enum","options":[{"value":"none","label":"No arthroplasty"},{"value":"implant","label":"Implant arthroplasty (replacement)"},{"value":"resection","label":"Resection arthroplasty (joint surface removed, no implant)"}],"evidence":["operative report"]},{"id":"surgical.acromioplasty","label":"Acromioplasty performed","type":"boolean","evidence":["operative report"]},{"id":"medical.rotatorCuffTearThickness","label":"Rotator cuff tear demonstrated by medical imaging study, by thickness","type":"enum","options":[{"value":"none","label":"No demonstrated tear"},{"value":"partial","label":"Partial thickness"},{"value":"full","label":"Full thickness"}],"evidence":["MRI, ultrasound, or arthrogram report"]},{"id":"medical.rotatorCuffTearPersists","label":"The tear persists despite treatment (false means healed, or surgically repaired with no persistent tear)","type":"boolean","evidence":["post-treatment imaging","operative and follow-up records"]},{"id":"medical.painfulOrganicSyndrome","label":"Painful organic syndrome (as defined at 5223.0310, subp. 40), substantiated by consistent, reproducible clinical or imaging findings, with persistent limitation of active motion","type":"boolean","evidence":["exam notes","imaging reports"]},{"id":"medical.passiveRomLimited","label":"Passive range of motion of the shoulder is limited","type":"boolean","evidence":["exam notes with passive range of motion measurements"]},{"id":"medical.unratableShoulderFractureOrDislocation","label":"Fracture or dislocation involving the scapula, clavicle, or humerus not otherwise ratable under this part or 5223.0460","type":"boolean","evidence":["x-ray or CT report"]},{"id":"medical.unlistedConditionMotionLossOnly","label":"A shoulder condition no category of subparts 2 or 3 represents, rated only on measured loss of motion under subpart 4","type":"boolean","evidence":["diagnosis records","range of motion measurements"]}],"nodes":[{"kind":"discrete","endpointId":"shoulder-ac-separation-1","role":"base","exclusiveFamily":"shoulder-ac","when":{"fact":"medical.acSeparationGrade","op":"eq","value":"grade1"}},{"kind":"discrete","endpointId":"shoulder-ac-separation-2","role":"base","exclusiveFamily":"shoulder-ac","when":{"fact":"medical.acSeparationGrade","op":"eq","value":"grade2"}},{"kind":"discrete","endpointId":"shoulder-ac-separation-3","role":"base","exclusiveFamily":"shoulder-ac","when":{"fact":"medical.acSeparationGrade","op":"eq","value":"grade3"}},{"kind":"discrete","endpointId":"shoulder-dislocation-first","role":"base","exclusiveFamily":"shoulder-dislocation","when":{"fact":"medical.shoulderDislocation","op":"eq","value":"first-or-infrequent"}},{"kind":"discrete","endpointId":"shoulder-dislocation-recurrent","role":"base","exclusiveFamily":"shoulder-dislocation","when":{"fact":"medical.shoulderDislocation","op":"eq","value":"recurrent-no-repair"}},{"kind":"discrete","endpointId":"shoulder-dislocation-recurrent-post-surgery","role":"base","exclusiveFamily":"shoulder-dislocation","when":{"fact":"medical.shoulderDislocation","op":"eq","value":"recurrent-after-repair"}},{"kind":"discrete","endpointId":"shoulder-dislocation-repaired-rom","role":"base","exclusiveFamily":"shoulder-dislocation","when":{"fact":"medical.shoulderDislocation","op":"eq","value":"repaired-no-recurrence"}},{"kind":"discrete","endpointId":"shoulder-distal-clavicle-resection","role":"base","exclusiveFamily":"shoulder-clavicle-resection","when":{"fact":"surgical.distalClavicleResection","op":"eq","value":true}},{"kind":"discrete","endpointId":"shoulder-chronic-bicipital-tendon-rupture","role":"base","exclusiveFamily":"shoulder-biceps","when":{"fact":"medical.chronicBicipitalTendonRupture","op":"eq","value":true}},{"kind":"discrete","endpointId":"shoulder-arthroplasty-resection","role":"base","exclusiveFamily":"shoulder-arthroplasty","when":{"fact":"surgical.glenohumeralArthroplasty","op":"eq","value":"resection"}},{"kind":"discrete","endpointId":"shoulder-arthroplasty-implant","role":"base","exclusiveFamily":"shoulder-arthroplasty","when":{"fact":"surgical.glenohumeralArthroplasty","op":"eq","value":"implant"}},{"kind":"discrete","endpointId":"shoulder-painful-organic-syndrome","role":"base","exclusiveFamily":"shoulder-pain-syndrome","when":{"all":[{"fact":"medical.painfulOrganicSyndrome","op":"eq","value":true},{"fact":"medical.passiveRomLimited","op":"eq","value":false}]}},{"kind":"discrete","endpointId":"shoulder-rotator-cuff-partial-pre2010","role":"base","exclusiveFamily":"shoulder-rotator-cuff","when":{"fact":"medical.rotatorCuffTearThickness","op":"eq","value":"partial"}},{"kind":"discrete","endpointId":"shoulder-rotator-cuff-full-pre2010","role":"base","exclusiveFamily":"shoulder-rotator-cuff","when":{"fact":"medical.rotatorCuffTearThickness","op":"eq","value":"full"}},{"kind":"discrete","endpointId":"shoulder-rotator-cuff-healed-post2010","role":"base","exclusiveFamily":"shoulder-rotator-cuff","when":{"all":[{"fact":"medical.rotatorCuffTearThickness","op":"in","value":["partial","full"]},{"fact":"medical.rotatorCuffTearPersists","op":"eq","value":false}]}},{"kind":"discrete","endpointId":"shoulder-rotator-cuff-partial-post2010","role":"base","exclusiveFamily":"shoulder-rotator-cuff","when":{"all":[{"fact":"medical.rotatorCuffTearThickness","op":"eq","value":"partial"},{"fact":"medical.rotatorCuffTearPersists","op":"eq","value":true}]}},{"kind":"discrete","endpointId":"shoulder-rotator-cuff-full-post2010","role":"base","exclusiveFamily":"shoulder-rotator-cuff","when":{"all":[{"fact":"medical.rotatorCuffTearThickness","op":"eq","value":"full"},{"fact":"medical.rotatorCuffTearPersists","op":"eq","value":true}]}},{"kind":"discrete","endpointId":"shoulder-acromioplasty-post2010","role":"base","exclusiveFamily":"shoulder-acromioplasty","when":{"fact":"surgical.acromioplasty","op":"eq","value":true}},{"kind":"discrete","endpointId":"shoulder-other-0","role":"base","exclusiveFamily":"shoulder-fracture-other","when":{"fact":"medical.unratableShoulderFractureOrDislocation","op":"eq","value":true}},{"kind":"discrete","endpointId":"shoulder-unlisted-rom","role":"base","exclusiveFamily":"shoulder-unlisted-motion-loss","when":{"any":[{"fact":"medical.unlistedConditionMotionLossOnly","op":"eq","value":true},{"all":[{"fact":"medical.painfulOrganicSyndrome","op":"eq","value":true},{"fact":"medical.passiveRomLimited","op":"eq","value":true}]}]}}],"extraEdges":[{"kind":"capBy","from":"5223.0450","to":"5223.0540","note":"Subp. 1: the whole-part total may not exceed the whole-body percent for amputation of the arm at the shoulder (R. 5223.0540)."},{"kind":"crossReference","from":"5223.0450","to":"5223.0460","note":"Subp. 3.C excludes fractures ratable under the elbow part (distal humerus fractures rate there)."}],"examples":[{"id":"shoulder-full-cuff-post2010","label":"Full thickness rotator cuff tear persisting despite treatment, date of injury after the 2010 rewrite","dateOfInjury":"2024-01-01","facts":{"medical.rotatorCuffTearThickness":"full","medical.rotatorCuffTearPersists":true},"expectedTotalPercent":6},{"id":"shoulder-repaired-cuff-post2010","label":"Repaired cuff with no persistent tear: the express 0 of 3.E(1)","dateOfInjury":"2024-01-01","facts":{"medical.rotatorCuffTearThickness":"full","medical.rotatorCuffTearPersists":false},"expectedTotalPercent":0},{"id":"shoulder-full-cuff-pre2010","label":"The same repaired full thickness tear with a 2009 injury still pays 6 under the old 3.A(2)","dateOfInjury":"2009-06-01","facts":{"medical.rotatorCuffTearThickness":"full","medical.rotatorCuffTearPersists":false},"expectedTotalPercent":6},{"id":"shoulder-implant-plus-clavicle","label":"Implant arthroplasty (18); the distal clavicle resection is lesser-included and does not add","dateOfInjury":"2024-01-01","facts":{"surgical.glenohumeralArthroplasty":"implant","surgical.distalClavicleResection":true},"expectedTotalPercent":18},{"id":"shoulder-recurrent-dislocation","label":"Dislocation recurring after attempted surgical repair","dateOfInjury":"2024-01-01","facts":{"medical.shoulderDislocation":"recurrent-after-repair"},"expectedTotalPercent":10}],"faq":[{"question":"What does a rotator cuff tear rate?","answer":"It depends on the date of injury. On or after August 9, 2010: a tear that persists despite treatment pays two percent (partial thickness) or six percent (full thickness), and a healed or successfully repaired tear pays an express zero. Before that date: the tear demonstrated by imaging pays two or six percent whether or not it was repaired. All cuff categories are combinable with the measured motion loss."},{"question":"My rotator cuff surgery was successful. Why would the rating be zero?","answer":"For dates of injury on or after August 9, 2010, subpart 3.E(1) expressly rates a healed or surgically repaired tear with no persistent tear at zero percent. Any lasting loss of motion still rates under subpart 4 and is combined with the zero."},{"question":"How are shoulder dislocations rated?","answer":"A first episode (or fewer than three in six months) is three percent. Dislocations recurring at least three times in six months without repair, or recurring after an attempted repair, are ten percent. A dislocation repaired surgically with no recurrence is rated only on the measured motion under subpart 4."},{"question":"What is the difference between the two shoulder replacement categories?","answer":"An implant arthroplasty (a replacement) is 18 percent, combinable with the measured motion loss. A resection arthroplasty, where the joint surface is removed without an implant, is 36 percent exclusive: it stands alone. They describe one impairing condition, so only one rates."},{"question":"Does an acromioplasty change the rating?","answer":"For dates of injury on or after August 9, 2010, acromioplasty is an express zero percent combinable category, so it anchors the measured motion rating without adding a percent of its own. Before that date the rule had no acromioplasty category and the surgery is rated on motion alone."}],"notes":["Subpart 4 (loss of function) is delegated to the ROM module across the shoulder arcs.","The August 9, 2010 amendment did two things here: it added the acromioplasty category (3.D) and rewrote the rotator cuff grammar from \"the demonstrated tear pays\" (3.A) to \"only a persisting tear pays\" (3.E). The graph carries both eras; the date of injury selects between them.","Grade definitions for AC separation live at 5223.0310, subparts 2 to 4, and are recorded as definition cross-references on the ladder nodes."],"schemaVersion":"1.0.0","snapshotRetrievedOn":"2026-08-02","authorityByEndpoint":{"shoulder-ac-separation-1":[{"part":"5223.0450","path":"2.A.1","quote":"(1) grade 1, as defined in part 5223.0310, subpart 2, zero percent;","textHash":"1e81bec5","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-ac-separation-2":[{"part":"5223.0450","path":"2.A.2","quote":"(2) grade 2, as defined in part 5223.0310, subpart 3, one percent;","textHash":"05d2d758","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-ac-separation-3":[{"part":"5223.0450","path":"2.A.3","quote":"(3) grade 3, as defined in part 5223.0310, subpart 4, three percent.","textHash":"6b97629c","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-dislocation-first":[{"part":"5223.0450","path":"2.B.1","quote":"(1) first episode or occurring less than three times in six months, three percent;","textHash":"a9333bab","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-dislocation-recurrent":[{"part":"5223.0450","path":"2.B.2","quote":"(2) occurring at least three times in six months, no surgical repair, ten percent;","textHash":"20ccc0af","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-dislocation-recurrent-post-surgery":[{"part":"5223.0450","path":"2.B.3","quote":"(3) recurring after attempted surgical repair, ten percent;","textHash":"eba49de2","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-dislocation-repaired-rom":[{"part":"5223.0450","path":"2.B.4","quote":"(4) if repaired surgically and there is no recurrence after surgical repair, the rating is as provided under subpart 4.","textHash":"7ccd6f61","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-distal-clavicle-resection":[{"part":"5223.0450","path":"2.C","quote":"C. Resection distal end of clavicle, three percent.","textHash":"c9b689ed","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-chronic-bicipital-tendon-rupture":[{"part":"5223.0450","path":"2.D","quote":"D. Chronic bicipital tendon rupture, one percent.","textHash":"f1d1d00a","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-arthroplasty-resection":[{"part":"5223.0450","path":"2.E","quote":"E. Resection arthroplasty of the glenohumeral joint, 36 percent.","textHash":"e598ec62","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-arthroplasty-implant":[{"part":"5223.0450","path":"3.B","quote":"B. Implant arthroplasty of the glenohumeral joint, 18 percent.","textHash":"6843eaee","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-painful-organic-syndrome":[{"part":"5223.0450","path":"2.F","quote":"F. Painful organic syndrome, as defined in part 5223.0310, subpart 40, not elsewhere specified and substantiated by appropriate, consistent, and reproducible clinical or medical imaging findings which results in persistent limitation of active range of motion but no limitation of passive range of motion, zero percent.","textHash":"3eb0858c","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-rotator-cuff-partial-pre2010":[{"part":"5223.0450","path":"3.A.1","quote":"(1) partial thickness, two percent;","textHash":"14766cd2","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-rotator-cuff-full-pre2010":[{"part":"5223.0450","path":"3.A.2","quote":"(2) full thickness, six percent.","textHash":"f94f624c","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-rotator-cuff-healed-post2010":[{"part":"5223.0450","path":"3.E.1","quote":"(1) healed or surgically repaired with no persistent tear, zero percent;","textHash":"33c36d06","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-rotator-cuff-partial-post2010":[{"part":"5223.0450","path":"3.E.2","quote":"(2) partial thickness tear which persists despite treatment, two percent;","textHash":"4edb2e87","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-rotator-cuff-full-post2010":[{"part":"5223.0450","path":"3.E.3","quote":"(3) full thickness tear which persists despite treatment, six percent.","textHash":"7bdef7c1","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-acromioplasty-post2010":[{"part":"5223.0450","path":"3.D","quote":"D. For dates of injury on or after August 9, 2010, acromioplasty, zero percent.","textHash":"ddc463c6","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-other-0":[{"part":"5223.0450","path":"3.C","quote":"C. Fracture or dislocation involving scapula, clavicle, humerus, not otherwise ratable under subpart 2 or 3, or part 5223.0460, zero percent.","textHash":"300ad095","url":"https://www.revisor.mn.gov/rules/5223.0450/"}],"shoulder-unlisted-rom":[{"part":"5223.0450","path":"1","quote":"Subpart 1. General. For permanent partial impairment to the shoulder and upper arm, disability of the whole body is as provided in subparts 2 to 4. The percent of whole body disability under this part may not exceed the percent of whole body disability for amputation of the arm at the shoulder. Each mutually exclusive impairing condition must be rated separately and the ratings must be combined as described in part 5223.0300, subpart 3, item E. If an impairing condition is represented by a category designated as exclusive under subpart 2, it must be rated by that category only and that rating may not be combined with a rating under any other category of this part for that impairing condition. If an impairing condition is represented by a category designated as combinable under subpart 3, it must be rated under that category and under the appropriate categories describing loss of function under subpart 4. The ratings obtained must be combined as described in part 5223.0300, subpart 3, item E. If an impairing condition is not represented by a category designated either exclusive or combinable, it must be rated only under the appropriate categories describing loss of function under subpart 4.","textHash":"97200d0b","url":"https://www.revisor.mn.gov/rules/5223.0450/"}]},"edges":[{"kind":"crossReference","from":"shoulder-ac-separation-1","to":"5223.0310:2","note":"Term defined at Minn. R. 5223.0310, subp. 2."},{"kind":"crossReference","from":"shoulder-ac-separation-2","to":"5223.0310:3","note":"Term defined at Minn. R. 5223.0310, subp. 3."},{"kind":"crossReference","from":"shoulder-ac-separation-3","to":"5223.0310:4","note":"Term defined at Minn. R. 5223.0310, subp. 4."},{"kind":"lesserIncluded","from":"shoulder-distal-clavicle-resection","to":"shoulder-arthroplasty-implant"},{"kind":"lesserIncluded","from":"shoulder-distal-clavicle-resection","to":"shoulder-arthroplasty-resection"},{"kind":"lesserIncluded","from":"shoulder-arthroplasty-implant","to":"shoulder-arthroplasty-resection"},{"kind":"crossReference","from":"shoulder-painful-organic-syndrome","to":"5223.0310:40","note":"Term defined at Minn. R. 5223.0310, subp. 40."},{"kind":"crossReference","from":"shoulder-other-0","to":"5223.0460"},{"kind":"crossReference","from":"shoulder-unlisted-rom","to":"5223.0300"},{"kind":"capBy","from":"5223.0450","to":"5223.0540","note":"Subp. 1: the whole-part total may not exceed the whole-body percent for amputation of the arm at the shoulder (R. 5223.0540)."},{"kind":"crossReference","from":"5223.0450","to":"5223.0460","note":"Subp. 3.C excludes fractures ratable under the elbow part (distal humerus fractures rate there)."}]}}