DVBCWJW3 ;ALB/CMM JOINTS WKS TEXT - 1 ; 6 MARCH 1997
;;2.7;AMIE;**63**;FEB 17, 2004
;
;
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. State 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.
;; 9. Dominance of extremity 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. 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.)
;;
;; 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:
;;
;; i. 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.
;; ii. 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.
;; 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.
;; 2. Include results of all diagnostic and clinical tests in the examination
;; report.
;;
;;
;;
;;F. Diagnosis:
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWJW3 8696 printed Dec 13, 2024@01:52:07 Page 2
DVBCWJW3 ;ALB/CMM JOINTS WKS TEXT - 1 ; 6 MARCH 1997
+1 ;;2.7;AMIE;**63**;FEB 17, 2004
+2 ;
+3 ;
TXT ;
+1 ;;A. Review of Medical Records:
+2 ;;
+3 ;;
+4 ;;
+5 ;;B. Medical History (Subjective Complaints):
+6 ;;
+7 ;; Comment on:
+8 ;;
+9 ;; 1. Pain, weakness, stiffness, swelling, heat and redness,
+10 ;; instability or giving way, "locking," fatigability, lack of
+11 ;; endurance, etc.
+12 ;; 2. Treatment - type, dose, frequency, response, side effects.
+13 ;; 3. If there are periods of flare-up of joint disease:
+14 ;;
+15 ;; a. State their severity, frequency, and duration.
+16 ;; b. Name the precipitating and alleviating factors.
+17 ;; c. State to what extent, if any, they result in additional
+18 ;; limitation of motion or functional impairment during the
+19 ;; flare-up.
+20 ;;
+21 ;; 4. Describe whether crutches, brace, cane, corrective shoes, etc.,
+22 ;; are needed.
+23 ;; 5. Describe details of any surgery or injury.
+24 ;; 6. Describe any episodes of dislocation or recurrent subluxation.
+25 ;; 7. For inflammatory arthritis, describe any constitutional symptoms.
+26 ;; 8. Describe the effects of the condition on the veteran's usual
+27 ;; occupation and daily activities.
+28 ;; 9. Dominance of extremity and means used to identify dominant extremity
+29 ;; 10. If there is a prosthesis, provide date of prosthetic implant
+30 ;; and describe any complaint of pain, weakness, or limitation of
+31 ;; motion. State whether crutches, brace, etc., are needed.
+32 ;;
+33 ;;
+34 ;;C. Physical Examination (Objective Findings):
+35 ;;
+36 ;; Address each of the following as appropriate to the condition
+37 ;; being examined and fully describe current findings: A DETAILED
+38 ;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED, INCLUDING JOINTS
+39 ;; WITH PROSTHESES.
+40 ;;
+41 ;; 1. Using a goniometer, measure the PASSIVE and ACTIVE range of
+42 ;; motion, including movement against gravity and against strong
+43 ;; resistance. Provide range of motion in degrees.
+44 ;; 2. If the joint is painful on motion, state at what point in the
+45 ;; range of motion pain begins and ends.
+46 ;; 3. State to what extent (if any) and in which degrees (if possible)
+47 ;; the range of motion or joint function is ADDITIONALLY LIMITED
+48 ;; by pain, fatigue, weakness, or lack of endurance following
+49 ;; repetitive use. If more than one of these is present, state,
+50 ;; if possible, which has the major functional impact.
+51 ;; 4. Describe objective evidence of painful motion, edema, effusion,
+52 ;; instability, weakness, tenderness, redness, heat, abnormal
+53 ;; movement, guarding of movement, etc.
+54 ;; 5. For weight bearing joints (hip, knee, ankle), describe gait
+55 ;; and functional limitations on standing and walking. Describe
+56 ;; any callosities, breakdown, or unusual shoe wear pattern that
+57 ;; would indicate abnormal weight bearing.
+58 ;; 6. If ankylosis is present, describe the position of the bones of
+59 ;; the joint in relationship to one another (in degrees of flexion,
+60 ;; external rotation, etc.), and state whether the ankylosis is
+61 ;; stable and pain free.
+62 ;; 7. If indicated, measure the leg length from the anterior superior
+63 ;; iliac spine to the medial malleolus.
+64 ;; 8. For INFLAMMATORY ARTHRITIS, describe any constitutional signs.
+65 ;; 9. Describe range of motion with prosthesis in same detail as
+66 ;; described above for non-prosthetic joints.
+67 ;;
+68 ;;
+69 ;;D. Normal Range of Motion: All joint Range of Motion measurements
+70 ;;must be made using a goniometer. Show each measured range of motion
+71 ;;separately rather than as a continuum. For example, if the veteran
+72 ;;lacks 10 degrees of full knee extension and has normal flexion, show
+73 ;;the range of motion as extension to minus 10 degrees (or lacks 10
+74 ;;degrees of extension) and flexion 0 to 140 degrees.
+75 ;;
+76 ;; 1. Hip range of motion: (Movement of femur as it rotates in the
+77 ;; acetabulum.)
+78 ;;
+79 ;; a. Normal range of motion, using the anatomical position as
+80 ;; zero degrees.
+81 ;;
+82 ;; Flexion = 0 to 125 degrees (To gain a true picture of hip
+83 ;; flexion, i.e., movement between the pelvis and femur in
+84 ;; the hip joint, the opposite thigh should be extended to
+85 ;; minimize motion between the pelvis and spine.)
+86 ;;
+87 ;; Extension = 0 to 30 degrees.
+88 ;;
+89 ;; Adduction = 0 to 25 degrees.
+90 ;;
+91 ;; Abduction = 0 to 45 degrees.
+92 ;;
+93 ;; External rotation = 0 to 60 degrees.
+94 ;;
+95 ;; Internal rotation = 0 to 40 degrees.
+96 ;;
+97 ;;
+98 ;;
+99 ;; 2. Knee range of motion:
+100 ;;
+101 ;; a. Normal range of motion, using the anatomical position as
+102 ;; zero degrees.
+103 ;;
+104 ;; Flexion = 0 to 140 degrees.
+105 ;;
+106 ;; Extension - zero degrees = full extension. Show loss of
+107 ;; extension by describing the degrees in which extension is
+108 ;; not possible. (e.g., Show range of motion as extension to
+109 ;; minus 10 degrees and flexion 0 to 140 degrees when full
+110 ;; extension is limited by 10 degrees and full flexion is
+111 ;; possible.)
+112 ;;
+113 ;; b. Stability.
+114 ;;
+115 ;; Medial and Lateral Collateral Ligaments: Varus/valgus in
+116 ;; neutral and in 30 degrees of flexion - normal is no motion.
+117 ;;
+118 ;; Anterior and Posterior Cruciate Ligaments: Anterior/posterior
+119 ;; in 30 degrees of flexion with foot stabilized - normal is
+120 ;; less than 5 mm. of motion (1/4 inch - Lachman's test) or in
+121 ;; 90 degrees of flexion with foot stabilized - normal is less
+122 ;; than 5mm. of motion (1/4 inch - anterior and posterior drawer
+123 ;; test).
+124 ;;
+125 ;; Medial and Lateral Meniscus: Perform McMurray's test.
+126 ;;
+127 ;;
+128 ;; 3. Ankle range of motion:
+129 ;;
+130 ;; a. Neutral position is with foot at 90 degrees to ankle.
+131 ;; From that position, dorsiflexion is 0 to 20 degrees;
+132 ;; plantar flexion is 0 to 45 degrees.
+133 ;; b. Describe any varus or valgus angulation of the os calcis
+134 ;; in relationship to the long axis of the tibia and fibula.
+135 ;;
+136 ;;
+137 ;; 4. Shoulder, elbow, forearm, and wrist range of motion:
+138 ;;
+139 ;; a. Normal range of motion is measured with zero degrees the
+140 ;; anatomical position except for 2 situations:
+141 ;;
+142 ;; i. Supination and pronation of the forearm is measured
+143 ;; with the arm against the body, the elbow flexed to 90
+144 ;; degrees, and the forearm in mid position (zero degrees)
+145 ;; between supination and pronation.
+146 ;; ii. Shoulder rotation is measured with the arm abducted
+147 ;; to 90 degrees, the elbow flexed to 90 degrees, and
+148 ;; the forearm reflecting the midpoint (zero degrees)
+149 ;; between internal and external rotation of the shoulder.
+150 ;;
+151 ;;
+152 ;; b. Shoulder forward flexion = zero to 180 degrees.
+153 ;; c. Shoulder abduction = zero to 180 degrees.
+154 ;; d. Shoulder external rotation = zero to 90 degrees.
+155 ;; e. Shoulder internal rotation = zero to 90 degrees.
+156 ;; f. Elbow flexion = zero to 145 degrees.
+157 ;; g. Forearm supination = zero to 85 degrees.
+158 ;; h. Forearm pronation = zero to 80 degrees.
+159 ;; i. Wrist dorsiflexion (extension) = zero to 70 degrees.
+160 ;; j. Wrist palmar flexion = zero to 80 degrees.
+161 ;; k. Wrist radial deviation = zero to 20 degrees.
+162 ;; l. Wrist ulnar deviation = zero to 45 degrees.
+163 ;;
+164 ;;
+165 ;;E. Diagnostic and Clinical Tests:
+166 ;;
+167 ;; 1. As indicated: X-rays, including special views or weight
+168 ;; bearing films, MRI, arthrogram, diagnostic arthroscopy.
+169 ;; NOTE: The diagnosis of degenerative arthritis or post-traumatic
+170 ;; arthritis of a joint requires X-ray confirmation. Once the diagnosis
+171 ;; has been confirmed in a joint, further X-rays of that joint are not
+172 ;; required.
+173 ;; 2. Include results of all diagnostic and clinical tests in the examination
+174 ;; report.
+175 ;;
+176 ;;
+177 ;;
+178 ;;F. Diagnosis:
+179 ;;
+180 ;;
+181 ;;Signature: Date:
+182 ;;END
