DVBCWJW7 ;ALB/RLC JOINTS WKS TEXT - 1 ; 7 APRIL 2005
;;2.7;AMIE;**144**;FEB 17, 2004;Build 5
;
;
TXT ;
;;A. Review of Medical Records:
;;
;;
;;B. Medical History (Subjective Complaints):
;;
;; Comment on:
;;
;; 1. Date, circumstances of onset, and course since onset.
;; 2. Pain, weakness, stiffness, deformity, instability or giving way,
;; "locking," weakness, lack of endurance, effusion, episodes of
;; dislocation or subluxation, etc.
;; 3. Signs of inflammation: swelling, heat, redness, tenderness or
;; drainage.
;; 4. Treatment - type, include dose for medication, frequency, response,
;; side effects.
;; 5. 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 (e.g., pain, weakness, fatigue, speed,
;; or incoordination) during the flare-up.
;;
;; 6. Describe whether crutches, brace, cane, corrective shoes,
;; etc., are needed.
;; 7. Describe details of any hospitalizations, surgery or injury.
;; 8. For inflammatory arthritis, describe any constitutional
;; symptoms and number and duration of incapacitating exacerbations
;; per year.
;; 9. Describe the effects of the condition on the veteran's usual
;; occupation and daily activities.
;; 10. Describe functional limitations on standing and walking.
;; 11. Dominance of extremity and means used to identify dominant
;; extremity.
;; 12. If there is a prosthesis, provide date of prosthetic implant
;; and describe any complaint of pain, weakness, or limitation
;; of motion.
;; 13. History of neoplasm:
;;
;; a. Date of diagnosis, diagnosis.
;; b. Benign or malignant.
;; c. Type and date(s) of treatment.
;; d. Last date of treatment.
;;
;;
;;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 ACTIVE range of motion, of the
;; unaffected joint (if normal) than the affected. Provide range of
;; motion in degrees.
;; 2. Describe presence of objective evidence of pain in the affected
;; joint at rest and during active range of motion.
;; 3. Describe objective evidence of edema, effusion, instability,
;; tenderness, redness, heat, abnormal movement, guarding of movement,
;; deformity, malalignment, drainage, weakness, etc.
;; 4. For weight bearing joints (hip, knee, ankle), describe gait.
;; Describe any callosities, breakdown, or unusual shoe wear pattern
;; that would indicate abnormal weight bearing.
;; 5. 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.
;; 6. If indicated, measure the leg length from the anterior
;; superior iliac spine to the medial malleolus.
;; 7. For INFLAMMATORY ARTHRITIS, describe any constitutional signs and
;; extra-articular manifestations (Follow appropriate worksheet for
;; required examination findings). State whether disease is active
;; and extent of overall impairment of health.
;; 8. Describe range of motion with prosthesis in same detail as described
;; above for nonprosthetic joints.
;;
;;
;;D. Loss of Joint Function with Use:
;;
;; Impairment of joint function is determine by range of joint motion as
;; reported in the physical examination and additional loss of range of
;; motion after repetitive use caused by the following factors:
;;
;; - Pain
;; - Fatigue
;; - Weakness
;; - Lack of endurance
;; - Incoordination
;;
;; Have the veteran move the affected joint/joints through repetitive active
;; range of motion, as tolerated (maximum of 3 repetitions). After
;; repetitive motion, re-measure the range of motion of the affected joint/
;; joints. Do any of the above factors cause any additional loss of range
;; of motion? If so, record the re-measured range of motion and the
;; predominant factor causing the change in motion.
;;
;; If repetitive active range of motion of a joint cannot be done, state
;; so and give the reason.
;;
;;
;;E. 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 10 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 10 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.
;;
;;
;;F. 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.
;;
;;
;;G. Diagnosis:
;;
;; For subluxation or instability of the knee, indicate whether it is
;; slight, moderate or severe.
;;
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWJW7 10373 printed Apr 09, 2024@20:49:08 Page 2
DVBCWJW7 ;ALB/RLC JOINTS WKS TEXT - 1 ; 7 APRIL 2005
+1 ;;2.7;AMIE;**144**;FEB 17, 2004;Build 5
+2 ;
+3 ;
TXT ;
+1 ;;A. Review of Medical Records:
+2 ;;
+3 ;;
+4 ;;B. Medical History (Subjective Complaints):
+5 ;;
+6 ;; Comment on:
+7 ;;
+8 ;; 1. Date, circumstances of onset, and course since onset.
+9 ;; 2. Pain, weakness, stiffness, deformity, instability or giving way,
+10 ;; "locking," weakness, lack of endurance, effusion, episodes of
+11 ;; dislocation or subluxation, etc.
+12 ;; 3. Signs of inflammation: swelling, heat, redness, tenderness or
+13 ;; drainage.
+14 ;; 4. Treatment - type, include dose for medication, frequency, response,
+15 ;; side effects.
+16 ;; 5. If there are periods of flare-up of joint disease:
+17 ;;
+18 ;; a. State their severity, frequency, and duration.
+19 ;; b. Name the precipitating and alleviating factors.
+20 ;; c. State to what extent, if any, per veteran, they
+21 ;; result in additional limitation of motion or
+22 ;; functional impairment (e.g., pain, weakness, fatigue, speed,
+23 ;; or incoordination) during the flare-up.
+24 ;;
+25 ;; 6. Describe whether crutches, brace, cane, corrective shoes,
+26 ;; etc., are needed.
+27 ;; 7. Describe details of any hospitalizations, surgery or injury.
+28 ;; 8. For inflammatory arthritis, describe any constitutional
+29 ;; symptoms and number and duration of incapacitating exacerbations
+30 ;; per year.
+31 ;; 9. Describe the effects of the condition on the veteran's usual
+32 ;; occupation and daily activities.
+33 ;; 10. Describe functional limitations on standing and walking.
+34 ;; 11. Dominance of extremity and means used to identify dominant
+35 ;; extremity.
+36 ;; 12. If there is a prosthesis, provide date of prosthetic implant
+37 ;; and describe any complaint of pain, weakness, or limitation
+38 ;; of motion.
+39 ;; 13. History of neoplasm:
+40 ;;
+41 ;; a. Date of diagnosis, diagnosis.
+42 ;; b. Benign or malignant.
+43 ;; c. Type and date(s) of treatment.
+44 ;; d. Last date of treatment.
+45 ;;
+46 ;;
+47 ;;C. Physical Examination (Objective Findings):
+48 ;;
+49 ;; Address each of the following as appropriate to the condition
+50 ;; being examined and fully describe current findings: A DETAILED
+51 ;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED, INCLUDING JOINTS
+52 ;; WITH PROSTHESES.
+53 ;;
+54 ;; 1. Using a goniometer, measure the ACTIVE range of motion, of the
+55 ;; unaffected joint (if normal) than the affected. Provide range of
+56 ;; motion in degrees.
+57 ;; 2. Describe presence of objective evidence of pain in the affected
+58 ;; joint at rest and during active range of motion.
+59 ;; 3. Describe objective evidence of edema, effusion, instability,
+60 ;; tenderness, redness, heat, abnormal movement, guarding of movement,
+61 ;; deformity, malalignment, drainage, weakness, etc.
+62 ;; 4. For weight bearing joints (hip, knee, ankle), describe gait.
+63 ;; Describe any callosities, breakdown, or unusual shoe wear pattern
+64 ;; that would indicate abnormal weight bearing.
+65 ;; 5. If ankylosis is present, describe the position of the bones of
+66 ;; the joint in relationship to one another (in degrees of flexion,
+67 ;; external rotation, etc.), and state whether the ankylosis is
+68 ;; stable and pain free.
+69 ;; 6. If indicated, measure the leg length from the anterior
+70 ;; superior iliac spine to the medial malleolus.
+71 ;; 7. For INFLAMMATORY ARTHRITIS, describe any constitutional signs and
+72 ;; extra-articular manifestations (Follow appropriate worksheet for
+73 ;; required examination findings). State whether disease is active
+74 ;; and extent of overall impairment of health.
+75 ;; 8. Describe range of motion with prosthesis in same detail as described
+76 ;; above for nonprosthetic joints.
+77 ;;
+78 ;;
+79 ;;D. Loss of Joint Function with Use:
+80 ;;
+81 ;; Impairment of joint function is determine by range of joint motion as
+82 ;; reported in the physical examination and additional loss of range of
+83 ;; motion after repetitive use caused by the following factors:
+84 ;;
+85 ;; - Pain
+86 ;; - Fatigue
+87 ;; - Weakness
+88 ;; - Lack of endurance
+89 ;; - Incoordination
+90 ;;
+91 ;; Have the veteran move the affected joint/joints through repetitive active
+92 ;; range of motion, as tolerated (maximum of 3 repetitions). After
+93 ;; repetitive motion, re-measure the range of motion of the affected joint/
+94 ;; joints. Do any of the above factors cause any additional loss of range
+95 ;; of motion? If so, record the re-measured range of motion and the
+96 ;; predominant factor causing the change in motion.
+97 ;;
+98 ;; If repetitive active range of motion of a joint cannot be done, state
+99 ;; so and give the reason.
+100 ;;
+101 ;;
+102 ;;E. Normal Range of Motion: All joint Range of Motion measurements
+103 ;;must be made using a goniometer. Show each measured range of motion
+104 ;;separately rather than as a continuum. For example, if the veteran
+105 ;;lacks 10 degrees of full knee extension and has normal flexion, show
+106 ;;the range of motion as extension to minus 10 degrees (or lacks 10
+107 ;;degrees of extension) and flexion 10 to 140 degrees.
+108 ;;
+109 ;; 1. Hip range of motion: (Movement of femur as it rotates in the
+110 ;; acetabulum.)
+111 ;;
+112 ;; a. Normal range of motion, using the anatomical
+113 ;; position as zero degrees.
+114 ;;
+115 ;; Flexion = 0 to 125 degrees (To gain a true picture of hip
+116 ;; flexion, i.e., movement between the pelvis and femur in
+117 ;; the hip joint, the opposite thigh should be extended to
+118 ;; minimize motion between the pelvis and spine.)
+119 ;;
+120 ;; Extension = 0 to 30 degrees.
+121 ;;
+122 ;; Adduction = 0 to 25 degrees.
+123 ;;
+124 ;; Abduction = 0 to 45 degrees.
+125 ;;
+126 ;; External rotation = 0 to 60 degrees.
+127 ;;
+128 ;; Internal rotation = 0 to 40 degrees.
+129 ;;
+130 ;;
+131 ;; 2. Knee range of motion:
+132 ;;
+133 ;; a. Normal range of motion, using the anatomical
+134 ;; position as zero degrees.
+135 ;;
+136 ;; Flexion = 0 to 140 degrees.
+137 ;;
+138 ;; Extension - zero degrees = full extension. Show loss of
+139 ;; extension by describing the degrees in which extension is
+140 ;; not possible. (e.g., Show range of motion as extension to
+141 ;; minus 10 degrees and flexion 10 to 140 degrees when full
+142 ;; extension is limited by 10 degrees and full flexion is
+143 ;; possible.)
+144 ;;
+145 ;; b. Stability.
+146 ;;
+147 ;; Medial and Lateral Collateral Ligaments:
+148 ;; Varus/valgus in neutral and in 30 degrees of flexion -
+149 ;; normal is no motion.
+150 ;;
+151 ;; Anterior and Posterior Cruciate Ligaments:
+152 ;; Anterior/posterior in 30 degrees of flexion with
+153 ;; foot stabilized - normal is less than 5 mm. of motion
+154 ;; (1/4 inch - Lachman's test) or in 90 degrees of flexion
+155 ;; with foot stabilized - normal is less than 5mm. of motion
+156 ;; (1/4 inch - anterior and posterior drawer test).
+157 ;;
+158 ;; Medial and Lateral Meniscus: Perform McMurray's test.
+159 ;;
+160 ;;
+161 ;; 3. Ankle range of motion:
+162 ;;
+163 ;; a. Neutral position is with foot at 90 degrees to
+164 ;; ankle. From that position, dorsiflexion is 0 to 20
+165 ;; degrees; plantar flexion is 0 to 45 degrees.
+166 ;; b. Describe any varus or valgus angulation of the
+167 ;; os calcis in relationship to the long axis of the
+168 ;; tibia and fibula.
+169 ;;
+170 ;;
+171 ;; 4. Shoulder, elbow, forearm, and wrist range of motion:
+172 ;;
+173 ;; a. Normal range of motion is measured with zero degrees the
+174 ;; anatomical position except for 2 situations:
+175 ;;
+176 ;; i. Supination and pronation of the
+177 ;; forearm is measured with the arm
+178 ;; against the body, the elbow
+179 ;; flexed to 90 degrees, and the
+180 ;; forearm in mid position (zero
+181 ;; degrees) between supination and
+182 ;; pronation.
+183 ;; ii. Shoulder rotation is measured
+184 ;; with the arm abducted to 90
+185 ;; degrees, the elbow flexed to 90
+186 ;; degrees, and the forearm
+187 ;; reflecting the midpoint (zero
+188 ;; degrees) between internal and
+189 ;; external rotation of the shoulder.
+190 ;;
+191 ;; b. Shoulder forward flexion = zero to 180
+192 ;; degrees.
+193 ;; c. Shoulder abduction = zero to 180 degrees.
+194 ;; d. Shoulder external rotation = zero to 90
+195 ;; degrees.
+196 ;; e. Shoulder internal rotation = zero to 90
+197 ;; degrees.
+198 ;; f. Elbow flexion = zero to 145 degrees.
+199 ;; g. Forearm supination = zero to 85 degrees.
+200 ;; h. Forearm pronation = zero to 80 degrees.
+201 ;; i. Wrist dorsiflexion (extension) = zero to 70
+202 ;; degrees.
+203 ;; j. Wrist palmar flexion = zero to 80 degrees.
+204 ;; k. Wrist radial deviation = zero to 20 degrees.
+205 ;; l. Wrist ulnar deviation = zero to 45 degrees.
+206 ;;
+207 ;;
+208 ;;F. Diagnostic and Clinical Tests:
+209 ;;
+210 ;; 1. As indicated: X-rays, including special views or weight
+211 ;; bearing films, MRI, arthrogram, diagnostic arthroscopy.
+212 ;; NOTE: The diagnosis of degenerative arthritis or post-
+213 ;; traumatic arthritis of a joint requires X-ray confirmation. Once
+214 ;; the diagnosis has been confirmed in a joint, further X-rays of
+215 ;; that joint are not required.
+216 ;; 2. Include results of all diagnostic and clinical tests in the
+217 ;; examination report.
+218 ;;
+219 ;;
+220 ;;G. Diagnosis:
+221 ;;
+222 ;; For subluxation or instability of the knee, indicate whether it is
+223 ;; slight, moderate or severe.
+224 ;;
+225 ;;
+226 ;;
+227 ;;Signature: Date:
+228 ;;END
