Impairment, disability, and handicap.

It seems clear that the orthopedic surgeon cannot separate impairment from disability. The measurement of impairment is clouded by the inability to measure dynamic function. A range of motion demonstrated by a patient in the doctor's office does not fully describe the functional potential of either the extremity or the spine. Moreover, the rules by which disability is defined are interpreted with a natural sympathy of the physician's care for the patient. The physician may have less sympathy if the individual being reviewed is a client of an insurance company or of an attorney, compared to being a "private" patient. In the future, the orthopedic surgeon would focus on the musculoskeletal handicap rather than disability, or function rather than impairment. Function must be measured in a dynamic manner. The guidelines for definition of function or dysfunction should be similar to those used in sports medicine regarding the decision as to when the athlete can resume sports. What was the capacity before injury? How close to the normal capacity has medical care restored function? This includes measurements of passage of time and consideration of the desire to return to previous activity. The goal is the development of methods that will accurately measure dynamic musculoskeletal function. Visceral organ systems have biochemical standards of measurement; comparable standards must be devised for the musculoskeletal system.