DVBCWAR1 ;ALB/CMM AMPUTATION, RESIDUALS OF WKS TEXT - 1 ; 6 MARCH 1997
;;2.7;AMIE;**12**;Apr 10, 1995
;
;
TXT ;
;;A. Review of Medical Records:
;;
;;
;;
;;B. Medical History (Subjective Complaints):
;;
;; Comment on:
;; 1. The location of the amputation site.
;;
;;
;; 2. If symptoms exist, describe precipitating factors, aggravating
;; factors, alleviating factors, alleviating medications, frequency,
;; severity, and duration.
;;
;;
;;C. Physical Examination (Objective Findings):
;;
;; Address each of the following and fully describe current findings:
;; 1. Swelling, deformity, tenderness of stump.
;;
;;
;; 2. Skin, including scar.
;;
;;
;; 3. Circulation.
;;
;;
;;
;; 4. Muscles.
;;
;;
;;
;; 5. Describe any limited motion or instability in the joint above
;; the amputation site.
;;
;;
;; 6. A DETAILED ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED.
;;
;; a. Using a goniometer, measure the PASSIVE and ACTIVE range
;; of motion, including movement against gravity and against
;; strong resistance.
;;
;;
;; b. If the joint is painful on motion, state at what point in
;; the range of motion pain begins and ends.
;;
;;
;; c. State to what extent, if any, the range of motion or function
;; is ADDITIONALLY limited by pain, fatigue, weakness, or lack
;; of endurance. If more than one of these is present, state,
;; if possible, which has the major functional impact.
;;
;;
;; 7. Bones.
;;
;;
;; 8. Length of stump.
;;
;;
;; 9. Neuroma, if present.
;;
;;
;; 10. Is amputation of lower extremity improbable by prosthesis
;; controlled by natural knee action?
;;
;;
;;MEASUREMENT OF THE STUMP:
;;
;;The stump of an amputated THIGH will be measured from the perineum, at
;;the origin of the adductor tendons, to the bony end of the stump, with
;;the claimant recumbent and the stump lying parallel with the other lower
;;limb. It is to be kept in mind that if the limb is abducted, flexed,
;;rotated or adducted, its length will be altered. The effective length
;;of a thigh stump is governed by its inside dimension. Measure length
;;of normal thigh if present and indicate whether amputation is in upper,
;;middle, or lower third. When amputation is bilateral, estimate the same
;;for a person of similar height.
;;
;;The stump of an amputated LEG BELOW THE KNEE must be measured from the
;;insertion of the internal hamstring muscles to the bony end of the stump
;;with the patient recumbent and the leg flexed at 90 degrees.
;;
;;The stump of an amputated ARM should be measured from the anterior
;;axillary fold to the bony end of the stump, with the stump hanging
;;parallel to the chest wall. Indicate whether the amputation site is
;;above or below the insertion of the deltoid muscle. A statement of
;;the remaining function is the best indicator of a disability's severity.
;;
;;The stump of an amputated FOREARM should be measured from the insertion
;;of the biceps tendon to the bony end, with the elbow flexed at 90
;;degrees. Indicate if the amputation site is above or below the
;;attachment of the pronator teres.
;;
;;TOF
;;Amputations of FINGERS should be described as through the distal,
;;middle, or proximal phalanx or as disarticulations through the
;;distal interphalangeal, proximal interphalangeal, or
;;metacarpophalangeal joint. Resection of the head of the metacarpal
;;will always be reported if shown. Complete or partial loss or resection
;;of bones of the hand will described in terms of the fraction of each
;;remaining. If surgery has altered the usefulness of remaining or
;;transplanted digits, this will be described.
;;
;;Complete or partial loss of TOES or METATARSAL OR TARSAL BONES should
;;be described as in the subparagraph above. Always report loss of
;;metatarsal head or other defects. Indicate if amputation is through
;;the tarsal-metatarsal joint and if any other portions of the bones of
;;the foot remain.
;;
;;D. Diagnostic and Clinical Tests:
;;
;; 1. X-ray if exact amputation level is not of record.
;; 2. Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
;;
;;E. Diagnosis:
;;
;; Amputations must be described in accordance with the following levels:
;; 1. ARM:
;; a. Disarticulation.
;; b. Amputation above insertion of deltoid muscle.
;; c. Amputation below insertion of deltoid muscle.
;;
;;
;; 2. FOREARM:
;; a. Above radial insertion of pronator teres (function is best
;; indicator of disability).
;; b. Below insertion of pronator teres.
;;
;;
;; 3. THIGH:
;; a. Disarticulation, with loss of extrinsic pelvic girdle muscles.
;; b. Amputation of upper, middle or lower third, always measured
;; from perineum to the bony end of the stump with the
;; claimant recumbent and stump lying parallel with the other
;; lower limb.
;; c. State whether this level permits satisfactory prosthesis.
;;
;;
;;TOF
;; 4. LEG:
;; a. Give level of amputation and condition of stump.
;; b. State whether this level permits a satisfactory prosthesis.
;; c. Describe any stump defects (e.g., painful neuroma or
;; circulatory disturbance).
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWAR1 5803 printed Apr 09, 2024@20:50:41 Page 2
DVBCWAR1 ;ALB/CMM AMPUTATION, RESIDUALS OF WKS TEXT - 1 ; 6 MARCH 1997
+1 ;;2.7;AMIE;**12**;Apr 10, 1995
+2 ;
+3 ;
TXT ;
+1 ;;A. Review of Medical Records:
+2 ;;
+3 ;;
+4 ;;
+5 ;;B. Medical History (Subjective Complaints):
+6 ;;
+7 ;; Comment on:
+8 ;; 1. The location of the amputation site.
+9 ;;
+10 ;;
+11 ;; 2. If symptoms exist, describe precipitating factors, aggravating
+12 ;; factors, alleviating factors, alleviating medications, frequency,
+13 ;; severity, and duration.
+14 ;;
+15 ;;
+16 ;;C. Physical Examination (Objective Findings):
+17 ;;
+18 ;; Address each of the following and fully describe current findings:
+19 ;; 1. Swelling, deformity, tenderness of stump.
+20 ;;
+21 ;;
+22 ;; 2. Skin, including scar.
+23 ;;
+24 ;;
+25 ;; 3. Circulation.
+26 ;;
+27 ;;
+28 ;;
+29 ;; 4. Muscles.
+30 ;;
+31 ;;
+32 ;;
+33 ;; 5. Describe any limited motion or instability in the joint above
+34 ;; the amputation site.
+35 ;;
+36 ;;
+37 ;; 6. A DETAILED ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED.
+38 ;;
+39 ;; a. Using a goniometer, measure the PASSIVE and ACTIVE range
+40 ;; of motion, including movement against gravity and against
+41 ;; strong resistance.
+42 ;;
+43 ;;
+44 ;; b. If the joint is painful on motion, state at what point in
+45 ;; the range of motion pain begins and ends.
+46 ;;
+47 ;;
+48 ;; c. State to what extent, if any, the range of motion or function
+49 ;; is ADDITIONALLY limited by pain, fatigue, weakness, or lack
+50 ;; of endurance. If more than one of these is present, state,
+51 ;; if possible, which has the major functional impact.
+52 ;;
+53 ;;
+54 ;; 7. Bones.
+55 ;;
+56 ;;
+57 ;; 8. Length of stump.
+58 ;;
+59 ;;
+60 ;; 9. Neuroma, if present.
+61 ;;
+62 ;;
+63 ;; 10. Is amputation of lower extremity improbable by prosthesis
+64 ;; controlled by natural knee action?
+65 ;;
+66 ;;
+67 ;;MEASUREMENT OF THE STUMP:
+68 ;;
+69 ;;The stump of an amputated THIGH will be measured from the perineum, at
+70 ;;the origin of the adductor tendons, to the bony end of the stump, with
+71 ;;the claimant recumbent and the stump lying parallel with the other lower
+72 ;;limb. It is to be kept in mind that if the limb is abducted, flexed,
+73 ;;rotated or adducted, its length will be altered. The effective length
+74 ;;of a thigh stump is governed by its inside dimension. Measure length
+75 ;;of normal thigh if present and indicate whether amputation is in upper,
+76 ;;middle, or lower third. When amputation is bilateral, estimate the same
+77 ;;for a person of similar height.
+78 ;;
+79 ;;The stump of an amputated LEG BELOW THE KNEE must be measured from the
+80 ;;insertion of the internal hamstring muscles to the bony end of the stump
+81 ;;with the patient recumbent and the leg flexed at 90 degrees.
+82 ;;
+83 ;;The stump of an amputated ARM should be measured from the anterior
+84 ;;axillary fold to the bony end of the stump, with the stump hanging
+85 ;;parallel to the chest wall. Indicate whether the amputation site is
+86 ;;above or below the insertion of the deltoid muscle. A statement of
+87 ;;the remaining function is the best indicator of a disability's severity.
+88 ;;
+89 ;;The stump of an amputated FOREARM should be measured from the insertion
+90 ;;of the biceps tendon to the bony end, with the elbow flexed at 90
+91 ;;degrees. Indicate if the amputation site is above or below the
+92 ;;attachment of the pronator teres.
+93 ;;
+94 ;;TOF
+95 ;;Amputations of FINGERS should be described as through the distal,
+96 ;;middle, or proximal phalanx or as disarticulations through the
+97 ;;distal interphalangeal, proximal interphalangeal, or
+98 ;;metacarpophalangeal joint. Resection of the head of the metacarpal
+99 ;;will always be reported if shown. Complete or partial loss or resection
+100 ;;of bones of the hand will described in terms of the fraction of each
+101 ;;remaining. If surgery has altered the usefulness of remaining or
+102 ;;transplanted digits, this will be described.
+103 ;;
+104 ;;Complete or partial loss of TOES or METATARSAL OR TARSAL BONES should
+105 ;;be described as in the subparagraph above. Always report loss of
+106 ;;metatarsal head or other defects. Indicate if amputation is through
+107 ;;the tarsal-metatarsal joint and if any other portions of the bones of
+108 ;;the foot remain.
+109 ;;
+110 ;;D. Diagnostic and Clinical Tests:
+111 ;;
+112 ;; 1. X-ray if exact amputation level is not of record.
+113 ;; 2. Include results of all diagnostic and clinical tests conducted
+114 ;; in the examination report.
+115 ;;
+116 ;;
+117 ;;E. Diagnosis:
+118 ;;
+119 ;; Amputations must be described in accordance with the following levels:
+120 ;; 1. ARM:
+121 ;; a. Disarticulation.
+122 ;; b. Amputation above insertion of deltoid muscle.
+123 ;; c. Amputation below insertion of deltoid muscle.
+124 ;;
+125 ;;
+126 ;; 2. FOREARM:
+127 ;; a. Above radial insertion of pronator teres (function is best
+128 ;; indicator of disability).
+129 ;; b. Below insertion of pronator teres.
+130 ;;
+131 ;;
+132 ;; 3. THIGH:
+133 ;; a. Disarticulation, with loss of extrinsic pelvic girdle muscles.
+134 ;; b. Amputation of upper, middle or lower third, always measured
+135 ;; from perineum to the bony end of the stump with the
+136 ;; claimant recumbent and stump lying parallel with the other
+137 ;; lower limb.
+138 ;; c. State whether this level permits satisfactory prosthesis.
+139 ;;
+140 ;;
+141 ;;TOF
+142 ;; 4. LEG:
+143 ;; a. Give level of amputation and condition of stump.
+144 ;; b. State whether this level permits a satisfactory prosthesis.
+145 ;; c. Describe any stump defects (e.g., painful neuroma or
+146 ;; circulatory disturbance).
+147 ;;
+148 ;;
+149 ;;Signature: Date:
+150 ;;END
