{"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":"5223.0460","title":"Elbow and forearm permanency rule 5223.0460","status":"published","publishedOn":"2026-08-18","auditDocument":"docs/audits/ppd-rule-5223-0460-attack.md"},"graph":{"part":"5223.0460","slug":"elbow","title":"Elbow and forearm","summary":"Rule 5223.0460 rates the elbow and forearm under exclusive categories (flail elbow at 39 percent, radial head resection, painful organic syndrome including chronic epicondylitis, the radial/median/ulnar entrapment ladders), combinable categories (total elbow arthroplasty at 17 percent, radial head replacement, the instability ladder, lateral deviation, the unratable fracture catch-all), and loss of measured motion under subpart 4. Distinct impairing conditions combine under 5223.0300, subpart 3, item E, and the whole part is capped at the amputation value for the arm at the elbow.","generalAuthority":{"part":"5223.0460","path":"1","quote":"Subpart 1. General. For permanent partial impairment to the elbow and forearm, 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 elbow under part 5223.0540. 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":"75e7dcd3","url":"https://www.revisor.mn.gov/rules/5223.0460/"},"facts":[{"id":"medical.flailElbow","label":"Flail elbow (the joint has no stability)","type":"boolean","evidence":["exam notes documenting a flail joint"]},{"id":"surgical.elbowArthroplasty","label":"Elbow arthroplasty or radial head surgery","type":"enum","options":[{"value":"none","label":"None"},{"value":"total","label":"Total elbow arthroplasty"},{"value":"radial-head-replacement","label":"Radial head replacement (implant)"},{"value":"radial-head-resection","label":"Radial head resection (no implant)"}],"evidence":["operative report"]},{"id":"medical.painfulOrganicSyndrome","label":"Painful organic syndrome (as defined at 5223.0310, subp. 40), including chronic medial or lateral epicondylitis, substantiated by consistent, reproducible clinical findings, with persistent limitation of active motion","type":"boolean","evidence":["exam notes"]},{"id":"medical.passiveRomLimited","label":"Passive range of motion of the elbow is limited","type":"boolean","evidence":["exam notes with passive range of motion measurements"]},{"id":"medical.radialEntrapment","label":"Radial nerve entrapment at the elbow or in the forearm","type":"enum","options":[{"value":"none","label":"No entrapment syndrome claimed"},{"value":"resolved","label":"Resolved with treatment"},{"value":"persistent-no-emg","label":"Pain and paresthesia persist or recur despite treatment, not substantiated by electrodiagnostic testing"},{"value":"persistent-emg","label":"Pain and paresthesia persist despite treatment, substantiated by persistent findings on electrodiagnostic testing"},{"value":"motor-sensory-loss","label":"Objectively demonstrable motor or sensory loss (rated under the nerve tables, 5223.0400 and 5223.0410)"}],"evidence":["EMG/nerve conduction study","exam notes"]},{"id":"medical.medianEntrapment","label":"Median nerve entrapment at the elbow or in the forearm (pronator syndrome)","type":"enum","options":[{"value":"none","label":"No entrapment syndrome claimed"},{"value":"resolved","label":"Resolved with treatment"},{"value":"persistent-no-emg","label":"Pain and paresthesia persist or recur despite treatment, not substantiated by electrodiagnostic testing"},{"value":"persistent-emg","label":"Pain and paresthesia persist despite treatment, substantiated by persistent findings on electrodiagnostic testing"},{"value":"motor-sensory-loss","label":"Objectively demonstrable motor or sensory loss (rated under the nerve tables, 5223.0400 and 5223.0410)"}],"evidence":["EMG/nerve conduction study","exam notes"]},{"id":"medical.ulnarEntrapment","label":"Ulnar nerve entrapment at the elbow or in the forearm (cubital tunnel syndrome)","type":"enum","options":[{"value":"none","label":"No entrapment syndrome claimed"},{"value":"resolved","label":"Resolved with treatment"},{"value":"persistent-no-emg","label":"Pain and paresthesia persist or recur despite treatment, not substantiated by electrodiagnostic testing"},{"value":"persistent-emg","label":"Pain and paresthesia persist despite treatment, substantiated by persistent findings on electrodiagnostic testing"},{"value":"motor-sensory-loss","label":"Objectively demonstrable motor or sensory loss (rated under the nerve tables, 5223.0400 and 5223.0410)"}],"evidence":["EMG/nerve conduction study","exam notes"]},{"id":"medical.elbowInstability","label":"Elbow instability: excessive passive mediolateral motion compared to normal","type":"enum","options":[{"value":"none","label":"No instability"},{"value":"subluxation-intermittent","label":"Subluxation in extension, reduced by flexion: intermittent"},{"value":"subluxation-continuous","label":"Subluxation in extension, reduced by flexion: continuous"},{"value":"dislocation-intermittent","label":"Dislocation: intermittent, or elicited only by examination"},{"value":"dislocation-spontaneous","label":"Dislocation: spontaneous continuous"}],"evidence":["exam notes documenting mediolateral stress testing"]},{"id":"medical.lateralDeviationDegrees","label":"Permanent lateral deviation deformity, in degrees, measured with the elbow in full passive extension (0 means none)","type":"number","unit":"degrees","evidence":["exam notes or x-ray measuring the carrying angle deformity"]},{"id":"medical.unratableElbowFractureOrDislocation","label":"Fracture or dislocation involving the humerus, radius, or ulna not otherwise ratable under this part, 5223.0450, or 5223.0470","type":"boolean","evidence":["x-ray or CT report"]},{"id":"medical.unlistedConditionMotionLossOnly","label":"An elbow or forearm 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":"elbow-flail","role":"base","exclusiveFamily":"elbow-flail","when":{"fact":"medical.flailElbow","op":"eq","value":true}},{"kind":"discrete","endpointId":"elbow-radial-head-resection","role":"base","exclusiveFamily":"elbow-arthroplasty","when":{"fact":"surgical.elbowArthroplasty","op":"eq","value":"radial-head-resection"}},{"kind":"discrete","endpointId":"elbow-radial-head-replacement","role":"base","exclusiveFamily":"elbow-arthroplasty","when":{"fact":"surgical.elbowArthroplasty","op":"eq","value":"radial-head-replacement"}},{"kind":"discrete","endpointId":"elbow-arthroplasty-total","role":"base","exclusiveFamily":"elbow-arthroplasty","when":{"fact":"surgical.elbowArthroplasty","op":"eq","value":"total"}},{"kind":"discrete","endpointId":"elbow-epicondylitis","role":"base","exclusiveFamily":"elbow-pain-syndrome","when":{"all":[{"fact":"medical.painfulOrganicSyndrome","op":"eq","value":true},{"fact":"medical.passiveRomLimited","op":"eq","value":false}]}},{"kind":"discrete","endpointId":"elbow-nerve-entrapment-radial-resolved","role":"base","exclusiveFamily":"elbow-entrapment-radial","when":{"fact":"medical.radialEntrapment","op":"eq","value":"resolved"}},{"kind":"discrete","endpointId":"elbow-nerve-entrapment-radial-symptoms-no-emg","role":"base","exclusiveFamily":"elbow-entrapment-radial","when":{"fact":"medical.radialEntrapment","op":"eq","value":"persistent-no-emg"}},{"kind":"discrete","endpointId":"elbow-nerve-entrapment-radial-persistent","role":"base","exclusiveFamily":"elbow-entrapment-radial","when":{"fact":"medical.radialEntrapment","op":"eq","value":"persistent-emg"}},{"kind":"discrete","endpointId":"elbow-nerve-entrapment-median-resolved","role":"base","exclusiveFamily":"elbow-entrapment-median","when":{"fact":"medical.medianEntrapment","op":"eq","value":"resolved"}},{"kind":"discrete","endpointId":"elbow-nerve-entrapment-median-symptoms-no-emg","role":"base","exclusiveFamily":"elbow-entrapment-median","when":{"fact":"medical.medianEntrapment","op":"eq","value":"persistent-no-emg"}},{"kind":"discrete","endpointId":"elbow-nerve-entrapment-median-persistent","role":"base","exclusiveFamily":"elbow-entrapment-median","when":{"fact":"medical.medianEntrapment","op":"eq","value":"persistent-emg"}},{"kind":"discrete","endpointId":"elbow-nerve-entrapment-resolved","role":"base","exclusiveFamily":"elbow-entrapment-ulnar","when":{"fact":"medical.ulnarEntrapment","op":"eq","value":"resolved"}},{"kind":"discrete","endpointId":"elbow-nerve-entrapment-symptoms-no-emg","role":"base","exclusiveFamily":"elbow-entrapment-ulnar","when":{"fact":"medical.ulnarEntrapment","op":"eq","value":"persistent-no-emg"}},{"kind":"discrete","endpointId":"elbow-ulnar-nerve","role":"base","exclusiveFamily":"elbow-entrapment-ulnar","when":{"fact":"medical.ulnarEntrapment","op":"eq","value":"persistent-emg"}},{"kind":"discrete","endpointId":"elbow-instability-subluxation-intermittent","role":"base","exclusiveFamily":"elbow-instability","when":{"fact":"medical.elbowInstability","op":"eq","value":"subluxation-intermittent"}},{"kind":"discrete","endpointId":"elbow-instability-subluxation-continuous","role":"base","exclusiveFamily":"elbow-instability","when":{"fact":"medical.elbowInstability","op":"eq","value":"subluxation-continuous"}},{"kind":"discrete","endpointId":"elbow-dislocation-intermittent","role":"base","exclusiveFamily":"elbow-instability","when":{"fact":"medical.elbowInstability","op":"eq","value":"dislocation-intermittent"}},{"kind":"discrete","endpointId":"elbow-dislocation-spontaneous","role":"base","exclusiveFamily":"elbow-instability","when":{"fact":"medical.elbowInstability","op":"eq","value":"dislocation-spontaneous"}},{"kind":"discrete","endpointId":"elbow-lateral-deviation-lt30","role":"base","exclusiveFamily":"elbow-lateral-deviation","when":{"all":[{"fact":"medical.lateralDeviationDegrees","op":"gte","value":1},{"fact":"medical.lateralDeviationDegrees","op":"lt","value":30}]}},{"kind":"discrete","endpointId":"elbow-lateral-deviation","role":"base","exclusiveFamily":"elbow-lateral-deviation","when":{"fact":"medical.lateralDeviationDegrees","op":"gte","value":30}},{"kind":"discrete","endpointId":"elbow-other-0","role":"base","exclusiveFamily":"elbow-fracture-other","when":{"fact":"medical.unratableElbowFractureOrDislocation","op":"eq","value":true}},{"kind":"discrete","endpointId":"elbow-unlisted-rom","role":"base","exclusiveFamily":"elbow-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":"5223.0460","to":"5223.0540","note":"Subp. 1: the whole-part total may not exceed the whole-body percent for amputation of the arm at the elbow (R. 5223.0540)."},{"kind":"crossReference","from":"5223.0460","to":"5223.0400","note":"Subp. 2.D(4): entrapment with objectively demonstrable motor loss rates under the upper-extremity motor nerve table of 5223.0400."},{"kind":"crossReference","from":"5223.0460","to":"5223.0410","note":"Subp. 2.D(4): entrapment with objectively demonstrable sensory loss rates under the upper-extremity sensory nerve table of 5223.0410."},{"kind":"crossReference","from":"5223.0460","to":"5223.0450","note":"Subp. 3.D excludes fractures ratable under the shoulder part (proximal humerus fractures rate there)."},{"kind":"crossReference","from":"5223.0460","to":"5223.0470","note":"Subp. 3.D excludes fractures ratable under the wrist part (distal radius and ulna fractures rate there)."}],"examples":[{"id":"elbow-total-arthroplasty","label":"Total elbow arthroplasty, category alone","dateOfInjury":"2024-01-01","facts":{"surgical.elbowArthroplasty":"total"},"expectedTotalPercent":17},{"id":"elbow-flail-joint","label":"Flail elbow, the part maximum short of the amputation cap","dateOfInjury":"2024-01-01","facts":{"medical.flailElbow":true},"expectedTotalPercent":39},{"id":"elbow-cubital-tunnel","label":"Cubital tunnel syndrome persisting despite treatment, substantiated by electrodiagnostic testing","dateOfInjury":"2024-01-01","facts":{"medical.ulnarEntrapment":"persistent-emg"},"expectedTotalPercent":2},{"id":"elbow-instability-plus-deviation","label":"Continuous subluxation (10) combined with a 30 degree lateral deviation (3), distinct conditions","dateOfInjury":"2024-01-01","facts":{"medical.elbowInstability":"subluxation-continuous","medical.lateralDeviationDegrees":30},"expectedTotalPercent":12.7}],"faq":[{"question":"What does chronic tennis elbow (epicondylitis) rate?","answer":"Chronic medial or lateral epicondylitis is expressly named in the painful organic syndrome category: zero percent when passive motion is full. The value of the category is the citation. If passive motion is limited, the condition rates on the measured motion under subpart 4 instead."},{"question":"How is cubital tunnel syndrome rated?","answer":"On the subpart 2.D ladder: zero percent if resolved or unconfirmed by electrodiagnostic testing, two percent for pain and paresthesia persisting despite treatment with persistent EMG findings. Objectively demonstrable motor or sensory loss moves the rating to the upper-extremity nerve tables, 5223.0400 and 5223.0410."},{"question":"Does a radial head resection rate differently from a replacement?","answer":"Both pay five percent, but differently: the resection (subpart 2.B) is exclusive and stands alone, while the replacement (subpart 3.A(2)) is combinable with the measured motion loss. They describe one impairing condition, so only one rates, and a later total elbow arthroplasty (17 percent) subsumes either."},{"question":"What counts as ratable elbow instability?","answer":"Excessive passive mediolateral motion compared to normal: subluxation in extension reduced by flexion pays five percent intermittent or ten percent continuous; dislocation pays six percent when intermittent or elicited only by examination and ten percent when spontaneous and continuous."}],"notes":["Subpart 4 (loss of function) is delegated to the ROM module, including the flexion/extension and pronation/supination arcs.","Flail elbow at 39 percent is the highest category percent in the part; the amputation cap for the arm at the elbow sits above it, so the cap constrains combinations rather than the lone category.","The master dataset carries two endpoint records for the 3.D catch-all ('elbow-fracture' and 'elbow-other-0', same cite, same zero); the graph binds one node for the clause."],"schemaVersion":"1.0.0","snapshotRetrievedOn":"2026-08-02","authorityByEndpoint":{"elbow-flail":[{"part":"5223.0460","path":"2.A","quote":"A. Flail elbow, 39 percent.","textHash":"ba67933a","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-radial-head-resection":[{"part":"5223.0460","path":"2.B","quote":"B. Resection head of radius, five percent.","textHash":"a1a1e25d","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-radial-head-replacement":[{"part":"5223.0460","path":"3.A.2","quote":"(2) radial head, five percent.","textHash":"a8ee459a","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-arthroplasty-total":[{"part":"5223.0460","path":"3.A.1","quote":"(1) total elbow, 17 percent;","textHash":"a0900432","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-epicondylitis":[{"part":"5223.0460","path":"2.C","quote":"C. Painful organic syndrome, as defined in part 5223.0310, subpart 40, including chronic epicondylitis, medial or lateral, not elsewhere specified, and substantiated by appropriate, consistent, and reproducible clinical findings which results in persistent limitation of active range of motion but no limitation of passive range of motion, zero percent.","textHash":"5d6caf82","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-nerve-entrapment-radial-resolved":[{"part":"5223.0460","path":"2.D.1","quote":"(1) resolved with treatment, zero percent;","textHash":"30c38a0f","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-nerve-entrapment-radial-symptoms-no-emg":[{"part":"5223.0460","path":"2.D.2","quote":"(2) pain and paresthesia recurring or persisting despite treatment, but not substantiated by persistent findings on electrodiagnostic testing, zero percent;","textHash":"e043a58d","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-nerve-entrapment-radial-persistent":[{"part":"5223.0460","path":"2.D.3","quote":"(3) pain and paresthesia persisting despite treatment, or recurring and persisting despite treatment and substantiated by persistent findings on electrodiagnostic testing, two percent;","textHash":"fc38b176","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-nerve-entrapment-median-resolved":[{"part":"5223.0460","path":"2.D.1","quote":"(1) resolved with treatment, zero percent;","textHash":"30c38a0f","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-nerve-entrapment-median-symptoms-no-emg":[{"part":"5223.0460","path":"2.D.2","quote":"(2) pain and paresthesia recurring or persisting despite treatment, but not substantiated by persistent findings on electrodiagnostic testing, zero percent;","textHash":"e043a58d","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-nerve-entrapment-median-persistent":[{"part":"5223.0460","path":"2.D.3","quote":"(3) pain and paresthesia persisting despite treatment, or recurring and persisting despite treatment and substantiated by persistent findings on electrodiagnostic testing, two percent;","textHash":"fc38b176","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-nerve-entrapment-resolved":[{"part":"5223.0460","path":"2.D.1","quote":"(1) resolved with treatment, zero percent;","textHash":"30c38a0f","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-nerve-entrapment-symptoms-no-emg":[{"part":"5223.0460","path":"2.D.2","quote":"(2) pain and paresthesia recurring or persisting despite treatment, but not substantiated by persistent findings on electrodiagnostic testing, zero percent;","textHash":"e043a58d","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-ulnar-nerve":[{"part":"5223.0460","path":"2.D.3","quote":"(3) pain and paresthesia persisting despite treatment, or recurring and persisting despite treatment and substantiated by persistent findings on electrodiagnostic testing, two percent;","textHash":"fc38b176","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-instability-subluxation-intermittent":[{"part":"5223.0460","path":"3.B.1.a","quote":"(a) intermittent, five percent;","textHash":"e164429c","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-instability-subluxation-continuous":[{"part":"5223.0460","path":"3.B.1.b","quote":"(b) continuous, ten percent;","textHash":"e30bd30a","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-dislocation-intermittent":[{"part":"5223.0460","path":"3.B.2.a","quote":"(a) intermittent or elicited only by examination, six percent;","textHash":"8dbe276c","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-dislocation-spontaneous":[{"part":"5223.0460","path":"3.B.2.b","quote":"(b) spontaneous continuous, ten percent.","textHash":"bbb8f05e","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-lateral-deviation-lt30":[{"part":"5223.0460","path":"3.C.1","quote":"(1) less than 30 degrees, zero percent;","textHash":"f3935767","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-lateral-deviation":[{"part":"5223.0460","path":"3.C.2","quote":"(2) greater than or equal to 30 degrees, three percent.","textHash":"d0d335a4","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-other-0":[{"part":"5223.0460","path":"3.D","quote":"D. Fracture or dislocation involving humerus, radius, or ulna, not otherwise ratable under subpart 2 or 3 or part 5223.0450 or 5223.0470, zero percent.","textHash":"44cbf24a","url":"https://www.revisor.mn.gov/rules/5223.0460/"}],"elbow-unlisted-rom":[{"part":"5223.0460","path":"1","quote":"Subpart 1. General. For permanent partial impairment to the elbow and forearm, 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 elbow under part 5223.0540. 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":"75e7dcd3","url":"https://www.revisor.mn.gov/rules/5223.0460/"}]},"edges":[{"kind":"lesserIncluded","from":"elbow-radial-head-replacement","to":"elbow-arthroplasty-total"},{"kind":"crossReference","from":"elbow-epicondylitis","to":"5223.0310:40","note":"Term defined at Minn. R. 5223.0310, subp. 40."},{"kind":"crossReference","from":"elbow-other-0","to":"5223.0450"},{"kind":"crossReference","from":"elbow-other-0","to":"5223.0470"},{"kind":"crossReference","from":"elbow-unlisted-rom","to":"5223.0540"},{"kind":"crossReference","from":"elbow-unlisted-rom","to":"5223.0300"},{"kind":"capBy","from":"5223.0460","to":"5223.0540","note":"Subp. 1: the whole-part total may not exceed the whole-body percent for amputation of the arm at the elbow (R. 5223.0540)."},{"kind":"crossReference","from":"5223.0460","to":"5223.0400","note":"Subp. 2.D(4): entrapment with objectively demonstrable motor loss rates under the upper-extremity motor nerve table of 5223.0400."},{"kind":"crossReference","from":"5223.0460","to":"5223.0410","note":"Subp. 2.D(4): entrapment with objectively demonstrable sensory loss rates under the upper-extremity sensory nerve table of 5223.0410."},{"kind":"crossReference","from":"5223.0460","to":"5223.0450","note":"Subp. 3.D excludes fractures ratable under the shoulder part (proximal humerus fractures rate there)."},{"kind":"crossReference","from":"5223.0460","to":"5223.0470","note":"Subp. 3.D excludes fractures ratable under the wrist part (distal radius and ulna fractures rate there)."}]}}