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1DVBCWAR1 ;ALB/CMM AMPUTATION, RESIDUALS OF WKS TEXT - 1 ; 6 MARCH 1997
2 ;;2.7;AMIE;**12**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;A. Review of Medical Records:
7 ;;
8 ;;
9 ;;
10 ;;B. Medical History (Subjective Complaints):
11 ;;
12 ;; Comment on:
13 ;; 1. The location of the amputation site.
14 ;;
15 ;;
16 ;; 2. If symptoms exist, describe precipitating factors, aggravating
17 ;; factors, alleviating factors, alleviating medications, frequency,
18 ;; severity, and duration.
19 ;;
20 ;;
21 ;;C. Physical Examination (Objective Findings):
22 ;;
23 ;; Address each of the following and fully describe current findings:
24 ;; 1. Swelling, deformity, tenderness of stump.
25 ;;
26 ;;
27 ;; 2. Skin, including scar.
28 ;;
29 ;;
30 ;; 3. Circulation.
31 ;;
32 ;;
33 ;;
34 ;; 4. Muscles.
35 ;;
36 ;;
37 ;;
38 ;; 5. Describe any limited motion or instability in the joint above
39 ;; the amputation site.
40 ;;
41 ;;
42 ;; 6. A DETAILED ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED.
43 ;;
44 ;; a. Using a goniometer, measure the PASSIVE and ACTIVE range
45 ;; of motion, including movement against gravity and against
46 ;; strong resistance.
47 ;;
48 ;;
49 ;; b. If the joint is painful on motion, state at what point in
50 ;; the range of motion pain begins and ends.
51 ;;
52 ;;
53 ;; c. State to what extent, if any, the range of motion or function
54 ;; is ADDITIONALLY limited by pain, fatigue, weakness, or lack
55 ;; of endurance. If more than one of these is present, state,
56 ;; if possible, which has the major functional impact.
57 ;;
58 ;;
59 ;; 7. Bones.
60 ;;
61 ;;
62 ;; 8. Length of stump.
63 ;;
64 ;;
65 ;; 9. Neuroma, if present.
66 ;;
67 ;;
68 ;; 10. Is amputation of lower extremity improbable by prosthesis
69 ;; controlled by natural knee action?
70 ;;
71 ;;
72 ;;MEASUREMENT OF THE STUMP:
73 ;;
74 ;;The stump of an amputated THIGH will be measured from the perineum, at
75 ;;the origin of the adductor tendons, to the bony end of the stump, with
76 ;;the claimant recumbent and the stump lying parallel with the other lower
77 ;;limb. It is to be kept in mind that if the limb is abducted, flexed,
78 ;;rotated or adducted, its length will be altered. The effective length
79 ;;of a thigh stump is governed by its inside dimension. Measure length
80 ;;of normal thigh if present and indicate whether amputation is in upper,
81 ;;middle, or lower third. When amputation is bilateral, estimate the same
82 ;;for a person of similar height.
83 ;;
84 ;;The stump of an amputated LEG BELOW THE KNEE must be measured from the
85 ;;insertion of the internal hamstring muscles to the bony end of the stump
86 ;;with the patient recumbent and the leg flexed at 90 degrees.
87 ;;
88 ;;The stump of an amputated ARM should be measured from the anterior
89 ;;axillary fold to the bony end of the stump, with the stump hanging
90 ;;parallel to the chest wall. Indicate whether the amputation site is
91 ;;above or below the insertion of the deltoid muscle. A statement of
92 ;;the remaining function is the best indicator of a disability's severity.
93 ;;
94 ;;The stump of an amputated FOREARM should be measured from the insertion
95 ;;of the biceps tendon to the bony end, with the elbow flexed at 90
96 ;;degrees. Indicate if the amputation site is above or below the
97 ;;attachment of the pronator teres.
98 ;;
99 ;;TOF
100 ;;Amputations of FINGERS should be described as through the distal,
101 ;;middle, or proximal phalanx or as disarticulations through the
102 ;;distal interphalangeal, proximal interphalangeal, or
103 ;;metacarpophalangeal joint. Resection of the head of the metacarpal
104 ;;will always be reported if shown. Complete or partial loss or resection
105 ;;of bones of the hand will described in terms of the fraction of each
106 ;;remaining. If surgery has altered the usefulness of remaining or
107 ;;transplanted digits, this will be described.
108 ;;
109 ;;Complete or partial loss of TOES or METATARSAL OR TARSAL BONES should
110 ;;be described as in the subparagraph above. Always report loss of
111 ;;metatarsal head or other defects. Indicate if amputation is through
112 ;;the tarsal-metatarsal joint and if any other portions of the bones of
113 ;;the foot remain.
114 ;;
115 ;;D. Diagnostic and Clinical Tests:
116 ;;
117 ;; 1. X-ray if exact amputation level is not of record.
118 ;; 2. Include results of all diagnostic and clinical tests conducted
119 ;; in the examination report.
120 ;;
121 ;;
122 ;;E. Diagnosis:
123 ;;
124 ;; Amputations must be described in accordance with the following levels:
125 ;; 1. ARM:
126 ;; a. Disarticulation.
127 ;; b. Amputation above insertion of deltoid muscle.
128 ;; c. Amputation below insertion of deltoid muscle.
129 ;;
130 ;;
131 ;; 2. FOREARM:
132 ;; a. Above radial insertion of pronator teres (function is best
133 ;; indicator of disability).
134 ;; b. Below insertion of pronator teres.
135 ;;
136 ;;
137 ;; 3. THIGH:
138 ;; a. Disarticulation, with loss of extrinsic pelvic girdle muscles.
139 ;; b. Amputation of upper, middle or lower third, always measured
140 ;; from perineum to the bony end of the stump with the
141 ;; claimant recumbent and stump lying parallel with the other
142 ;; lower limb.
143 ;; c. State whether this level permits satisfactory prosthesis.
144 ;;
145 ;;
146 ;;TOF
147 ;; 4. LEG:
148 ;; a. Give level of amputation and condition of stump.
149 ;; b. State whether this level permits a satisfactory prosthesis.
150 ;; c. Describe any stump defects (e.g., painful neuroma or
151 ;; circulatory disturbance).
152 ;;
153 ;;
154 ;;Signature: Date:
155 ;;END
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