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1DVBCWJW3 ;ALB/CMM JOINTS WKS TEXT - 1 ; 6 MARCH 1997
2 ;;2.7;AMIE;**63**;FEB 17, 2004
3 ;
4 ;
5TXT ;
6 ;;A. Review of Medical Records:
7 ;;
8 ;;
9 ;;
10 ;;B. Medical History (Subjective Complaints):
11 ;;
12 ;; Comment on:
13 ;;
14 ;; 1. Pain, weakness, stiffness, swelling, heat and redness,
15 ;; instability or giving way, "locking," fatigability, lack of
16 ;; endurance, etc.
17 ;; 2. Treatment - type, dose, frequency, response, side effects.
18 ;; 3. If there are periods of flare-up of joint disease:
19 ;;
20 ;; a. State their severity, frequency, and duration.
21 ;; b. Name the precipitating and alleviating factors.
22 ;; c. State to what extent, if any, they result in additional
23 ;; limitation of motion or functional impairment during the
24 ;; flare-up.
25 ;;
26 ;; 4. Describe whether crutches, brace, cane, corrective shoes, etc.,
27 ;; are needed.
28 ;; 5. Describe details of any surgery or injury.
29 ;; 6. Describe any episodes of dislocation or recurrent subluxation.
30 ;; 7. For inflammatory arthritis, describe any constitutional symptoms.
31 ;; 8. Describe the effects of the condition on the veteran's usual
32 ;; occupation and daily activities.
33 ;; 9. Dominance of extremity and means used to identify dominant extremity
34 ;; 10. If there is a prosthesis, provide date of prosthetic implant
35 ;; and describe any complaint of pain, weakness, or limitation of
36 ;; motion. State whether crutches, brace, etc., are needed.
37 ;;
38 ;;
39 ;;C. Physical Examination (Objective Findings):
40 ;;
41 ;; Address each of the following as appropriate to the condition
42 ;; being examined and fully describe current findings: A DETAILED
43 ;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED, INCLUDING JOINTS
44 ;; WITH PROSTHESES.
45 ;;
46 ;; 1. Using a goniometer, measure the PASSIVE and ACTIVE range of
47 ;; motion, including movement against gravity and against strong
48 ;; resistance. Provide range of motion in degrees.
49 ;; 2. If the joint is painful on motion, state at what point in the
50 ;; range of motion pain begins and ends.
51 ;; 3. State to what extent (if any) and in which degrees (if possible)
52 ;; the range of motion or joint function is ADDITIONALLY LIMITED
53 ;; by pain, fatigue, weakness, or lack of endurance following
54 ;; repetitive use. If more than one of these is present, state,
55 ;; if possible, which has the major functional impact.
56 ;; 4. Describe objective evidence of painful motion, edema, effusion,
57 ;; instability, weakness, tenderness, redness, heat, abnormal
58 ;; movement, guarding of movement, etc.
59 ;; 5. For weight bearing joints (hip, knee, ankle), describe gait
60 ;; and functional limitations on standing and walking. Describe
61 ;; any callosities, breakdown, or unusual shoe wear pattern that
62 ;; would indicate abnormal weight bearing.
63 ;; 6. If ankylosis is present, describe the position of the bones of
64 ;; the joint in relationship to one another (in degrees of flexion,
65 ;; external rotation, etc.), and state whether the ankylosis is
66 ;; stable and pain free.
67 ;; 7. If indicated, measure the leg length from the anterior superior
68 ;; iliac spine to the medial malleolus.
69 ;; 8. For INFLAMMATORY ARTHRITIS, describe any constitutional signs.
70 ;; 9. Describe range of motion with prosthesis in same detail as
71 ;; described above for non-prosthetic joints.
72 ;;
73 ;;
74 ;;D. Normal Range of Motion: All joint Range of Motion measurements
75 ;;must be made using a goniometer. Show each measured range of motion
76 ;;separately rather than as a continuum. For example, if the veteran
77 ;;lacks 10 degrees of full knee extension and has normal flexion, show
78 ;;the range of motion as extension to minus 10 degrees (or lacks 10
79 ;;degrees of extension) and flexion 0 to 140 degrees.
80 ;;
81 ;; 1. Hip range of motion: (Movement of femur as it rotates in the
82 ;; acetabulum.)
83 ;;
84 ;; a. Normal range of motion, using the anatomical position as
85 ;; zero degrees.
86 ;;
87 ;; Flexion = 0 to 125 degrees (To gain a true picture of hip
88 ;; flexion, i.e., movement between the pelvis and femur in
89 ;; the hip joint, the opposite thigh should be extended to
90 ;; minimize motion between the pelvis and spine.)
91 ;;
92 ;; Extension = 0 to 30 degrees.
93 ;;
94 ;; Adduction = 0 to 25 degrees.
95 ;;
96 ;; Abduction = 0 to 45 degrees.
97 ;;
98 ;; External rotation = 0 to 60 degrees.
99 ;;
100 ;; Internal rotation = 0 to 40 degrees.
101 ;;
102 ;;
103 ;;
104 ;; 2. Knee range of motion:
105 ;;
106 ;; a. Normal range of motion, using the anatomical position as
107 ;; zero degrees.
108 ;;
109 ;; Flexion = 0 to 140 degrees.
110 ;;
111 ;; Extension - zero degrees = full extension. Show loss of
112 ;; extension by describing the degrees in which extension is
113 ;; not possible. (e.g., Show range of motion as extension to
114 ;; minus 10 degrees and flexion 0 to 140 degrees when full
115 ;; extension is limited by 10 degrees and full flexion is
116 ;; possible.)
117 ;;
118 ;; b. Stability.
119 ;;
120 ;; Medial and Lateral Collateral Ligaments: Varus/valgus in
121 ;; neutral and in 30 degrees of flexion - normal is no motion.
122 ;;
123 ;; Anterior and Posterior Cruciate Ligaments: Anterior/posterior
124 ;; in 30 degrees of flexion with foot stabilized - normal is
125 ;; less than 5 mm. of motion (1/4 inch - Lachman's test) or in
126 ;; 90 degrees of flexion with foot stabilized - normal is less
127 ;; than 5mm. of motion (1/4 inch - anterior and posterior drawer
128 ;; test).
129 ;;
130 ;; Medial and Lateral Meniscus: Perform McMurray's test.
131 ;;
132 ;;
133 ;; 3. Ankle range of motion:
134 ;;
135 ;; a. Neutral position is with foot at 90 degrees to ankle.
136 ;; From that position, dorsiflexion is 0 to 20 degrees;
137 ;; plantar flexion is 0 to 45 degrees.
138 ;; b. Describe any varus or valgus angulation of the os calcis
139 ;; in relationship to the long axis of the tibia and fibula.
140 ;;
141 ;;
142 ;; 4. Shoulder, elbow, forearm, and wrist range of motion:
143 ;;
144 ;; a. Normal range of motion is measured with zero degrees the
145 ;; anatomical position except for 2 situations:
146 ;;
147 ;; i. Supination and pronation of the forearm is measured
148 ;; with the arm against the body, the elbow flexed to 90
149 ;; degrees, and the forearm in mid position (zero degrees)
150 ;; between supination and pronation.
151 ;; ii. Shoulder rotation is measured with the arm abducted
152 ;; to 90 degrees, the elbow flexed to 90 degrees, and
153 ;; the forearm reflecting the midpoint (zero degrees)
154 ;; between internal and external rotation of the shoulder.
155 ;;
156 ;;
157 ;; b. Shoulder forward flexion = zero to 180 degrees.
158 ;; c. Shoulder abduction = zero to 180 degrees.
159 ;; d. Shoulder external rotation = zero to 90 degrees.
160 ;; e. Shoulder internal rotation = zero to 90 degrees.
161 ;; f. Elbow flexion = zero to 145 degrees.
162 ;; g. Forearm supination = zero to 85 degrees.
163 ;; h. Forearm pronation = zero to 80 degrees.
164 ;; i. Wrist dorsiflexion (extension) = zero to 70 degrees.
165 ;; j. Wrist palmar flexion = zero to 80 degrees.
166 ;; k. Wrist radial deviation = zero to 20 degrees.
167 ;; l. Wrist ulnar deviation = zero to 45 degrees.
168 ;;
169 ;;
170 ;;E. Diagnostic and Clinical Tests:
171 ;;
172 ;; 1. As indicated: X-rays, including special views or weight
173 ;; bearing films, MRI, arthrogram, diagnostic arthroscopy.
174 ;; NOTE: The diagnosis of degenerative arthritis or post-traumatic
175 ;; arthritis of a joint requires X-ray confirmation. Once the diagnosis
176 ;; has been confirmed in a joint, further X-rays of that joint are not
177 ;; required.
178 ;; 2. Include results of all diagnostic and clinical tests in the examination
179 ;; report.
180 ;;
181 ;;
182 ;;
183 ;;F. Diagnosis:
184 ;;
185 ;;
186 ;;Signature: Date:
187 ;;END
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