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