Assessment of impairment and disability has often been based on a subjective history from the patient along with subjective complaints to provocative tests.The physical examination should distinguish between subjective complaints and objective findings.The factors affecting impairment and disability are outlined, and a thorough evaluation of the patient’s medical, work, and social history is reported. A step-by-step process is outlined for impairment assessment, including pain evaluation, medical history, history of the hand injury, job description, and physical examination. The controversial "cumulative trauma disorders" including incidence, definition, epidemiology, diagnosis, media and physicians’ roles, and expense are discussed. The determination of causation should be based on sound epidemiologic evidence. If the opinion is based only on the physician’s personal opinion and not on the literature, it should be stated as such.