Tendons and Impairment Ratings

20 September 2012 / Impairment Physical Exam / Comments Off on Tendons and Impairment Ratings

The tendon is a tough, fibrous tissue structure that connects muscle to bone. A tendon differs from a ligament, which connects bone to bone.

Injury occurs when a tendon becomes stretched, partially torn, or completely disrupted. Disastrous results can occur when a tendon is completely torn in the knee, heel cord (Achilles tendon), distal bicep, and rotator cuff. Tendon injuries may be diagnosed through a palpable (visible) defect and/or MRI.

Timely diagnosis is essential to prevent shortening of the muscle and optimize surgical outcome. Significant disability and impairment can result if diagnosis is delayed. Concern over a complete tendon rupture should prompt urgent consultation with an orthopedist.


  • Tendon injuries may range from minor strains to complete disruption.
  • Delay in diagnosis may result in significant disability and impairment, especially in the knee, heel, spinal cord, distal bicep, or rotator cuff.
  • Prompt referral for imaging and consultation with an orthopedist is necessary to determine extent of injury and to prevent further damage.

Rating Comment: The AMA Guides to the Evaluation of Permanent Impairment Fifth Edition provides impairment rating for tendon injuries with regards to weakness and range of motion impairment. AMA Guides do not allow impairment rating for weakness in the presence of a painful condition.

The AMA Guides 5th Edition instruct on page 531 section 17.2e, “Individuals whose performance is inhibited by pain or fear of pain are not good candidates for manual muscle testing, and other evaluation methods should be considered for them.”

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