Listing 1.23 deals with severe fractures in any major bones of the upper extremity—such as the humerus, radius, or ulna—that do not heal (non-union) or otherwise remain complex (e.g., multiple fragments, complications) despite treatment. The inability to perform fine and gross motor tasks effectively is central to meeting this listing. If the claimant’s arm or hand function is significantly compromised for at least 12 months, they may qualify at Step 3 of the sequential evaluation.
Listing 1.23
1.23 Non-healing or complex fracture of an upper extremity (including the bones of the shoulder, arm, forearm, wrist, or hand) under continuing surgical management, with an inability to perform fine and gross movements effectively, as defined in 1.00C7, and a documented medical need for a one-handed, hand-held assistive device if the other upper extremity is not functional, or an inability to use both upper extremities for work-related activities involving fine and gross movements.
(Source: 20 C.F.R. Part 404, Subpart P, Appendix 1, Listing 1.23. Effective April 2, 2021.)
Key Elements
- Upper-Extremity Fracture
- A non-healing or complex break in shoulder, arm, forearm, wrist, or hand bones.
- Continuing Surgical Management
- Multiple procedures (internal fixation, bone grafts) or complicated healing (infection, hardware displacement) that persist over an extended period.
- Inability to Perform Fine and Gross Movements
- The claimant must show they cannot reliably grasp, handle, reach, lift, or do other routine tasks with the affected upper extremity (or extremities).
- Long-Term Duration
- The condition must last or be projected to last at least 12 months, during which time the upper limb cannot recover meaningful function.
Tips on Proving the Claimant Meets Listing 1.23
- Operative and Imaging Evidence
- Submit X-rays, CT scans, or MRIs demonstrating nonunion, malunion, or complex fracture patterns. Surgeons’ notes should confirm repeated attempts at fixation or grafting that failed to restore stability.
- Orthopedic Follow-Up Records
- Notes from specialists on limited range of motion, atrophy, or pain that undermines dexterity and strength. If there is nerve involvement (e.g., radial nerve palsy), emphasize how that impedes grip or fine manipulation.
- Physical and Occupational Therapy Documentation
- Reports on the claimant’s progress (or lack thereof) in regaining motor skills. Show that standard rehab cannot correct the chronic deficits in fine or gross motor tasks.
- Functional Demonstrations
- Detailed physician statements or standardized tests (e.g., dynamometer readings for grip strength) illustrating how the claimant cannot handle objects, write, use utensils, dress independently, or lift routine weights with the injured arm.
- Assistive Device Necessity
- If the claimant needs a one-handed, hand-held assistive device—like a cane or crutch—for balance, and the other arm is compromised, that further proves severe upper-limb dysfunction.
- Alternatively, if both upper extremities are too impaired for fine/gross movements, that meets a separate criterion under this listing.
- Consistent 12-Month Record
- Ensure the treatment history spans at least a year, documenting how the fracture hasn’t healed and continues to block effective limb use.
Listing 1.23 applies to non-healing or complex upper-extremity fractures that require ongoing surgical management and lead to marked difficulty performing fine and gross motor functions. Combining imaging, operative notes, physical therapy reports, and functional tests are crucial for a Social Security Disability lawyer to establish listing-level severity at Step 3.