DVBCWJW5 ;ALB/RLC JOINTS WKS TEXT - 1 ; 7 APRIL 2005
;;2.7;AMIE;**94**;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, per veteran, 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. Describe presence or absence of: pain (including pain on repeated
;; use); fatigue; weakness; lack of endurance; and incoordination.
;; 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:
;;
;;
;;G. Additional Limitation of Joint Function:
;;
;; Impairment of joint function is determined by actual range of joint
;; motion as reported in the physical examination and additional limitation
;; of joint function caused by the following factors:
;;
;; - Pain, including pain on repeated use and pain during flare-ups
;; - Fatigue
;; - Weakness
;; - Lack of endurance
;; - Incoordination
;;
;; 1. Do any of the above factors additionally limit joint function?
;; If so, express the additional limitation in degrees.
;;
;; 2. Indicate if you cannot determine, without resort to mere
;; speculation, whether any of these factors cause additional functional
;; loss. For example, indicate if you would need to resort to mere
;; speculation in order to express additional limitation due to
;; flare-ups.
;;
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWJW5 9662 printed Nov 22, 2024@17:02:21 Page 2
DVBCWJW5 ;ALB/RLC JOINTS WKS TEXT - 1 ; 7 APRIL 2005
+1 ;;2.7;AMIE;**94**;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, per veteran, they
+18 ;; result in additional limitation of motion or
+19 ;; functional impairment during the flare-up.
+20 ;;
+21 ;; 4. Describe whether crutches, brace, cane, corrective shoes,
+22 ;; etc., 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
+26 ;; symptoms.
+27 ;; 8. Describe the effects of the condition on the veteran's usual
+28 ;; occupation and daily activities.
+29 ;; 9. Dominance of extremity and means used to identify
+30 ;; dominant extremity.
+31 ;; 10. If there is a prosthesis, provide date of prosthetic implant
+32 ;; and describe any complaint of pain, weakness, or limitation
+33 ;; of motion. State whether crutches, brace, etc., are needed.
+34 ;;
+35 ;;
+36 ;;C. Physical Examination (Objective Findings):
+37 ;;
+38 ;; Address each of the following as appropriate to the condition
+39 ;; being examined and fully describe current findings: A DETAILED
+40 ;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED, INCLUDING JOINTS
+41 ;; WITH PROSTHESES.
+42 ;;
+43 ;; 1. Using a goniometer, measure the PASSIVE and ACTIVE range of
+44 ;; motion, including movement against gravity and against strong
+45 ;; resistance. Provide range of motion in degrees.
+46 ;; 2. If the joint is painful on motion, state at what point in the
+47 ;; range of motion pain begins and ends.
+48 ;; 3. Describe presence or absence of: pain (including pain on repeated
+49 ;; use); fatigue; weakness; lack of endurance; and incoordination.
+50 ;; 4. Describe objective evidence of painful motion, edema,
+51 ;; effusion, instability, weakness, tenderness, redness, heat,
+52 ;; abnormal movement, guarding of movement, etc.
+53 ;; 5. For weight bearing joints (hip, knee, ankle), describe gait
+54 ;; and functional limitations on standing and walking. Describe
+55 ;; any callosities, breakdown, or unusual shoe wear pattern that
+56 ;; would indicate abnormal weight bearing.
+57 ;; 6. If ankylosis is present, describe the position of the bones of
+58 ;; the joint in relationship to one another (in degrees of flexion,
+59 ;; external rotation, etc.), and state whether the ankylosis is
+60 ;; stable and pain free.
+61 ;; 7. If indicated, measure the leg length from the anterior
+62 ;; superior iliac spine to the medial malleolus.
+63 ;; 8. For INFLAMMATORY ARTHRITIS, describe any constitutional signs.
+64 ;; 9. Describe range of motion with prosthesis in same detail as
+65 ;; described above for non-prosthetic joints.
+66 ;;
+67 ;;
+68 ;;D. Normal Range of Motion: All joint Range of Motion measurements
+69 ;;must be made using a goniometer. Show each measured range of motion
+70 ;;separately rather than as a continuum. For example, if the veteran
+71 ;;lacks 10 degrees of full knee extension and has normal flexion, show
+72 ;;the range of motion as extension to minus 10 degrees (or lacks 10
+73 ;;degrees of extension) and flexion 0 to 140 degrees.
+74 ;;
+75 ;; 1. Hip range of motion: (Movement of femur as it rotates in the
+76 ;; acetabulum.)
+77 ;;
+78 ;; a. Normal range of motion, using the anatomical
+79 ;; position as zero degrees.
+80 ;;
+81 ;; Flexion = 0 to 125 degrees (To gain a true picture of hip
+82 ;; flexion, i.e., movement between the pelvis and femur in
+83 ;; the hip joint, the opposite thigh should be extended to
+84 ;; minimize motion between the pelvis and spine.)
+85 ;;
+86 ;; Extension = 0 to 30 degrees.
+87 ;;
+88 ;; Adduction = 0 to 25 degrees.
+89 ;;
+90 ;; Abduction = 0 to 45 degrees.
+91 ;;
+92 ;; External rotation = 0 to 60 degrees.
+93 ;;
+94 ;; Internal rotation = 0 to 40 degrees.
+95 ;;
+96 ;;
+97 ;; 2. Knee range of motion:
+98 ;;
+99 ;; a. Normal range of motion, using the anatomical
+100 ;; position as zero degrees.
+101 ;;
+102 ;; Flexion = 0 to 140 degrees.
+103 ;;
+104 ;; Extension - zero degrees = full extension. Show loss of
+105 ;; extension by describing the degrees in which extension is
+106 ;; not possible. (e.g., Show range of motion as extension to
+107 ;; minus 10 degrees and flexion 0 to 140 degrees when full
+108 ;; extension is limited by 10 degrees and full flexion is
+109 ;; possible.)
+110 ;;
+111 ;; b. Stability.
+112 ;;
+113 ;; Medial and Lateral Collateral Ligaments:
+114 ;; Varus/valgus in neutral and in 30 degrees of flexion -
+115 ;; normal is no motion.
+116 ;;
+117 ;; Anterior and Posterior Cruciate Ligaments:
+118 ;; Anterior/posterior in 30 degrees of flexion with
+119 ;; foot stabilized - normal is less than 5 mm. of motion
+120 ;; (1/4 inch - Lachman's test) or in 90 degrees of flexion
+121 ;; with foot stabilized - normal is less than 5mm. of motion
+122 ;; (1/4 inch - anterior and posterior drawer test).
+123 ;;
+124 ;; Medial and Lateral Meniscus: Perform McMurray's test.
+125 ;;
+126 ;;
+127 ;; 3. Ankle range of motion:
+128 ;;
+129 ;; a. Neutral position is with foot at 90 degrees to
+130 ;; ankle. From that position, dorsiflexion is 0 to 20
+131 ;; degrees; plantar flexion is 0 to 45 degrees.
+132 ;; b. Describe any varus or valgus angulation of the
+133 ;; os calcis in relationship to the long axis of the
+134 ;; 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
+143 ;; forearm is measured with the arm
+144 ;; against the body, the elbow
+145 ;; flexed to 90 degrees, and the
+146 ;; forearm in mid position (zero
+147 ;; degrees) between supination and
+148 ;; pronation.
+149 ;; ii. Shoulder rotation is measured
+150 ;; with the arm abducted to 90
+151 ;; degrees, the elbow flexed to 90
+152 ;; degrees, and the forearm
+153 ;; reflecting the midpoint (zero
+154 ;; degrees) between internal and
+155 ;; external rotation of the shoulder.
+156 ;;
+157 ;; b. Shoulder forward flexion = zero to 180
+158 ;; degrees.
+159 ;; c. Shoulder abduction = zero to 180 degrees.
+160 ;; d. Shoulder external rotation = zero to 90
+161 ;; degrees.
+162 ;; e. Shoulder internal rotation = zero to 90
+163 ;; degrees.
+164 ;; f. Elbow flexion = zero to 145 degrees.
+165 ;; g. Forearm supination = zero to 85 degrees.
+166 ;; h. Forearm pronation = zero to 80 degrees.
+167 ;; i. Wrist dorsiflexion (extension) = zero to 70
+168 ;; degrees.
+169 ;; j. Wrist palmar flexion = zero to 80 degrees.
+170 ;; k. Wrist radial deviation = zero to 20 degrees.
+171 ;; l. Wrist ulnar deviation = zero to 45 degrees.
+172 ;;
+173 ;;
+174 ;;E. Diagnostic and Clinical Tests:
+175 ;;
+176 ;; 1. As indicated: X-rays, including special views or weight
+177 ;; bearing films, MRI, arthrogram, diagnostic arthroscopy.
+178 ;; NOTE: The diagnosis of degenerative arthritis or post-
+179 ;; traumatic arthritis of a joint requires X-ray confirmation. Once
+180 ;; the diagnosis has been confirmed in a joint, further X-rays of
+181 ;; that joint are not required.
+182 ;; 2. Include results of all diagnostic and clinical tests in the
+183 ;; examination report.
+184 ;;
+185 ;;
+186 ;;F. Diagnosis:
+187 ;;
+188 ;;
+189 ;;G. Additional Limitation of Joint Function:
+190 ;;
+191 ;; Impairment of joint function is determined by actual range of joint
+192 ;; motion as reported in the physical examination and additional limitation
+193 ;; of joint function caused by the following factors:
+194 ;;
+195 ;; - Pain, including pain on repeated use and pain during flare-ups
+196 ;; - Fatigue
+197 ;; - Weakness
+198 ;; - Lack of endurance
+199 ;; - Incoordination
+200 ;;
+201 ;; 1. Do any of the above factors additionally limit joint function?
+202 ;; If so, express the additional limitation in degrees.
+203 ;;
+204 ;; 2. Indicate if you cannot determine, without resort to mere
+205 ;; speculation, whether any of these factors cause additional functional
+206 ;; loss. For example, indicate if you would need to resort to mere
+207 ;; speculation in order to express additional limitation due to
+208 ;; flare-ups.
+209 ;;
+210 ;;
+211 ;;
+212 ;;Signature: Date:
+213 ;;END
