85 lines
3.4 KiB
Mathematica
85 lines
3.4 KiB
Mathematica
DVBCWHT7 ;ALB/RLC HAND, THUMB, FINGERS WKS TEXT ; 31 JULY 2003
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;;2.7;AMIE;**81**;FEB 17, 2004
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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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;;B. Medical History (Subjective Complaints):
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;;
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;; Comment on;
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;;
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;; Are there flair ups of joint disease affecting hand, thumb or fingers?
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;; If so:
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;; 1. State severity, frequency and duration of flair ups.
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;; 2. Name precipitating and alleviating factors.
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;; 3. Estimate to what extent, if any, flair ups result in additional
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;; limitation of motion or functional impairment. (Per Veteran).
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;;
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;;C. Physical Examination (Objective Findings):
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;;
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;; Designate fingers as: thumb, index, long, ring, and little. Provide a detailed
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;;assessment of each affected joint. State whether the individual is right
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;;or left hand dominant. Use a goniometer for measuring joint angles. Refer to
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;;Residuals of Amputations worksheet, if applicable.
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;;
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;;1. Evaluation of Ankylosis
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;;
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;;For each anklyosed joint, include angle of anklyosis. Describe any rotation or
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;;any angulation of bone.
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;;
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;;Zero degrees of flexion represents the fingers fully extended, making a
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;;straight line with the rest of the hand.
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;; The "position of function" of the hand is:
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;; Wrist dorsiflexion: 20 to 30 degrees
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;; Metacarpophalangeal flexion: 30 degrees
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;; Proximal interphalangeal joint flexion: 30 degrees
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;; Thumb abduction and rotation: thumb pad faces the finger pads.
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;;
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;;2. Evaluation of Limitation of Motion of Single or Multiple Digits of the
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;; Hand
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;;
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;;Provide range of motion for each digit of the hand.
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;;
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;;Normal Ranges of Motion for index, long, ring and little fingers:
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;; Metacarpophalangeal joint: zero to 90 degrees of flexion
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;; Proximal interphalangeal joint: zero to 100 degrees of flexion
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;; Distal (terminal) interphalangeal joint: zero to 70 or 80 degrees of flexion
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;;
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;;3. Evaluation of Hand as a unit
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;;
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;;Measure the gap, in inches:
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;; Between the tip of the thumb and the fingers
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;; Between the tips of the fingers and the proximal transverse crease of the palm
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;; Between the thumb pad and the fingers with the thumb attempting to oppose
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;; the fingers
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;;
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;;Describe strength for pushing, pulling and twisting. Describe dexterity for
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;;twisting, probing, writing, touching and expression. Comment on whether and
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;;how (e.g. decreased range of motion, in degrees) the flexion deformity
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;;interferes with the function of the other fingers.
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;;
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;;4. Additional detailed measurements and consideration of other factors
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;; affecting function
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;;
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;;a. Measure the active and passive range of motion of each affected joint.
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;; Include movement against gravity and against strong resistance.
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;;b. State whether and to what extent the range of motion (in degrees) or joint
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;; function is additionally limited by pain, fatigue, weakness, or lack of
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;; endurance following repetitive use. If more than one of these is present,
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;; state, if possible, which has the major functional impact. If you cannot
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;; provide this information without resort to mere speculation, please discuss.
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;; Include rationale for all conclusions.
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;;
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;;D. Diagnostic and Clinical Tests:
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;;
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;; Include results of all diagnostic and clinical tests upon which examiner is
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;; basing the diagnosis.
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;;
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;;E. Diagnosis:
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;;
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;;
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;;
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;;
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;;Signature: Date:
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;;END
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