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1DVBCWHT7 ;ALB/RLC HAND, THUMB, FINGERS WKS TEXT ; 31 JULY 2003
2 ;;2.7;AMIE;**81**;FEB 17, 2004
3 ;
4TXT ;
5 ;;A. Review of Medical Records:
6 ;;
7 ;;B. Medical History (Subjective Complaints):
8 ;;
9 ;; Comment on;
10 ;;
11 ;; Are there flair ups of joint disease affecting hand, thumb or fingers?
12 ;; If so:
13 ;; 1. State severity, frequency and duration of flair ups.
14 ;; 2. Name precipitating and alleviating factors.
15 ;; 3. Estimate to what extent, if any, flair ups result in additional
16 ;; limitation of motion or functional impairment. (Per Veteran).
17 ;;
18 ;;C. Physical Examination (Objective Findings):
19 ;;
20 ;; Designate fingers as: thumb, index, long, ring, and little. Provide a detailed
21 ;;assessment of each affected joint. State whether the individual is right
22 ;;or left hand dominant. Use a goniometer for measuring joint angles. Refer to
23 ;;Residuals of Amputations worksheet, if applicable.
24 ;;
25 ;;1. Evaluation of Ankylosis
26 ;;
27 ;;For each anklyosed joint, include angle of anklyosis. Describe any rotation or
28 ;;any angulation of bone.
29 ;;
30 ;;Zero degrees of flexion represents the fingers fully extended, making a
31 ;;straight line with the rest of the hand.
32 ;; The "position of function" of the hand is:
33 ;; Wrist dorsiflexion: 20 to 30 degrees
34 ;; Metacarpophalangeal flexion: 30 degrees
35 ;; Proximal interphalangeal joint flexion: 30 degrees
36 ;; Thumb abduction and rotation: thumb pad faces the finger pads.
37 ;;
38 ;;2. Evaluation of Limitation of Motion of Single or Multiple Digits of the
39 ;; Hand
40 ;;
41 ;;Provide range of motion for each digit of the hand.
42 ;;
43 ;;Normal Ranges of Motion for index, long, ring and little fingers:
44 ;; Metacarpophalangeal joint: zero to 90 degrees of flexion
45 ;; Proximal interphalangeal joint: zero to 100 degrees of flexion
46 ;; Distal (terminal) interphalangeal joint: zero to 70 or 80 degrees of flexion
47 ;;
48 ;;3. Evaluation of Hand as a unit
49 ;;
50 ;;Measure the gap, in inches:
51 ;; Between the tip of the thumb and the fingers
52 ;; Between the tips of the fingers and the proximal transverse crease of the palm
53 ;; Between the thumb pad and the fingers with the thumb attempting to oppose
54 ;; the fingers
55 ;;
56 ;;Describe strength for pushing, pulling and twisting. Describe dexterity for
57 ;;twisting, probing, writing, touching and expression. Comment on whether and
58 ;;how (e.g. decreased range of motion, in degrees) the flexion deformity
59 ;;interferes with the function of the other fingers.
60 ;;
61 ;;4. Additional detailed measurements and consideration of other factors
62 ;; affecting function
63 ;;
64 ;;a. Measure the active and passive range of motion of each affected joint.
65 ;; Include movement against gravity and against strong resistance.
66 ;;b. State whether and to what extent the range of motion (in degrees) or joint
67 ;; function is additionally limited by pain, fatigue, weakness, or lack of
68 ;; endurance following repetitive use. If more than one of these is present,
69 ;; state, if possible, which has the major functional impact. If you cannot
70 ;; provide this information without resort to mere speculation, please discuss.
71 ;; Include rationale for all conclusions.
72 ;;
73 ;;D. Diagnostic and Clinical Tests:
74 ;;
75 ;; Include results of all diagnostic and clinical tests upon which examiner is
76 ;; basing the diagnosis.
77 ;;
78 ;;E. Diagnosis:
79 ;;
80 ;;
81 ;;
82 ;;
83 ;;Signature: Date:
84 ;;END
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