source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWAR1.m@ 1132

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