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Routine: DVBCWHT7

DVBCWHT7.m

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DVBCWHT7 ;ALB/RLC HAND, THUMB, FINGERS WKS TEXT ; 31 JULY 2003

 ;;2.7;AMIE;**81**;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 index, long, ring and little fingers:

 ;;  Metacarpophalangeal joint: 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