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Oregon WCD Form 4842: Shoulder Range of Motion

Oregon examiners use this one-page WCD form to report shoulder impairment at closing and other impairment-focused exams under Bulletin 239. It records active range of motion for both shoulders in six directions: flexion, extension, abduction, adduction, and internal and external rotation. The insurer or the Workers' Compensation Division rates impairment from the measurements, together with strength and other findings in the narrative report.

Who completes it

The examining physician records both shoulders and prints name and title, signs and dates the form. Attending physicians and medical arbiters complete these 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

  • Norms printed on the form are flexion 180, extension 50, abduction 170 to 180, adduction 40 to 50, internal rotation 80 to 90 and external rotation 60 to 90 degrees.
  • Bulletin 239 asks for internal rotation measured with the arm in abduction, and for active, unassisted motion of both shoulders.
  • For shoulder strength loss, identify both the affected muscle and the peripheral nerve and grade strength on the 0 to 5 scale in the report.
  • If the joint is ankylosed, give the plane of motion and the angle of fixation; also note chronic dislocations when present.

Get the official form

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

Shoulder Range of Motion

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

Does Oregon Form 4842 need both shoulders measured?

Yes, unless the opposite shoulder has a history of injury or disease. Bulletin 239 asks for active ranges of motion of both shoulders and requires the examiner to state whether the contralateral joint has such a history, since the uninjured side serves as the comparison.

Is the shoulder rated on the upper extremity form?

No. Oregon's upper extremity form, 2279, covers the humeral head to the fingers but excludes the shoulder joint. Shoulder motion goes on Form 4842, and the elbow, wrist and hand go on Form 2279 when the injury involves both areas.