DVBCWHT7 ;ALB/RLC HAND, THUMB, FINGERS WKS TEXT ; 31 JULY 2003
 ;;2.7;AMIE;**81**;FEB 17, 2004
 ;
TXT ;
 ;;A. Review of Medical Records:
 ;;
 ;;B. Medical History (Subjective Complaints):
 ;;
 ;;   Comment on;
 ;;
 ;;   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. (Per Veteran).
 ;;
 ;;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 index, long, ring and little fingers:
 ;;  Metacarpophalangeal joint: 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
 ;;
 ;;a. Measure the active and passive range of motion of each affected joint.
 ;;      Include movement against gravity and against strong resistance.
 ;;b. 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. If more than one of these is present, 
 ;;   state, if possible, which has the major functional impact. If you cannot 
 ;;   provide this information without resort to mere speculation, please discuss.
 ;;   Include rationale for all 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