source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWHT9.m@ 1169

DVBCWHT9 ;ALB/RLC HAND, THUMB, FINGERS WKS TEXT ; 16 JAN 2007
 ;;2.7;AMIE;**120**;FEB 17, 2004;Build 4
 ;
TXT ;
 ;;A. Review of Medical Records:
 ;;
 ;;B. Medical History (Subjective Complaints):
 ;;
 ;;   Comment on;
 ;;
 ;;   1.  History of hospitalizations or surgery (Date and location if known,
 ;;       reason or type of surgery).
 ;;   2.  History of trauma to hands or fingers.
 ;;   3.  History of neoplasm:
 ;;
 ;;       a. Date of diagnosis, diagnosis.
 ;;       b. Benign or malignant.
 ;;       c. Types and dates of treatment.
 ;;       d. Date of last treatment.
 ;;
 ;;   4.  Treatment-type, dose, frequency, response, and side effects.
 ;;   5.  Dominant hand and how determined.
 ;;   6.  Current symptoms-any decreased strength or dexterity.
 ;;   7.  Effects on occupational functioning and activities of daily living.
 ;;   8.  Are there flare-ups of joint disease affecting hand, thumb or fingers?
 ;;       If so:
 ;;
 ;;          a.  State severity, frequency and duration of flare-ups.
 ;;          b.  Name precipitating and alleviating factors.
 ;;          c.  Estimate to what extent, if any, flare-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 range of motion of each affected joint.
 ;;      b. Measure the range of motion of each affected joint after at least
 ;;         three repetitive motions.  State whether and to what extent the
 ;;         range of motion (in degrees) 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.  Include rationale for all
 ;;         conclusions.  If unable to do repetitive motions, so state and
 ;;         provide reason.
 ;;
 ;;D. Diagnostic and Clinical Tests:
 ;;
 ;;   1.  Include results of all diagnostic and clinical tests conducted in
 ;;       the examination report.
 ;;
 ;;E. Diagnosis:
 ;;
 ;;
 ;;
 ;;Signature:                                                Date:
 ;;END