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
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCHTF1 6784 printed Apr 09, 2024@20:55:42 Page 2
DVBCHTF1 ;ALB/RLC HAND, THUMB, FINGERS WKS TEXT ; 16 JAN 2007
+1 ;;2.7;AMIE;**183**;FEB 17, 2004;Build 8
+2 ;
TXT ;
+1 ;;A. Review of Medical Records:
+2 ;;
+3 ;;B. Medical History (Subjective Complaints):
+4 ;;
+5 ;; Comment on;
+6 ;;
+7 ;; 1. Date and circumstances of onset, course since onset.
+8 ;; 2. History of hospitalizations or surgery (Date and location if known,
+9 ;; reason or type of surgery).
+10 ;; 3. History of trauma to hands or fingers (type, location, date).
+11 ;; 4. History of neoplasm:
+12 ;;
+13 ;; a. date of diagnosis, exact diagnosis.
+14 ;; b. Benign or malignant.
+15 ;; c. Types and dates of treatment.
+16 ;; d. Date of last treatment.
+17 ;; e. State if treatment has been completed, and, if not, expected date of
+18 ;; completion.
+19 ;;
+20 ;; 5. Treatment-type, dose, frequency, response, and side effects.
+21 ;; 6. Indicate dominant hand and how determined.
+22 ;; 7. Report current symptoms, including decreased strength or overall
+23 ;; decrease in dexterity, pain, locking, stiffness, swelling, etc.
+24 ;; Indicate side and digits affected.
+25 ;; 8. If there are flare-ups of joint disease affecting hand, thumb or fingers:
+26 ;;
+27 ;; a. State severity, frequency and duration of flare-ups.
+28 ;; b. Name precipitating and alleviating factors.
+29 ;; c. Estimate to what extent, if any, they result in additional
+30 ;; limitation of motion or functional impairment during the flare-up.
+31 ;; (Per Veteran).
+32 ;;
+33 ;;C. Physical Examination (Objective Findings):
+34 ;;
+35 ;; 1. Digit and joint designations:
+36 ;;
+37 ;; a. Designate fingers as: thumb, index, long, ring, and little.
+38 ;; b. Designate joints as DIP (distal interphalangeal), PIP (proximal
+39 ;; (interphalangeal), MP (metacarpophalangeal), and CP (carpometacarpal).
+40 ;;
+41 ;; 2. Hand "position of function":
+42 ;;
+43 ;; a. Wrist dorsiflexed 20 to 30 degrees.
+44 ;; b. MP and PIP joints flexed to 30 degrees.
+45 ;; c. Thumb abducted and rotated so that the thumb pad faces the finger
+46 ;; pads.
+47 ;;
+48 ;; 3. Instructions for joint measurement:
+49 ;;
+50 ;; a. Provide a detailed assessment of each joint of each affected digit.
+51 ;; b. Use a goniometer for measuring joint angles and range of motion.
+52 ;; c. Assess joints on both left and right hands, even if only one hand is
+53 ;; affected.
+54 ;; d. Refer to Residuals of Amputations worksheet, if applicable.
+55 ;;
+56 ;; 4. Normal range of motion for index, long, ring, and little fingers:
+57 ;;
+58 ;; a. Zero degrees of flexion represents the fingers fully extended, making
+59 ;; a straight line with the rest of the hand.
+60 ;; b. Metacarpophalangeal joint: zero to 90 degrees of flexion.
+61 ;; c. Proximal interphalangeal joint: zero to 100 degrees of flexion.
+62 ;; d. Distal (terminal) interphalangeal joint: zero to 70 or 80 degrees
+63 ;; of flexion.
+64 ;;
+65 ;; 5. Range of motion (ROM) examination of index, long, ring, and little
+66 ;; fingers:
+67 ;;
+68 ;; a. Measure active ROM of DIP, PIP, and MP joints.
+69 ;; b. For index and long finger, also report size of gap between fingertip
+70 ;; and proximal transverse crease of hand on maximal flexion of finger
+71 ;; (none, less than one inch, one inch, etc.).
+72 ;; c. State whether there is objective evidence of pain on active ROM.
+73 ;; d. Conduct at least 3 repetitions of ROM.
+74 ;; e. State whether there is objective evidence of pain after repetitive
+75 ;; ROM.
+76 ;; f. State whether there is additional (or new) limitation of motion
+77 ;; (including whether there is an increased gap between fingertip and
+78 ;; hand for index and long fingers) after repetitive ROM. If there is,
+79 ;; report the ROM (and size of gap) and state whether pain, weakness,
+80 ;; incoordination, fatigue, or lack of endurance is the most important
+81 ;; factor in the decreased ROM.
+82 ;; g. If unable to do repetitive motion, so state and provide reason.
+83 ;;
+84 ;; 6. Range of motion (ROM) examination of thumb:
+85 ;;
+86 ;; a. Report size of gap between the thumb pad and the fingers (none, less
+87 ;; than one inch, one inch, etc.), with the thumb attempting to oppose
+88 ;; the fingers.
+89 ;; b. State whether there is objective evidence of pain on attempted
+90 ;; opposition of thumb to fingers.
+91 ;; c. Conduct at least 3 repetitions of ROM.
+92 ;; d. State whether there is objective evidence of pain after repetitive
+93 ;; ROM.
+94 ;; e. State whether there is additional (or new) limitation of motion after
+95 ;; repetitive ROM. If there is, report the ROM (gap) and state whether
+96 ;; pain, weakness, incoordination, fatigue, or lack of endurance is the
+97 ;; most important factor in the decreased ROM.
+98 ;; f. If unable to do repetitive motion, so state and provide reason.
+99 ;;
+100 ;; 7. Ankylosis examination:
+101 ;;
+102 ;; For each anklyosed joint:
+103 ;;
+104 ;; a. Report angle of anklyosis.
+105 ;; b. Describe any rotation or any angulation of either bone at an
+106 ;; anklyosed joint.
+107 ;; c. State whether the ankylosis interferes with motion of the other
+108 ;; digits or with overall hand function.
+109 ;; d. For thumb: Additionally state whether the ankylosed thumb is
+110 ;; abducted and rotated so that the thumb pad faces the finger pad.
+111 ;; Report size of gap between the thumb pad and the fingers (none, less
+112 ;; than one inch, one inch, etc.).
+113 ;; e. For index, long, ring, and little fingers: Additionally report size
+114 ;; of gap between the finger and the proximal transverse crease of hand
+115 ;; on maximal flexion of finger (none, less than one inch, one inch,
+116 ;; etc.).
+117 ;;
+118 ;; 8. If there is deformity of one or more digits, state digit, joint, and
+119 ;; type of deformity, including degrees of any angulation.
+120 ;;
+121 ;; 9. Describe any decreased strength for pushing, pulling and twisting.
+122 ;; Describe any decreased dexterity for twisting, probing, writing,
+123 ;; touching and expression.
+124 ;;
+125 ;;D. Diagnostic and Clinical Tests:
+126 ;;
+127 ;; 1. Include results of all diagnostic and clinical tests conducted in
+128 ;; the examination report, including X-ray or other imaging studies, as
+129 ;; needed.
+130 ;;
+131 ;;E. Diagnosis:
+132 ;;
+133 ;; 1. Describe the effects of the condition on usual occupation and daily
+134 ;; activities.
+135 ;;
+136 ;;
+137 ;;
+138 ;;Signature: Date:
+139 ;;END
