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1DVBCWHT2 ;ALB/JER HAND, THUMB, FINGERS WKS TEXT ; 31 JULY 2003
2 ;;2.7;AMIE;**58**;JULY 31, 2003
3 ;
4TXT ;
5 ;;A. Review of Medical Records:
6 ;;
7 ;;B. Medical History (Subjective Complaints):
8 ;;Are there flair ups of joint disease affecting hand, thumb or fingers?
9 ;; If so:
10 ;; 1. State severity, frequency and duration of flair ups.
11 ;; 2. Name precipitating and alleviating factors.
12 ;; 3. Estimate to what extent, if any, flair ups result in additional
13 ;; limitation of motion or functional impairment.
14 ;;
15 ;;C. Physical Examination (Objective Findings):
16 ;;Designate fingers as: thumb, index, long, ring, and little. Provide a detailed
17 ;;assessment of each affected joint. State whether the individual is right
18 ;;or left hand dominant. Use a goniometer for measuring joint angles. Refer to
19 ;;Residuals of Amputations worksheet, if applicable.
20 ;;
21 ;; 1. Evaluation of Ankylosis
22 ;;For each anklyosed joint, include angle of anklyosis. Describe any rotation or
23 ;;any angulation of bone.
24 ;;Zero degrees of flexion represents the fingers fully extended, making a
25 ;;straight line with the rest of the hand.
26 ;; The "position of function" of the hand is:
27 ;; Wrist dorsiflexion: 20 to 30 degrees
28 ;; Metacarpophalangeal flexion: 30 degrees
29 ;; Proximal interphalangeal joint flexion: 30 degrees
30 ;; Thumb abduction and rotation: thumb pad faces the finger pads.
31 ;;
32 ;; 2. Evaluation of Limitation of Motion of Single or Multiple Digits of the
33 ;; Hand
34 ;;Provide range of motion for each digit of the hand.
35 ;;Normal Ranges of Motion for wrist, index, long, ring and little fingers:
36 ;; Metacarpophalangeal joint (wrist): zero to 90 degrees of flexion
37 ;; Proximal interphalangeal joint: zero to 100 degrees of flexion
38 ;; Distal (terminal) interphalangeal joint: zero to 70 or 80 degrees of flexion
39 ;;
40 ;; 3. Evaluation of Hand as a unit
41 ;;Measure the gap, in inches:
42 ;; Between the tip of the thumb and the fingers
43 ;; Between the tips of the fingers and the proximal transverse crease of the palm
44 ;; Between the thumb pad and the fingers with the thumb attempting to oppose
45 ;; the fingers
46 ;; Describe strength for pushing, pulling and twisting. Describe dexterity for
47 ;; twisting, probing, writing, touching and expression. Comment on whether and
48 ;; how (e.g. decreased range of motion, in degrees) the flexion deformity
49 ;; interferes with the function of the other fingers.
50 ;;
51 ;; 4. Additional detailed measurements and consideration of other factors
52 ;; affecting function
53 ;;Measure the active and passive range of motion of each affected joint. Include
54 ;;movement against gravity and against strong resistance.
55 ;;State whether and to what extent the range of motion (in degrees) or joint
56 ;;function is additionally limited by pain, fatigue, weakness, or lack of
57 ;;endurance following repetitive use or during flair-ups. If more than one
58 ;;of these is present, state, if possible, which has the major functional
59 ;;impact. Include rationale for conclusions.
60 ;;
61 ;; D. Diagnostic and Clinical Tests:
62 ;;Include results of all diagnostic and clinical tests upon which examiner is
63 ;;basing the diagnosis.
64 ;;
65 ;; E. Diagnosis:
66 ;;
67 ;;
68 ;;
69 ;;
70 ;;Signature: Date:
71 ;;END
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