DVBCWHT5 ;ALB/JER HAND, THUMB, FINGERS WKS TEXT ; 31 JULY 2003
;;2.7;AMIE;**63**;FEB 17, 2004
;
TXT ;
;;A. Review of Medical Records:
;;
;;B. Medical History (Subjective Complaints):
;;
;; Comment on;
;;
;; Are there flair ups of joint disease affecting hand, thumb or fingers?
;; If so:
;; 1. State severity, frequency and duration of flair ups.
;; 2. Name precipitating and alleviating factors.
;; 3. Estimate to what extent, if any, flair ups result in additional
;; limitation of motion or functional impairment. (Per Veteran).
;;
;;C. Physical Examination (Objective Findings):
;;
;; Designate fingers as: thumb, index, long, ring, and little. Provide a detailed
;;assessment of each affected joint. State whether the individual is right
;;or left hand dominant. Use a goniometer for measuring joint angles. Refer to
;;Residuals of Amputations worksheet, if applicable.
;;
;;1. Evaluation of Ankylosis
;;
;;For each anklyosed joint, include angle of anklyosis. Describe any rotation or
;;any angulation of bone.
;;
;;Zero degrees of flexion represents the fingers fully extended, making a
;;straight line with the rest of the hand.
;; The "position of function" of the hand is:
;; Wrist dorsiflexion: 20 to 30 degrees
;; Metacarpophalangeal flexion: 30 degrees
;; Proximal interphalangeal joint flexion: 30 degrees
;; Thumb abduction and rotation: thumb pad faces the finger pads.
;;
;;2. Evaluation of Limitation of Motion of Single or Multiple Digits of the
;; Hand
;;
;;Provide range of motion for each digit of the hand.
;;
;;Normal Ranges of Motion for wrist, index, long, ring and little fingers:
;; Metacarpophalangeal joint (wrist): zero to 90 degrees of flexion
;; Proximal interphalangeal joint: zero to 100 degrees of flexion
;; Distal (terminal) interphalangeal joint: zero to 70 or 80 degrees of flexion
;;
;;3. Evaluation of Hand as a unit
;;
;;Measure the gap, in inches:
;; Between the tip of the thumb and the fingers
;; Between the tips of the fingers and the proximal transverse crease of the palm
;; Between the thumb pad and the fingers with the thumb attempting to oppose
;; the fingers
;;
;;Describe strength for pushing, pulling and twisting. Describe dexterity for
;;twisting, probing, writing, touching and expression. Comment on whether and
;;how (e.g. decreased range of motion, in degrees) the flexion deformity
;;interferes with the function of the other fingers.
;;
;;4. Additional detailed measurements and consideration of other factors
;; affecting function
;;
;;a. Measure the active and passive range of motion of each affected joint.
;; Include movement against gravity and against strong resistance.
;;b. State whether and to what extent the range of motion (in degrees) or joint
;; function is additionally limited by pain, fatigue, weakness, or lack of
;; endurance following repetitive use. If more than one of these is present,
;; state, if possible, which has the major functional impact. If you cannot
;; provide this information without resort to mere speculation, please discuss.
;; Include rationale for all conclusions.
;;
;;D. Diagnostic and Clinical Tests:
;;
;; Include results of all diagnostic and clinical tests upon which examiner is
;; basing the diagnosis.
;;
;;E. Diagnosis:
;;
;;
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWHT5 3603 printed Nov 22, 2024@17:02:02 Page 2
DVBCWHT5 ;ALB/JER HAND, THUMB, FINGERS WKS TEXT ; 31 JULY 2003
+1 ;;2.7;AMIE;**63**;FEB 17, 2004
+2 ;
TXT ;
+1 ;;A. Review of Medical Records:
+2 ;;
+3 ;;B. Medical History (Subjective Complaints):
+4 ;;
+5 ;; Comment on;
+6 ;;
+7 ;; Are there flair ups of joint disease affecting hand, thumb or fingers?
+8 ;; If so:
+9 ;; 1. State severity, frequency and duration of flair ups.
+10 ;; 2. Name precipitating and alleviating factors.
+11 ;; 3. Estimate to what extent, if any, flair ups result in additional
+12 ;; limitation of motion or functional impairment. (Per Veteran).
+13 ;;
+14 ;;C. Physical Examination (Objective Findings):
+15 ;;
+16 ;; Designate fingers as: thumb, index, long, ring, and little. Provide a detailed
+17 ;;assessment of each affected joint. State whether the individual is right
+18 ;;or left hand dominant. Use a goniometer for measuring joint angles. Refer to
+19 ;;Residuals of Amputations worksheet, if applicable.
+20 ;;
+21 ;;1. Evaluation of Ankylosis
+22 ;;
+23 ;;For each anklyosed joint, include angle of anklyosis. Describe any rotation or
+24 ;;any angulation of bone.
+25 ;;
+26 ;;Zero degrees of flexion represents the fingers fully extended, making a
+27 ;;straight line with the rest of the hand.
+28 ;; The "position of function" of the hand is:
+29 ;; Wrist dorsiflexion: 20 to 30 degrees
+30 ;; Metacarpophalangeal flexion: 30 degrees
+31 ;; Proximal interphalangeal joint flexion: 30 degrees
+32 ;; Thumb abduction and rotation: thumb pad faces the finger pads.
+33 ;;
+34 ;;2. Evaluation of Limitation of Motion of Single or Multiple Digits of the
+35 ;; Hand
+36 ;;
+37 ;;Provide range of motion for each digit of the hand.
+38 ;;
+39 ;;Normal Ranges of Motion for wrist, index, long, ring and little fingers:
+40 ;; Metacarpophalangeal joint (wrist): zero to 90 degrees of flexion
+41 ;; Proximal interphalangeal joint: zero to 100 degrees of flexion
+42 ;; Distal (terminal) interphalangeal joint: zero to 70 or 80 degrees of flexion
+43 ;;
+44 ;;3. Evaluation of Hand as a unit
+45 ;;
+46 ;;Measure the gap, in inches:
+47 ;; Between the tip of the thumb and the fingers
+48 ;; Between the tips of the fingers and the proximal transverse crease of the palm
+49 ;; Between the thumb pad and the fingers with the thumb attempting to oppose
+50 ;; the fingers
+51 ;;
+52 ;;Describe strength for pushing, pulling and twisting. Describe dexterity for
+53 ;;twisting, probing, writing, touching and expression. Comment on whether and
+54 ;;how (e.g. decreased range of motion, in degrees) the flexion deformity
+55 ;;interferes with the function of the other fingers.
+56 ;;
+57 ;;4. Additional detailed measurements and consideration of other factors
+58 ;; affecting function
+59 ;;
+60 ;;a. Measure the active and passive range of motion of each affected joint.
+61 ;; Include movement against gravity and against strong resistance.
+62 ;;b. State whether and to what extent the range of motion (in degrees) or joint
+63 ;; function is additionally limited by pain, fatigue, weakness, or lack of
+64 ;; endurance following repetitive use. If more than one of these is present,
+65 ;; state, if possible, which has the major functional impact. If you cannot
+66 ;; provide this information without resort to mere speculation, please discuss.
+67 ;; Include rationale for all conclusions.
+68 ;;
+69 ;;D. Diagnostic and Clinical Tests:
+70 ;;
+71 ;; Include results of all diagnostic and clinical tests upon which examiner is
+72 ;; basing the diagnosis.
+73 ;;
+74 ;;E. Diagnosis:
+75 ;;
+76 ;;
+77 ;;
+78 ;;
+79 ;;Signature: Date:
+80 ;;END
