DVBCWJW1 ;ALB/CMM JOINTS 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. Pain, weakness, stiffness, swelling, heat and redness,
;; instability or giving way, "locking," fatigability, lack of
;; endurance, etc.
;;
;;
;; 2. Treatment - type, dose, frequency, response, side effects.
;;
;;
;; 3. If there are periods of flare-up of joint disease:
;; a. State their severity, frequency, and duration.
;;
;;
;; b. Name the 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.
;;
;;
;; 4. Describe whether crutches, brace, cane, corrective shoes, etc.,
;; are needed.
;;
;;
;; 5. Describe details of any surgery or injury.
;;
;;
;; 6. Describe any episodes of dislocation or recurrent subluxation.
;;
;;
;; 7. For inflammatory arthritis, describe any constitutional symptoms.
;;
;;
;; 8. Describe the effects of the condition on the veteran's usual
;; occupation and daily activities.
;;
;;TOF
;; 9. For upper extremity, state which is dominant and means used to
;; identify dominant extremity.
;;
;;
;; 10. If there is a prosthesis, provide date of prosthetic implant
;; and describe any complaint of pain, weakness, or limitation of
;; motion. State whether crutches, brace, etc., are needed.
;;
;;
;;C. Physical Examination (Objective Findings):
;;
;; Address each of the following as appropriate to the condition
;; being examined and fully describe current findings: A DETAILED
;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED, INCLUDING JOINTS
;; WITH PROSTHESES.
;; 1. Using a goniometer, measure the PASSIVE and ACTIVE range of
;; motion, including movement against gravity and against strong
;; resistance. Provide range of motion in degrees.
;;
;;
;; 2. If the joint is painful on motion, state at what point in the
;; range of motion pain begins and ends.
;;
;;
;; 3. State to what extent (if any) and in which degrees (if possible)
;; the range of motion or joint function is ADDITIONALLY LIMITED
;; by pain, fatigue, weakness, or lack of endurance following
;; repetitive use or during flare-ups. If more than one of these
;; is present, state, if possible, which has the major functional
;; impact.
;;
;;
;; 4. Describe objective evidence of painful motion, edema, effusion,
;; instability, weakness, tenderness, redness, heat, abnormal
;; movement, guarding of movement, etc.
;;
;;
;; 5. For weight bearing joints (hip, knee, ankle), describe gait
;; and functional limitations on standing and walking. Describe
;; any callosities, breakdown, or unusual shoe wear pattern that
;; would indicate abnormal weight bearing.
;;
;;
;; 6. If ankylosis is present, describe the position of the bones of
;; the joint in relationship to one another (in degrees of flexion,
;; external rotation, etc.), and state whether the ankylosis is
;; stable and pain free.
;;
;;
;; 7. If indicated, measure the leg length from the anterior superior
;; iliac spine to the medial malleolus.
;;
;;
;; 8. For INFLAMMATORY ARTHRITIS, describe any constitutional signs.
;;
;;
;; 9. Describe range of motion with prosthesis in same detail as
;; described above for non-prosthetic joints.
;;
;;
;;D. Normal Range of Motion: All joint Range of Motion measurements
;;must be made using a GONIOMETER. Show each measured range of motion
;;separately rather than as a continuum. For example, if the veteran
;;lacks 10 degrees of full knee extension and has normal flexion, show
;;the range of motion as extension to minus 10 degrees (or lacks 10
;;degrees of extension) and flexion 0 to 140 degrees.
;;
;; 1. Hip range of motion: (Movement of femur as it rotates in the
;; acetabulum.)
;;
;; a. Normal range of motion, using the anatomical position as
;; zero degrees.
;; Flexion = 0 to 125 degrees (To gain a true picture of hip
;; flexion, i.e., movement between the pelvis and femur in
;; the hip joint, the opposite thigh should be extended to
;; minimize motion between the pelvis and spine.)
;; Extension = 0 to 30 degrees.
;; Adduction = 0 to 25 degrees.
;; Abduction = 0 to 45 degrees.
;; External rotation = 0 to 60 degrees.
;; Internal rotation = 0 to 40 degrees.
;;
;;
;; 2. Knee range of motion:
;; a. Normal range of motion, using the anatomical position as
;; zero degrees.
;; Flexion = 0 to 140 degrees.
;; Extension - zero degrees = full extension. Show loss of
;; extension by describing the degrees in which extension is
;; not possible. (e.g., Show range of motion as extension to
;; minus 10 degrees and flexion 0 to 140 degrees when full
;; extension is limited by 10 degrees and full flexion is
;; possible.)
;;
;;TOF
;; b. Stability.
;; Medial and Lateral Collateral Ligaments:
;; Varus/valgus in neutral and in 30 degrees of flexion -
;; normal is no motion.
;; Anterior and Posterior Cruciate Ligaments:
;; Anterior/posterior in 30 degrees of flexion with foot
;; stabilized - normal is less than 5 mm. of motion (1/4
;; inch - Lachman's test) or in 90 degrees of flexion with
;; foot stabilized - normal is less than 5mm. of motion
;; (1/4 inch - anterior and posterior drawer test).
;; Medial and Lateral Meniscus: Perform McMurray's test.
;;
;;
;; 3. Ankle range of motion:
;; a. Neutral position is with foot at 90 degrees to ankle.
;; From that position, dorsiflexion is 0 to 20 degrees;
;; plantar flexion is 0 to 45 degrees.
;;
;;
;; b. Describe any varus or valgus angulation of the os calcis
;; in relationship to the long axis of the tibia and fibula.
;;
;;
;; 4. Shoulder, elbow, forearm, and wrist range of motion:
;; a. Normal range of motion is measured with zero degrees the
;; anatomical position except for 2 situations:
;;
;; (1) Supination and pronation of the forearm is measured
;; with the arm against the body, the elbow flexed to 90
;; degrees, and the forearm in mid position (zero degrees)
;; between supination and pronation.
;;
;;
;; (2) Shoulder rotation is measured with the arm abducted
;; to 90 degrees, the elbow flexed to 90 degrees, and
;; the forearm reflecting the midpoint (zero degrees)
;; between internal and external rotation of the shoulder.
;;
;;
;; b. Shoulder forward flexion = zero to 180 degrees.
;;
;;
;; c. Shoulder abduction = zero to 180 degrees.
;;
;;
;; d. Shoulder external rotation = zero to 90 degrees.
;;
;;
;; e. Shoulder internal rotation = zero to 90 degrees.
;;
;;
;; f. Elbow flexion = zero to 145 degrees.
;;
;;
;; g. Forearm supination = zero to 85 degrees.
;;
;;
;; h. Forearm pronation = zero to 80 degrees.
;;
;;
;; i. Wrist dorsiflexion (extension) = zero to 70 degrees.
;;
;;
;; j. Wrist palmar flexion = zero to 80 degrees.
;;
;;
;; k. Wrist radial deviation = zero to 20 degrees.
;;
;;
;; l. Wrist ulnar deviation = zero to 45 degrees.
;;
;;
;;E. Diagnostic and Clinical Tests:
;;
;; 1. As indicated: X-rays, including special views or weight
;; bearing films, MRI, arthrogram, diagnostic arthroscopy.
;; 2. Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
;;NOTE: The diagnosis of degenerative arthritis or post-traumatic
;;arthritis of a joint requires X-ray confirmation. Once the diagnosis
;;has been confirmed in a joint, further X-rays of that joint are not required.
;;
;;
;;F. Diagnosis:
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWJW1 8949 printed Oct 16, 2024@17:52:56 Page 2
DVBCWJW1 ;ALB/CMM JOINTS 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. Pain, weakness, stiffness, swelling, heat and redness,
+9 ;; instability or giving way, "locking," fatigability, lack of
+10 ;; endurance, etc.
+11 ;;
+12 ;;
+13 ;; 2. Treatment - type, dose, frequency, response, side effects.
+14 ;;
+15 ;;
+16 ;; 3. If there are periods of flare-up of joint disease:
+17 ;; a. State their severity, frequency, and duration.
+18 ;;
+19 ;;
+20 ;; b. Name the precipitating and alleviating factors.
+21 ;;
+22 ;;
+23 ;; c. Estimate to what extent, if any, they result in additional
+24 ;; limitation of motion or functional impairment during the
+25 ;; flare-up.
+26 ;;
+27 ;;
+28 ;; 4. Describe whether crutches, brace, cane, corrective shoes, etc.,
+29 ;; are needed.
+30 ;;
+31 ;;
+32 ;; 5. Describe details of any surgery or injury.
+33 ;;
+34 ;;
+35 ;; 6. Describe any episodes of dislocation or recurrent subluxation.
+36 ;;
+37 ;;
+38 ;; 7. For inflammatory arthritis, describe any constitutional symptoms.
+39 ;;
+40 ;;
+41 ;; 8. Describe the effects of the condition on the veteran's usual
+42 ;; occupation and daily activities.
+43 ;;
+44 ;;TOF
+45 ;; 9. For upper extremity, state which is dominant and means used to
+46 ;; identify dominant extremity.
+47 ;;
+48 ;;
+49 ;; 10. If there is a prosthesis, provide date of prosthetic implant
+50 ;; and describe any complaint of pain, weakness, or limitation of
+51 ;; motion. State whether crutches, brace, etc., are needed.
+52 ;;
+53 ;;
+54 ;;C. Physical Examination (Objective Findings):
+55 ;;
+56 ;; Address each of the following as appropriate to the condition
+57 ;; being examined and fully describe current findings: A DETAILED
+58 ;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED, INCLUDING JOINTS
+59 ;; WITH PROSTHESES.
+60 ;; 1. Using a goniometer, measure the PASSIVE and ACTIVE range of
+61 ;; motion, including movement against gravity and against strong
+62 ;; resistance. Provide range of motion in degrees.
+63 ;;
+64 ;;
+65 ;; 2. If the joint is painful on motion, state at what point in the
+66 ;; range of motion pain begins and ends.
+67 ;;
+68 ;;
+69 ;; 3. State to what extent (if any) and in which degrees (if possible)
+70 ;; the range of motion or joint function is ADDITIONALLY LIMITED
+71 ;; by pain, fatigue, weakness, or lack of endurance following
+72 ;; repetitive use or during flare-ups. If more than one of these
+73 ;; is present, state, if possible, which has the major functional
+74 ;; impact.
+75 ;;
+76 ;;
+77 ;; 4. Describe objective evidence of painful motion, edema, effusion,
+78 ;; instability, weakness, tenderness, redness, heat, abnormal
+79 ;; movement, guarding of movement, etc.
+80 ;;
+81 ;;
+82 ;; 5. For weight bearing joints (hip, knee, ankle), describe gait
+83 ;; and functional limitations on standing and walking. Describe
+84 ;; any callosities, breakdown, or unusual shoe wear pattern that
+85 ;; would indicate abnormal weight bearing.
+86 ;;
+87 ;;
+88 ;; 6. If ankylosis is present, describe the position of the bones of
+89 ;; the joint in relationship to one another (in degrees of flexion,
+90 ;; external rotation, etc.), and state whether the ankylosis is
+91 ;; stable and pain free.
+92 ;;
+93 ;;
+94 ;; 7. If indicated, measure the leg length from the anterior superior
+95 ;; iliac spine to the medial malleolus.
+96 ;;
+97 ;;
+98 ;; 8. For INFLAMMATORY ARTHRITIS, describe any constitutional signs.
+99 ;;
+100 ;;
+101 ;; 9. Describe range of motion with prosthesis in same detail as
+102 ;; described above for non-prosthetic joints.
+103 ;;
+104 ;;
+105 ;;D. Normal Range of Motion: All joint Range of Motion measurements
+106 ;;must be made using a GONIOMETER. Show each measured range of motion
+107 ;;separately rather than as a continuum. For example, if the veteran
+108 ;;lacks 10 degrees of full knee extension and has normal flexion, show
+109 ;;the range of motion as extension to minus 10 degrees (or lacks 10
+110 ;;degrees of extension) and flexion 0 to 140 degrees.
+111 ;;
+112 ;; 1. Hip range of motion: (Movement of femur as it rotates in the
+113 ;; acetabulum.)
+114 ;;
+115 ;; a. Normal range of motion, using the anatomical position as
+116 ;; zero degrees.
+117 ;; Flexion = 0 to 125 degrees (To gain a true picture of hip
+118 ;; flexion, i.e., movement between the pelvis and femur in
+119 ;; the hip joint, the opposite thigh should be extended to
+120 ;; minimize motion between the pelvis and spine.)
+121 ;; Extension = 0 to 30 degrees.
+122 ;; Adduction = 0 to 25 degrees.
+123 ;; Abduction = 0 to 45 degrees.
+124 ;; External rotation = 0 to 60 degrees.
+125 ;; Internal rotation = 0 to 40 degrees.
+126 ;;
+127 ;;
+128 ;; 2. Knee range of motion:
+129 ;; a. Normal range of motion, using the anatomical position as
+130 ;; zero degrees.
+131 ;; Flexion = 0 to 140 degrees.
+132 ;; Extension - zero degrees = full extension. Show loss of
+133 ;; extension by describing the degrees in which extension is
+134 ;; not possible. (e.g., Show range of motion as extension to
+135 ;; minus 10 degrees and flexion 0 to 140 degrees when full
+136 ;; extension is limited by 10 degrees and full flexion is
+137 ;; possible.)
+138 ;;
+139 ;;TOF
+140 ;; b. Stability.
+141 ;; Medial and Lateral Collateral Ligaments:
+142 ;; Varus/valgus in neutral and in 30 degrees of flexion -
+143 ;; normal is no motion.
+144 ;; Anterior and Posterior Cruciate Ligaments:
+145 ;; Anterior/posterior in 30 degrees of flexion with foot
+146 ;; stabilized - normal is less than 5 mm. of motion (1/4
+147 ;; inch - Lachman's test) or in 90 degrees of flexion with
+148 ;; foot stabilized - normal is less than 5mm. of motion
+149 ;; (1/4 inch - anterior and posterior drawer test).
+150 ;; Medial and Lateral Meniscus: Perform McMurray's test.
+151 ;;
+152 ;;
+153 ;; 3. Ankle range of motion:
+154 ;; a. Neutral position is with foot at 90 degrees to ankle.
+155 ;; From that position, dorsiflexion is 0 to 20 degrees;
+156 ;; plantar flexion is 0 to 45 degrees.
+157 ;;
+158 ;;
+159 ;; b. Describe any varus or valgus angulation of the os calcis
+160 ;; in relationship to the long axis of the tibia and fibula.
+161 ;;
+162 ;;
+163 ;; 4. Shoulder, elbow, forearm, and wrist range of motion:
+164 ;; a. Normal range of motion is measured with zero degrees the
+165 ;; anatomical position except for 2 situations:
+166 ;;
+167 ;; (1) Supination and pronation of the forearm is measured
+168 ;; with the arm against the body, the elbow flexed to 90
+169 ;; degrees, and the forearm in mid position (zero degrees)
+170 ;; between supination and pronation.
+171 ;;
+172 ;;
+173 ;; (2) Shoulder rotation is measured with the arm abducted
+174 ;; to 90 degrees, the elbow flexed to 90 degrees, and
+175 ;; the forearm reflecting the midpoint (zero degrees)
+176 ;; between internal and external rotation of the shoulder.
+177 ;;
+178 ;;
+179 ;; b. Shoulder forward flexion = zero to 180 degrees.
+180 ;;
+181 ;;
+182 ;; c. Shoulder abduction = zero to 180 degrees.
+183 ;;
+184 ;;
+185 ;; d. Shoulder external rotation = zero to 90 degrees.
+186 ;;
+187 ;;
+188 ;; e. Shoulder internal rotation = zero to 90 degrees.
+189 ;;
+190 ;;
+191 ;; f. Elbow flexion = zero to 145 degrees.
+192 ;;
+193 ;;
+194 ;; g. Forearm supination = zero to 85 degrees.
+195 ;;
+196 ;;
+197 ;; h. Forearm pronation = zero to 80 degrees.
+198 ;;
+199 ;;
+200 ;; i. Wrist dorsiflexion (extension) = zero to 70 degrees.
+201 ;;
+202 ;;
+203 ;; j. Wrist palmar flexion = zero to 80 degrees.
+204 ;;
+205 ;;
+206 ;; k. Wrist radial deviation = zero to 20 degrees.
+207 ;;
+208 ;;
+209 ;; l. Wrist ulnar deviation = zero to 45 degrees.
+210 ;;
+211 ;;
+212 ;;E. Diagnostic and Clinical Tests:
+213 ;;
+214 ;; 1. As indicated: X-rays, including special views or weight
+215 ;; bearing films, MRI, arthrogram, diagnostic arthroscopy.
+216 ;; 2. Include results of all diagnostic and clinical tests conducted
+217 ;; in the examination report.
+218 ;;
+219 ;;NOTE: The diagnosis of degenerative arthritis or post-traumatic
+220 ;;arthritis of a joint requires X-ray confirmation. Once the diagnosis
+221 ;;has been confirmed in a joint, further X-rays of that joint are not required.
+222 ;;
+223 ;;
+224 ;;F. Diagnosis:
+225 ;;
+226 ;;
+227 ;;Signature: Date:
+228 ;;END
