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Oregon WCD Form 2279: Upper Extremity ROM and Sensation

For most Oregon upper extremity injuries, Bulletin 239 asks examiners to complete this two-page WCD form with the closing examination report. Side one records active range of motion for the elbow, forearm, wrist, thumb and fingers on both hands, plus rotational deformity or lateral deviation. Side two records the level of any thumb or finger amputation and grades palmar sensation by two-point discrimination.

Who completes it

The examining physician completes both sides and prints name and title, signs and dates side one. Attending physicians and medical arbiters perform these closing and impairment exams in Oregon.

Submitting and payment

How to submit it
Return the form with the closing or impairment exam report to the insurer or self-insured employer.
Who pays
The insurer pays the lesser of the billed amount or the OAR 436-009-0040 physician fee schedule amount, and the worker cannot be billed for an accepted claim.

Good to know

  • Report the contralateral joint too unless it has a history of injury or disease, and say in the report whether such a history exists.
  • The upper extremity runs from the humeral head to the fingers but excludes the shoulder joint, which has its own Form 4842.
  • Sensation grades follow two-point discrimination: grade 1 normal at 6 mm or less, grade 2 at 7 to 10 mm, grade 3 protective at 11 to 15 mm, grade 4 over 15 mm.
  • For amputations, mark the most proximal level on the illustrations; for reattached digits, note any loss of overall length instead.

Get the official form

Download the current version from the source each time; forms change without notice.

Upper Extremity Range of Motion Deformity/Deviation Amputation and Sensation

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What norms are on Oregon Form 2279?

Examples printed on the form include elbow flexion 150 degrees, pronation and supination 80 degrees, wrist dorsiflexion 60 and palmar flexion 70 degrees, radial deviation 20 and ulnar deviation 30 degrees, finger MP 0 to 90, PIP 0 to 100 and DIP 0 to 70 degrees.

Are goniometer measurements required on Form 2279?

Yes. Bulletin 239 requires goniometric measurements for range of motion in all body parts other than the spine, which uses an inclinometer. Record active motion with full worker effort, unassisted by the examiner, in degrees from the neutral zero position.