156 lines
5.5 KiB
Mathematica
156 lines
5.5 KiB
Mathematica
DVBCWAR1 ;ALB/CMM AMPUTATION, RESIDUALS OF WKS TEXT - 1 ; 6 MARCH 1997
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;;2.7;AMIE;**12**;Apr 10, 1995
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;
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TXT ;
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;;A. Review of Medical Records:
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;;
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;;
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;;
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;;B. Medical History (Subjective Complaints):
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;;
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;; Comment on:
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;; 1. The location of the amputation site.
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;;
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;;
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;; 2. If symptoms exist, describe precipitating factors, aggravating
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;; factors, alleviating factors, alleviating medications, frequency,
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;; severity, and duration.
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;;
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;;
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;;C. Physical Examination (Objective Findings):
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;;
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;; Address each of the following and fully describe current findings:
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;; 1. Swelling, deformity, tenderness of stump.
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;;
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;;
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;; 2. Skin, including scar.
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;;
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;;
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;; 3. Circulation.
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;;
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;;
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;;
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;; 4. Muscles.
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;;
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;;
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;;
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;; 5. Describe any limited motion or instability in the joint above
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;; the amputation site.
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;;
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;;
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;; 6. A DETAILED ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED.
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;;
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;; a. Using a goniometer, measure the PASSIVE and ACTIVE range
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;; of motion, including movement against gravity and against
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;; strong resistance.
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;;
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;;
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;; b. If the joint is painful on motion, state at what point in
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;; the range of motion pain begins and ends.
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;;
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;;
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;; c. State to what extent, if any, the range of motion or function
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;; is ADDITIONALLY limited by pain, fatigue, weakness, or lack
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;; of endurance. If more than one of these is present, state,
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;; if possible, which has the major functional impact.
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;;
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;;
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;; 7. Bones.
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;;
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;;
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;; 8. Length of stump.
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;;
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;;
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;; 9. Neuroma, if present.
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;;
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;;
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;; 10. Is amputation of lower extremity improbable by prosthesis
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;; controlled by natural knee action?
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;;
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;;
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;;MEASUREMENT OF THE STUMP:
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;;
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;;The stump of an amputated THIGH will be measured from the perineum, at
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;;the origin of the adductor tendons, to the bony end of the stump, with
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;;the claimant recumbent and the stump lying parallel with the other lower
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;;limb. It is to be kept in mind that if the limb is abducted, flexed,
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;;rotated or adducted, its length will be altered. The effective length
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;;of a thigh stump is governed by its inside dimension. Measure length
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;;of normal thigh if present and indicate whether amputation is in upper,
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;;middle, or lower third. When amputation is bilateral, estimate the same
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;;for a person of similar height.
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;;
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;;The stump of an amputated LEG BELOW THE KNEE must be measured from the
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;;insertion of the internal hamstring muscles to the bony end of the stump
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;;with the patient recumbent and the leg flexed at 90 degrees.
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;;
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;;The stump of an amputated ARM should be measured from the anterior
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;;axillary fold to the bony end of the stump, with the stump hanging
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;;parallel to the chest wall. Indicate whether the amputation site is
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;;above or below the insertion of the deltoid muscle. A statement of
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;;the remaining function is the best indicator of a disability's severity.
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;;
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;;The stump of an amputated FOREARM should be measured from the insertion
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;;of the biceps tendon to the bony end, with the elbow flexed at 90
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;;degrees. Indicate if the amputation site is above or below the
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;;attachment of the pronator teres.
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;;
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;;TOF
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;;Amputations of FINGERS should be described as through the distal,
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;;middle, or proximal phalanx or as disarticulations through the
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;;distal interphalangeal, proximal interphalangeal, or
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;;metacarpophalangeal joint. Resection of the head of the metacarpal
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;;will always be reported if shown. Complete or partial loss or resection
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;;of bones of the hand will described in terms of the fraction of each
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;;remaining. If surgery has altered the usefulness of remaining or
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;;transplanted digits, this will be described.
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;;
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;;Complete or partial loss of TOES or METATARSAL OR TARSAL BONES should
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;;be described as in the subparagraph above. Always report loss of
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;;metatarsal head or other defects. Indicate if amputation is through
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;;the tarsal-metatarsal joint and if any other portions of the bones of
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;;the foot remain.
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;;
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;;D. Diagnostic and Clinical Tests:
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;;
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;; 1. X-ray if exact amputation level is not of record.
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;; 2. Include results of all diagnostic and clinical tests conducted
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;; in the examination report.
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;;
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;;
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;;E. Diagnosis:
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;;
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;; Amputations must be described in accordance with the following levels:
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;; 1. ARM:
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;; a. Disarticulation.
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;; b. Amputation above insertion of deltoid muscle.
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;; c. Amputation below insertion of deltoid muscle.
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;;
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;;
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;; 2. FOREARM:
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;; a. Above radial insertion of pronator teres (function is best
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;; indicator of disability).
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;; b. Below insertion of pronator teres.
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;;
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;;
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;; 3. THIGH:
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;; a. Disarticulation, with loss of extrinsic pelvic girdle muscles.
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;; b. Amputation of upper, middle or lower third, always measured
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;; from perineum to the bony end of the stump with the
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;; claimant recumbent and stump lying parallel with the other
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;; lower limb.
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;; c. State whether this level permits satisfactory prosthesis.
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;;
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;;
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;;TOF
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;; 4. LEG:
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;; a. Give level of amputation and condition of stump.
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;; b. State whether this level permits a satisfactory prosthesis.
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;; c. Describe any stump defects (e.g., painful neuroma or
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;; circulatory disturbance).
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;;
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;;
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;;Signature: Date:
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;;END
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