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Routine: DVBCHTF1

DVBCHTF1.m

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DVBCHTF1 ;ALB/RLC HAND, THUMB, FINGERS WKS TEXT ; 16 JAN 2007
 ;;2.7;AMIE;**183**;FEB 17, 2004;Build 8
 ;
TXT ;
 ;;A. Review of Medical Records:
 ;;
 ;;B. Medical History (Subjective Complaints):
 ;;
 ;;   Comment on;
 ;;
 ;;   1.  Date and circumstances of onset, course since onset.
 ;;   2.  History of hospitalizations or surgery (Date and location if known,
 ;;       reason or type of surgery).
 ;;   3.  History of trauma to hands or fingers (type, location, date).
 ;;   4.  History of neoplasm:
 ;;
 ;;       a. date of diagnosis, exact diagnosis.
 ;;       b. Benign or malignant.
 ;;       c. Types and dates of treatment.
 ;;       d. Date of last treatment.
 ;;       e. State if treatment has been completed, and, if not, expected date of
 ;;          completion.
 ;;
 ;;   5.  Treatment-type, dose, frequency, response, and side effects.
 ;;   6.  Indicate dominant hand and how determined.
 ;;   7.  Report current symptoms, including decreased strength or overall
 ;;       decrease in dexterity, pain, locking, stiffness, swelling, etc.
 ;;       Indicate side and digits affected.
 ;;   8.  If there are flare-ups of joint disease affecting hand, thumb or fingers:
 ;;
 ;;       a. State severity, frequency and duration of flare-ups.
 ;;       b. Name precipitating and alleviating factors.
 ;;       c. Estimate to what extent, if any, they result in additional
 ;;          limitation of motion or functional impairment during the flare-up.
 ;;         (Per Veteran).
 ;;
 ;;C. Physical Examination (Objective Findings):
 ;;
 ;;   1.  Digit and joint designations:
 ;;
 ;;       a. Designate fingers as: thumb, index, long, ring, and little.
 ;;       b. Designate joints as DIP (distal interphalangeal), PIP (proximal
 ;;          (interphalangeal), MP (metacarpophalangeal), and CP (carpometacarpal).
 ;;
 ;;   2.  Hand "position of function":
 ;;
 ;;       a. Wrist dorsiflexed 20 to 30 degrees.
 ;;       b. MP and PIP joints flexed to 30 degrees.
 ;;       c. Thumb abducted and rotated so that the thumb pad faces the finger
 ;;          pads.
 ;;
 ;;   3.  Instructions for joint measurement:
 ;;
 ;;       a. Provide a detailed assessment of each joint of each affected digit.
 ;;       b. Use a goniometer for measuring joint angles and range of motion.
 ;;       c. Assess joints on both left and right hands, even if only one hand is
 ;;          affected.
 ;;       d. Refer to Residuals of Amputations worksheet, if applicable.
 ;;
 ;;   4.  Normal range of motion for index, long, ring, and little fingers:
 ;;
 ;;       a. Zero degrees of flexion represents the fingers fully extended, making
 ;;          a straight line with the rest of the hand.
 ;;       b. Metacarpophalangeal joint:  zero to 90 degrees of flexion.
 ;;       c. Proximal interphalangeal joint:  zero to 100 degrees of flexion.
 ;;       d. Distal (terminal) interphalangeal joint:  zero to 70 or 80 degrees
 ;;          of flexion.
 ;;
 ;;   5.  Range of motion (ROM) examination of index, long, ring, and little
 ;;       fingers:
 ;;
 ;;       a. Measure active ROM of DIP, PIP, and MP joints.
 ;;       b. For index and long finger, also report size of gap between fingertip
 ;;          and proximal transverse crease of hand on maximal flexion of finger
 ;;          (none, less than one inch, one inch, etc.).
 ;;       c. State whether there is objective evidence of pain on active ROM.
 ;;       d. Conduct at least 3 repetitions of ROM.
 ;;       e. State whether there is objective evidence of pain after repetitive
 ;;          ROM.
 ;;       f. State whether there is additional (or new) limitation of motion
 ;;          (including whether there is an increased gap between fingertip and
 ;;          hand for index and long fingers) after repetitive ROM.  If there is,
 ;;          report the ROM (and size of gap) and state whether pain, weakness,
 ;;          incoordination, fatigue, or lack of endurance is the most important
 ;;          factor in the decreased ROM.
 ;;       g. If unable to do repetitive motion, so state and provide reason.
 ;;
 ;;   6.  Range of motion (ROM) examination of thumb:
 ;;
 ;;       a. Report size of gap between the thumb pad and the fingers (none, less
 ;;          than one inch, one inch, etc.), with the thumb attempting to oppose
 ;;          the fingers.
 ;;       b. State whether there is objective evidence of pain on attempted
 ;;          opposition of thumb to fingers.
 ;;       c. Conduct at least 3 repetitions of ROM.
 ;;       d. State whether there is objective evidence of pain after repetitive
 ;;          ROM.
 ;;       e. State whether there is additional (or new) limitation of motion after
 ;;          repetitive ROM.  If there is, report the ROM (gap) and state whether
 ;;          pain, weakness, incoordination, fatigue, or lack of endurance is the
 ;;          most important factor in the decreased ROM.
 ;;       f. If unable to do repetitive motion, so state and provide reason.
 ;;
 ;;   7.  Ankylosis examination:
 ;;
 ;;   For each anklyosed joint:
 ;;
 ;;       a. Report angle of anklyosis.
 ;;       b. Describe any rotation or any angulation of either bone at an
 ;;          anklyosed joint.
 ;;       c. State whether the ankylosis interferes with motion of the other
 ;;          digits or with overall hand function.
 ;;       d. For thumb:  Additionally state whether the ankylosed thumb is
 ;;          abducted and rotated so that the thumb pad faces the finger pad.
 ;;          Report size of gap between the thumb pad and the fingers (none, less
 ;;          than one inch, one inch, etc.).
 ;;       e. For index, long, ring, and little fingers:  Additionally report size
 ;;          of gap between the finger and the proximal transverse crease of hand
 ;;          on maximal flexion of finger (none, less than one inch, one inch,
 ;;          etc.).
 ;;
 ;;    8.  If there is deformity of one or more digits, state digit, joint, and
 ;;        type of deformity, including degrees of any angulation.
 ;;
 ;;    9.  Describe any decreased strength for pushing, pulling and twisting.
 ;;        Describe any decreased dexterity for twisting, probing, writing,
 ;;        touching and expression.
 ;;
 ;;D. Diagnostic and Clinical Tests:
 ;;
 ;;   1.  Include results of all diagnostic and clinical tests conducted in
 ;;       the examination report, including X-ray or other imaging studies, as
 ;;       needed.
 ;;
 ;;E. Diagnosis:
 ;;
 ;;   1.  Describe the effects of the condition on usual occupation and daily
 ;;       activities.
 ;;
 ;;
 ;;
 ;;Signature:                                                Date:
 ;;END