[613] | 1 | DVBCWHT9 ;ALB/RLC HAND, THUMB, FINGERS WKS TEXT ; 16 JAN 2007
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| 2 | ;;2.7;AMIE;**120**;FEB 17, 2004;Build 4
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| 3 | ;
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| 4 | TXT ;
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| 5 | ;;A. Review of Medical Records:
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| 6 | ;;
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| 7 | ;;B. Medical History (Subjective Complaints):
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| 8 | ;;
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| 9 | ;; Comment on;
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| 10 | ;;
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| 11 | ;; 1. History of hospitalizations or surgery (Date and location if known,
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| 12 | ;; reason or type of surgery).
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| 13 | ;; 2. History of trauma to hands or fingers.
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| 14 | ;; 3. History of neoplasm:
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| 15 | ;;
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| 16 | ;; a. Date of diagnosis, diagnosis.
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| 17 | ;; b. Benign or malignant.
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| 18 | ;; c. Types and dates of treatment.
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| 19 | ;; d. Date of last treatment.
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| 20 | ;;
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| 21 | ;; 4. Treatment-type, dose, frequency, response, and side effects.
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| 22 | ;; 5. Dominant hand and how determined.
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| 23 | ;; 6. Current symptoms-any decreased strength or dexterity.
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| 24 | ;; 7. Effects on occupational functioning and activities of daily living.
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| 25 | ;; 8. Are there flare-ups of joint disease affecting hand, thumb or fingers?
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| 26 | ;; If so:
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| 27 | ;;
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| 28 | ;; a. State severity, frequency and duration of flare-ups.
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| 29 | ;; b. Name precipitating and alleviating factors.
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| 30 | ;; c. Estimate to what extent, if any, flare-ups result in additional
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| 31 | ;; limitation of motion or functional impairment. (Per Veteran).
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| 32 | ;;
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| 33 | ;;C. Physical Examination (Objective Findings):
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| 34 | ;;
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| 35 | ;; Designate fingers as: thumb, index, long, ring, and little. Provide a detailed
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| 36 | ;;assessment of each affected joint. State whether the individual is right
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| 37 | ;;or left hand dominant. Use a goniometer for measuring joint angles. Refer to
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| 38 | ;;Residuals of Amputations worksheet, if applicable.
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| 39 | ;;
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| 40 | ;; 1. Evaluation of Ankylosis
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| 41 | ;;
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| 42 | ;;For each anklyosed joint, include angle of anklyosis. Describe any
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| 43 | ;;rotation or any angulation of bone.
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| 44 | ;;
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| 45 | ;;Zero degrees of flexion represents the fingers fully extended, making
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| 46 | ;;a straight line with the rest of the hand. The "position of function"
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| 47 | ;;of the hand is:
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| 48 | ;;
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| 49 | ;; Wrist dorsiflexion: 20 to 30 degrees
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| 50 | ;; Metacarpophalangeal flexion: 30 degrees
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| 51 | ;; Proximal interphalangeal joint flexion: 30 degrees
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| 52 | ;; Thumb abduction and rotation: thumb pad faces the finger pads.
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| 53 | ;;
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| 54 | ;; 2. Evaluation of Limitation of Motion of Single or Multiple Digits of the
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| 55 | ;; Hand
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| 56 | ;;
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| 57 | ;;Provide range of motion for each digit of the hand.
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| 58 | ;;
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| 59 | ;;Normal Ranges of Motion for index, long, ring and little fingers:
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| 60 | ;;
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| 61 | ;; Metacarpophalangeal joint: zero to 90 degrees of flexion
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| 62 | ;; Proximal interphalangeal joint: zero to 100 degrees of flexion
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| 63 | ;; Distal (terminal) interphalangeal joint: zero to 70 or 80 degrees
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| 64 | ;; of flexion
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| 65 | ;;
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| 66 | ;; 3. Evaluation of Hand as a unit
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| 67 | ;;
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| 68 | ;;Measure the gap, in inches:
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| 69 | ;;
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| 70 | ;; Between the tip of the thumb and the fingers
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| 71 | ;; Between the tips of the fingers and the proximal transverse crease
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| 72 | ;; of the palm
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| 73 | ;; Between the thumb pad and the fingers with the thumb attempting
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| 74 | ;; to oppose the fingers
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| 75 | ;;
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| 76 | ;;Describe strength for pushing, pulling and twisting. Describe dexterity for
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| 77 | ;;twisting, probing, writing, touching and expression. Comment on whether and
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| 78 | ;;how (e.g. decreased range of motion, in degrees) the flexion deformity
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| 79 | ;;interferes with the function of the other fingers.
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| 80 | ;;
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| 81 | ;; 4. Additional detailed measurements and consideration of other factors
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| 82 | ;; affecting function
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| 83 | ;;
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| 84 | ;; a. Measure the active range of motion of each affected joint.
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| 85 | ;; b. Measure the range of motion of each affected joint after at least
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| 86 | ;; three repetitive motions. State whether and to what extent the
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| 87 | ;; range of motion (in degrees) is additionally limited by pain,
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| 88 | ;; fatigue, weakness, or lack of endurance following repetitive use.
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| 89 | ;; If more than one of these is present, state, if possible, which
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| 90 | ;; has the major functional impact. Include rationale for all
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| 91 | ;; conclusions. If unable to do repetitive motions, so state and
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| 92 | ;; provide reason.
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| 93 | ;;
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| 94 | ;;D. Diagnostic and Clinical Tests:
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| 95 | ;;
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| 96 | ;; 1. Include results of all diagnostic and clinical tests conducted in
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| 97 | ;; the examination report.
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| 98 | ;;
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| 99 | ;;E. Diagnosis:
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| 100 | ;;
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| 101 | ;;
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| 102 | ;;
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| 103 | ;;Signature: Date:
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| 104 | ;;END
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