Overview for NSW injured workers
Start with the dispute, not just the diagnosis
May be relevant when
Benefits to check
Legal help is useful when
How this affects your claim in practice
In a shoulder dislocation claim, the diagnosis is only the starting point. The records should connect emergency reduction and imaging records and MRI or CT identifying Bankart, Hill-Sachs, labral or bony injury with the worker's practical limits, including overhead reach, forceful pulling, climbing, manual handling and work at height and whether recurrence risk makes proposed duties unsafe. If the insurer disputes whether later instability is linked to the work event, the response should address that reason directly.
Assessment source
- NSW Guidelines for the Evaluation of Permanent Impairment, paras 1.8-1.12: NSW Guidelines control the assessment method and AMA5 is used only where adopted and not modified.
- NSW Guidelines para 1.12: AMA5 Chapter 18 pain is excluded; chronic pain is assessed through the underlying diagnosed condition, while CRPS is assessed under the relevant NSW method.
- NSW Guidelines para 1.15: assessment should usually wait until maximum medical improvement, meaning the condition is stable and unlikely to change substantially in the next year.
- NSW Guidelines para 1.24: the effect on activities of daily living must not be used to increase or reduce an upper-extremity impairment calculated under the applicable upper-limb method.
- NSW Guidelines paras 1.26 and 2.8: values are rounded at each conversion stage; digit impairment converts to hand impairment, hand and other regional values convert to upper-extremity impairment, and AMA5 Table 16-3 converts upper-extremity impairment to WPI.
- NSW Guidelines paras 2.5 and 2.20: active movement is measured with a goniometer or inclinometer, passive movement is recorded for clinical comparison only, unreliable readings should be repeated, and the uninjured opposite limb may provide the worker's normal baseline.
- NSW Guidelines paras 2.8-2.13: values within one joint are added, same-limb regional values must be expressed in a common unit before combination, a deficit caused solely by a peripheral nerve lesion is not also rated as abnormal movement, and strength is used only in rare permitted cases.
- NSW Guidelines paras 2.14-2.20 modify the shoulder, biceps, impingement, joint-surface fracture and epicondylitis methods in AMA5 Chapter 16; para 2.21 directs upper-limb CRPS to the NSW Chapter 17 method rather than an AMA5 Chapter 16 or Chapter 18 pain rating.
- NSW Guidelines para 2.4: maximum upper extremity impairment is 60% WPI, equivalent to amputation through the shoulder.
What injuries or conditions may be assessed?
Instability can follow anterior, posterior or multidirectional dislocation and may involve a Bankart lesion, Hill-Sachs defect, capsular injury, axillary nerve injury or recurrent subluxation.
- The assessor distinguishes measured movement loss from a diagnosis-based instability value. Arthroplasty impairment cannot also be combined with instability, subluxation or dislocation of the same joint.
- Shoulder symptoms should also be separated from cervical radiculopathy and a named peripheral nerve lesion.
Symptoms and findings that matter
For shoulder dislocation, flexion means lifting the arm forward and overhead; extension means reaching backwards; abduction means lifting sideways; and adduction means bringing the arm towards the body.
When shoulder dislocation affects rotation, external rotation can limit reaching behind the head or washing hair, while internal rotation can limit reaching behind the back or dressing. These examples explain function, not an extra percentage.
The NSW examination for shoulder dislocation measures internal and external rotation with the arm abducted to 90 degrees and the elbow flexed to 90 degrees, or at the worker's maximum symmetrical abduction if 90 degrees is not possible.
Only repeatable active shoulder movement is converted for shoulder dislocation. Passive movement, imaging, pain and daily activities provide clinical context but cannot replace the prescribed calculation.
What investigations are usually relevant
Investigations for shoulder dislocation may include repeat active flexion, extension, abduction, adduction, internal rotation and external rotation measurements and ultrasound or MRI identifying cuff, labral, biceps or joint pathology and whether it matches the examination. Each result should answer a defined clinical question and be read with the examination, diagnosis and history.
- Operation reports for repair, stabilisation, tenodesis, clavicle resection or arthroplasty and follow-up imaging where relevant.
- Physiotherapy records showing whether movement has stabilised and whether the measurements are consistent over time.
How WPI is assessed for this body part
For shoulder dislocation, the assessor first identifies whether repeatable active shoulder movement or a specific diagnosis-based NSW rule best describes the accepted impairment. Surgery or an MRI label does not select a percentage by itself.
Flexion, extension, abduction, adduction, internal rotation and external rotation values for shoulder dislocation are added within the shoulder before the upper-extremity result is converted through AMA5 Table 16-3.
If shoulder dislocation includes a named nerve lesion, movement caused solely by that lesion is not rated again. Sensory and motor nerve findings instead follow the applicable named-nerve method.
Strength is only a rare alternative in a pain-free shoulder dislocation assessment where reduced movement does not adequately reflect the deficit; it is not added to duplicate pain or movement loss.
Reaching, dressing and washing-hair examples help describe shoulder dislocation, but NSW paragraph 1.24 prevents an activities-of-daily-living adjustment to the calculated upper-extremity result.
Table and value examples
Maximum upper extremity impairment
60% WPIThis is the upper extremity maximum, not the expected rating for ordinary shoulder, elbow, wrist or hand claims.
Source: NSW Guidelines para 2.4
Worked assessment illustrations
These examples paraphrase the assessment reasoning in the source material. They explain method only and are not predicted outcomes.
Illustration 1
Shoulder dislocation: reduced shoulder movement in several planes
Assumed facts: Assume a shoulder remains measurably restricted after instability treatment and the movement component is assessed separately from any permitted diagnosis-based instability method. At maximum medical improvement, repeat active measurements record 156 degrees flexion, 20 degrees extension, 140 degrees abduction, 40 degrees adduction, 50 degrees external rotation and 40 degrees internal rotation.
Method: For this shoulder dislocation illustration, Using the corresponding AMA5 shoulder-motion figures, the assumed losses contribute 1%, 2%, 2%, 0%, 1% and 3% upper-extremity impairment. Values for the same shoulder joint are added: 1 + 2 + 2 + 0 + 1 + 3 = 9% upper-extremity impairment.
Illustrative outcome: This shows how the relevant shoulder dislocation findings move through the upper-limb conversion process. AMA5 Table 16-3 converts 9% upper-extremity impairment to 5% WPI. NSW paragraph 1.24 does not permit an extra uplift or reduction for activities of daily living. This paraphrased illustration is not an estimate for any individual claim.
Source: NSW Guidelines paras 1.24, 1.26, 2.5, 2.8 and 2.14; AMA5 Figures 16-40 to 16-46 and Table 16-3
What usually does not increase WPI
Pain, tenderness, weakness complaints or an imaging label without a stable measurable impairment.
Passive movement loss used as though it were active movement impairment.
Grip or other strength loss used to duplicate pain, restricted movement, deformity or nerve loss.
An activities-of-daily-living adjustment added to or subtracted from the calculated upper-extremity value.
The same functional loss counted once under a nerve method and again as restricted movement.
Evidence checklist
The records for shoulder dislocation should include the accepted injury description and any dispute notice identifying the body part and diagnosis and repeat active range-of-motion measurements and opposite-side comparison where appropriate. They are most useful when the diagnosis, examination and practical restrictions are consistent.
- Imaging, operative reports and treatment records for the actual tendon, joint, fracture or arthroplasty condition.
- Sensory mapping, motor testing, static two-point discrimination or electrodiagnostic evidence where a nerve lesion is alleged.
- Work-duties and therapy records explaining the practical movement or nerve function affected.
How this injury commonly happens at work
Work-related shoulder dislocation can arise through a fall onto an outstretched arm and forceful traction or collision. The chronology should identify the actual task or event and when symptoms or function changed.
Work-related shoulder dislocation can arise through a sudden overhead event causing anterior or posterior dislocation and recurrent instability following an accepted traumatic dislocation. The chronology should record the actual task or event and the point at which symptoms or function changed.
Common insurer disputes
For shoulder dislocation, an insurer may dispute whether later instability is linked to the work event and whether recurrent episodes are true dislocations or pain-related giving way. The written decision should be answered with evidence directed to those reasons.
Further disputes about shoulder dislocation may concern whether movement or diagnosis-based instability is the proper method and whether axillary nerve injury is separately supported. The decision notice should identify which issue is relied on and the evidence said to support it.
Treatment and surgery issues
Depending on the diagnosis and treating opinion, management of shoulder dislocation may involve immobilisation, physiotherapy or stabilisation surgery where supported and rehabilitation addressing confidence, movement and safe load handling. The request should explain the expected functional benefit and its connection to the accepted injury.
Weekly payments and work capacity
Capacity evidence for shoulder dislocation should address overhead reach, forceful pulling, climbing, manual handling and work at height and whether recurrence risk makes proposed duties unsafe. Proposed duties must be sustainable for the proposed hours, not merely possible once.
How NSW Work Injury Claim can help
For shoulder dislocation, a claim review can help to separate diagnosis, work exposure and capacity evidence and test suitable duties against actual hand, wrist, elbow or shoulder demands. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
For shoulder dislocation, a claim review can help to review treatment denial reasons and IME assumptions and plan WPI or dispute steps where appropriate. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
Common questions about shoulder dislocation claims
How can work cause or aggravate shoulder dislocation?
For shoulder dislocation, the relevant work history may include a fall onto an outstretched arm, forceful traction or collision, and a sudden overhead event causing anterior or posterior dislocation. A claim still depends on the actual chronology and medical evidence. The records should identify what changed, when symptoms began or worsened, and how the diagnosed condition affects the worker's duties.
How is WPI assessed for shoulder dislocation?
For shoulder dislocation, the assessor first identifies whether repeatable active shoulder movement or a specific diagnosis-based NSW rule best describes the accepted impairment. Surgery or an MRI label does not select a percentage by itself. For shoulder dislocation, flexion means lifting the arm forward and overhead; extension means reaching backwards; abduction means lifting sideways; and adduction means bringing the arm towards the body. The assessor must apply the NSW Guidelines to the accepted, stable condition; the diagnosis or an operation does not by itself determine a percentage.
Which records are most useful for a shoulder dislocation assessment?
A shoulder dislocation assessment commonly needs the accepted injury description and any dispute notice identifying the body part and diagnosis, repeat active range-of-motion measurements and opposite-side comparison where appropriate, imaging, operative reports and treatment records for the actual tendon, joint, fracture or arthroplasty condition, and sensory mapping, motor testing, static two-point discrimination or electrodiagnostic evidence where a nerve lesion is alleged. Those records are most useful when they describe the same diagnosis, examination findings, treatment history and practical work restrictions.
What does an insurer commonly dispute about shoulder dislocation?
For shoulder dislocation, common issues include whether later instability is linked to the work event, whether recurrent episodes are true dislocations or pain-related giving way, and whether movement or diagnosis-based instability is the proper method. The response should address the insurer's stated reason with the relevant chronology, clinical findings, investigations and duties evidence rather than relying on the diagnosis alone.
How can shoulder dislocation affect weekly payments and suitable duties?
Capacity evidence for shoulder dislocation may need to address overhead reach, forceful pulling, climbing, manual handling and work at height and whether recurrence risk makes proposed duties unsafe. A certificate should describe what the worker can do safely and sustainably. Proposed duties should then be checked against those restrictions and the real demands of the job.
What does not establish WPI for shoulder dislocation by itself?
For shoulder dislocation, pain, tenderness, weakness complaints or an imaging label without a stable measurable impairment. WPI depends on the accepted injury, objective findings and the method required by the NSW Guidelines after the condition has stabilised.
Request a calm claim position review
If you have received an insurer decision or you are unsure how your injury evidence fits together, we can help you identify the issue, organise the documents and consider the next step. Where ILARS funding is approved, eligible legal costs and necessary disbursements may be covered.