DVBCWHT2 ;ALB/JER HAND, THUMB, FINGERS WKS TEXT ; 31 JULY 2003
 ;;2.7;AMIE;**58**;JULY 31, 2003
 ;
TXT ;
 ;;A. Review of Medical Records:
 ;;
 ;;B. Medical History (Subjective Complaints):
 ;;Are there flair ups of joint disease affecting hand, thumb or fingers?
 ;;   If so:
 ;;     1.  State severity, frequency and duration of flair ups.
 ;;     2.  Name precipitating and alleviating factors.
 ;;     3.  Estimate to what extent, if any, flair ups result in additional 
 ;;         limitation of motion or functional impairment.
 ;;
 ;;C. Physical Examination (Objective Findings):
 ;;Designate fingers as: thumb, index, long, ring, and little.  Provide a detailed 
 ;;assessment of each affected joint. State whether the individual is right 
 ;;or left hand dominant. Use a goniometer for measuring joint angles. Refer to
 ;;Residuals of Amputations worksheet, if applicable.
 ;;
 ;;    1. Evaluation of Ankylosis      
 ;;For each anklyosed joint, include angle of anklyosis. Describe any rotation or 
 ;;any angulation of bone.
 ;;Zero degrees of flexion represents the fingers fully extended, making a  
 ;;straight line with the rest of the hand.
 ;;    The "position of function" of the hand is:
 ;;        Wrist dorsiflexion: 20 to 30 degrees
 ;;        Metacarpophalangeal flexion: 30 degrees 
 ;;        Proximal interphalangeal joint flexion: 30 degrees 
 ;;        Thumb abduction and rotation: thumb pad faces the finger pads.
 ;;
 ;;    2. Evaluation of Limitation of Motion of Single or Multiple Digits of the  
 ;;       Hand
 ;;Provide range of motion for each digit of the hand. 
 ;;Normal Ranges of Motion for wrist, index, long, ring and little fingers:
 ;;  Metacarpophalangeal joint (wrist): zero to 90 degrees of flexion
 ;;  Proximal interphalangeal joint: zero to 100 degrees of flexion
 ;;  Distal (terminal) interphalangeal joint: zero to 70 or 80 degrees of flexion
 ;;
 ;;    3. Evaluation of Hand as a unit 
 ;;Measure the gap, in inches:
 ;; Between the tip of the thumb and the fingers 
 ;; Between the tips of the fingers and the proximal transverse crease of the palm
 ;; Between the thumb pad and the fingers with the thumb attempting to oppose
 ;; the fingers
 ;; Describe strength for pushing, pulling and twisting. Describe dexterity for 
 ;; twisting, probing, writing, touching and expression. Comment on whether and
 ;; how (e.g. decreased range of motion, in degrees) the flexion deformity 
 ;; interferes with the function of the other fingers.
 ;;
 ;;       4. Additional detailed measurements and consideration of other factors
 ;;          affecting function
 ;;Measure the active and passive range of motion of each affected joint. Include
 ;;movement against gravity and against strong resistance.
 ;;State whether and to what extent the range of motion (in degrees) or joint
 ;;function is additionally limited by pain, fatigue, weakness, or lack of 
 ;;endurance following repetitive use or during flair-ups. If more than one 
 ;;of these is present, state, if possible, which has the major functional  
 ;;impact. Include rationale for conclusions.
 ;;
 ;;  D. Diagnostic and Clinical Tests:
 ;;Include results of all diagnostic and clinical tests upon which examiner is
 ;;basing the diagnosis.
 ;;
 ;;  E.  Diagnosis:
 ;;
 ;;
 ;;
 ;;
 ;;Signature:                                                Date:
 ;;END