Home   Package List   Routine Alphabetical List   Global Alphabetical List   FileMan Files List   FileMan Sub-Files List   Package Component Lists   Package-Namespace Mapping  
Routine: DVBCWJW7

DVBCWJW7.m

Go to the documentation of this file.
  1. DVBCWJW7 ;ALB/RLC JOINTS WKS TEXT - 1 ; 7 APRIL 2005
  1. ;;2.7;AMIE;**144**;FEB 17, 2004;Build 5
  1. ;
  1. ;
  1. TXT ;
  1. ;;A. Review of Medical Records:
  1. ;;
  1. ;;
  1. ;;B. Medical History (Subjective Complaints):
  1. ;;
  1. ;; Comment on:
  1. ;;
  1. ;; 1. Date, circumstances of onset, and course since onset.
  1. ;; 2. Pain, weakness, stiffness, deformity, instability or giving way,
  1. ;; "locking," weakness, lack of endurance, effusion, episodes of
  1. ;; dislocation or subluxation, etc.
  1. ;; 3. Signs of inflammation: swelling, heat, redness, tenderness or
  1. ;; drainage.
  1. ;; 4. Treatment - type, include dose for medication, frequency, response,
  1. ;; side effects.
  1. ;; 5. If there are periods of flare-up of joint disease:
  1. ;;
  1. ;; a. State their severity, frequency, and duration.
  1. ;; b. Name the precipitating and alleviating factors.
  1. ;; c. State to what extent, if any, per veteran, they
  1. ;; result in additional limitation of motion or
  1. ;; functional impairment (e.g., pain, weakness, fatigue, speed,
  1. ;; or incoordination) during the flare-up.
  1. ;;
  1. ;; 6. Describe whether crutches, brace, cane, corrective shoes,
  1. ;; etc., are needed.
  1. ;; 7. Describe details of any hospitalizations, surgery or injury.
  1. ;; 8. For inflammatory arthritis, describe any constitutional
  1. ;; symptoms and number and duration of incapacitating exacerbations
  1. ;; per year.
  1. ;; 9. Describe the effects of the condition on the veteran's usual
  1. ;; occupation and daily activities.
  1. ;; 10. Describe functional limitations on standing and walking.
  1. ;; 11. Dominance of extremity and means used to identify dominant
  1. ;; extremity.
  1. ;; 12. If there is a prosthesis, provide date of prosthetic implant
  1. ;; and describe any complaint of pain, weakness, or limitation
  1. ;; of motion.
  1. ;; 13. History of neoplasm:
  1. ;;
  1. ;; a. Date of diagnosis, diagnosis.
  1. ;; b. Benign or malignant.
  1. ;; c. Type and date(s) of treatment.
  1. ;; d. Last date of treatment.
  1. ;;
  1. ;;
  1. ;;C. Physical Examination (Objective Findings):
  1. ;;
  1. ;; Address each of the following as appropriate to the condition
  1. ;; being examined and fully describe current findings: A DETAILED
  1. ;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED, INCLUDING JOINTS
  1. ;; WITH PROSTHESES.
  1. ;;
  1. ;; 1. Using a goniometer, measure the ACTIVE range of motion, of the
  1. ;; unaffected joint (if normal) than the affected. Provide range of
  1. ;; motion in degrees.
  1. ;; 2. Describe presence of objective evidence of pain in the affected
  1. ;; joint at rest and during active range of motion.
  1. ;; 3. Describe objective evidence of edema, effusion, instability,
  1. ;; tenderness, redness, heat, abnormal movement, guarding of movement,
  1. ;; deformity, malalignment, drainage, weakness, etc.
  1. ;; 4. For weight bearing joints (hip, knee, ankle), describe gait.
  1. ;; Describe any callosities, breakdown, or unusual shoe wear pattern
  1. ;; that would indicate abnormal weight bearing.
  1. ;; 5. If ankylosis is present, describe the position of the bones of
  1. ;; the joint in relationship to one another (in degrees of flexion,
  1. ;; external rotation, etc.), and state whether the ankylosis is
  1. ;; stable and pain free.
  1. ;; 6. If indicated, measure the leg length from the anterior
  1. ;; superior iliac spine to the medial malleolus.
  1. ;; 7. For INFLAMMATORY ARTHRITIS, describe any constitutional signs and
  1. ;; extra-articular manifestations (Follow appropriate worksheet for
  1. ;; required examination findings). State whether disease is active
  1. ;; and extent of overall impairment of health.
  1. ;; 8. Describe range of motion with prosthesis in same detail as described
  1. ;; above for nonprosthetic joints.
  1. ;;
  1. ;;
  1. ;;D. Loss of Joint Function with Use:
  1. ;;
  1. ;; Impairment of joint function is determine by range of joint motion as
  1. ;; reported in the physical examination and additional loss of range of
  1. ;; motion after repetitive use caused by the following factors:
  1. ;;
  1. ;; - Pain
  1. ;; - Fatigue
  1. ;; - Weakness
  1. ;; - Lack of endurance
  1. ;; - Incoordination
  1. ;;
  1. ;; Have the veteran move the affected joint/joints through repetitive active
  1. ;; range of motion, as tolerated (maximum of 3 repetitions). After
  1. ;; repetitive motion, re-measure the range of motion of the affected joint/
  1. ;; joints. Do any of the above factors cause any additional loss of range
  1. ;; of motion? If so, record the re-measured range of motion and the
  1. ;; predominant factor causing the change in motion.
  1. ;;
  1. ;; If repetitive active range of motion of a joint cannot be done, state
  1. ;; so and give the reason.
  1. ;;
  1. ;;
  1. ;;E. Normal Range of Motion: All joint Range of Motion measurements
  1. ;;must be made using a goniometer. Show each measured range of motion
  1. ;;separately rather than as a continuum. For example, if the veteran
  1. ;;lacks 10 degrees of full knee extension and has normal flexion, show
  1. ;;the range of motion as extension to minus 10 degrees (or lacks 10
  1. ;;degrees of extension) and flexion 10 to 140 degrees.
  1. ;;
  1. ;; 1. Hip range of motion: (Movement of femur as it rotates in the
  1. ;; acetabulum.)
  1. ;;
  1. ;; a. Normal range of motion, using the anatomical
  1. ;; position as zero degrees.
  1. ;;
  1. ;; Flexion = 0 to 125 degrees (To gain a true picture of hip
  1. ;; flexion, i.e., movement between the pelvis and femur in
  1. ;; the hip joint, the opposite thigh should be extended to
  1. ;; minimize motion between the pelvis and spine.)
  1. ;;
  1. ;; Extension = 0 to 30 degrees.
  1. ;;
  1. ;; Adduction = 0 to 25 degrees.
  1. ;;
  1. ;; Abduction = 0 to 45 degrees.
  1. ;;
  1. ;; External rotation = 0 to 60 degrees.
  1. ;;
  1. ;; Internal rotation = 0 to 40 degrees.
  1. ;;
  1. ;;
  1. ;; 2. Knee range of motion:
  1. ;;
  1. ;; a. Normal range of motion, using the anatomical
  1. ;; position as zero degrees.
  1. ;;
  1. ;; Flexion = 0 to 140 degrees.
  1. ;;
  1. ;; Extension - zero degrees = full extension. Show loss of
  1. ;; extension by describing the degrees in which extension is
  1. ;; not possible. (e.g., Show range of motion as extension to
  1. ;; minus 10 degrees and flexion 10 to 140 degrees when full
  1. ;; extension is limited by 10 degrees and full flexion is
  1. ;; possible.)
  1. ;;
  1. ;; b. Stability.
  1. ;;
  1. ;; Medial and Lateral Collateral Ligaments:
  1. ;; Varus/valgus in neutral and in 30 degrees of flexion -
  1. ;; normal is no motion.
  1. ;;
  1. ;; Anterior and Posterior Cruciate Ligaments:
  1. ;; Anterior/posterior in 30 degrees of flexion with
  1. ;; foot stabilized - normal is less than 5 mm. of motion
  1. ;; (1/4 inch - Lachman's test) or in 90 degrees of flexion
  1. ;; with foot stabilized - normal is less than 5mm. of motion
  1. ;; (1/4 inch - anterior and posterior drawer test).
  1. ;;
  1. ;; Medial and Lateral Meniscus: Perform McMurray's test.
  1. ;;
  1. ;;
  1. ;; 3. Ankle range of motion:
  1. ;;
  1. ;; a. Neutral position is with foot at 90 degrees to
  1. ;; ankle. From that position, dorsiflexion is 0 to 20
  1. ;; degrees; plantar flexion is 0 to 45 degrees.
  1. ;; b. Describe any varus or valgus angulation of the
  1. ;; os calcis in relationship to the long axis of the
  1. ;; tibia and fibula.
  1. ;;
  1. ;;
  1. ;; 4. Shoulder, elbow, forearm, and wrist range of motion:
  1. ;;
  1. ;; a. Normal range of motion is measured with zero degrees the
  1. ;; anatomical position except for 2 situations:
  1. ;;
  1. ;; i. Supination and pronation of the
  1. ;; forearm is measured with the arm
  1. ;; against the body, the elbow
  1. ;; flexed to 90 degrees, and the
  1. ;; forearm in mid position (zero
  1. ;; degrees) between supination and
  1. ;; pronation.
  1. ;; ii. Shoulder rotation is measured
  1. ;; with the arm abducted to 90
  1. ;; degrees, the elbow flexed to 90
  1. ;; degrees, and the forearm
  1. ;; reflecting the midpoint (zero
  1. ;; degrees) between internal and
  1. ;; external rotation of the shoulder.
  1. ;;
  1. ;; b. Shoulder forward flexion = zero to 180
  1. ;; degrees.
  1. ;; c. Shoulder abduction = zero to 180 degrees.
  1. ;; d. Shoulder external rotation = zero to 90
  1. ;; degrees.
  1. ;; e. Shoulder internal rotation = zero to 90
  1. ;; degrees.
  1. ;; f. Elbow flexion = zero to 145 degrees.
  1. ;; g. Forearm supination = zero to 85 degrees.
  1. ;; h. Forearm pronation = zero to 80 degrees.
  1. ;; i. Wrist dorsiflexion (extension) = zero to 70
  1. ;; degrees.
  1. ;; j. Wrist palmar flexion = zero to 80 degrees.
  1. ;; k. Wrist radial deviation = zero to 20 degrees.
  1. ;; l. Wrist ulnar deviation = zero to 45 degrees.
  1. ;;
  1. ;;
  1. ;;F. Diagnostic and Clinical Tests:
  1. ;;
  1. ;; 1. As indicated: X-rays, including special views or weight
  1. ;; bearing films, MRI, arthrogram, diagnostic arthroscopy.
  1. ;; NOTE: The diagnosis of degenerative arthritis or post-
  1. ;; traumatic arthritis of a joint requires X-ray confirmation. Once
  1. ;; the diagnosis has been confirmed in a joint, further X-rays of
  1. ;; that joint are not required.
  1. ;; 2. Include results of all diagnostic and clinical tests in the
  1. ;; examination report.
  1. ;;
  1. ;;
  1. ;;G. Diagnosis:
  1. ;;
  1. ;; For subluxation or instability of the knee, indicate whether it is
  1. ;; slight, moderate or severe.
  1. ;;
  1. ;;
  1. ;;
  1. ;;Signature: Date:
  1. ;;END