Appendix

FCEase Manual

Upper Limb Testing

These tests should be added to Upper Limb Testing.

Maximum Static Lateral Pinch

The 0-30 pound Pinch Dynamometer is used for this test and should be supported by the examiner. The outside silver dial of the Pinch Dynamometer can be moved to reset the black needle on zero (0). The elbow should be held at the employee’s side and bent to 90 with the forearm in neutral position. The thumb should be on top against the side of the index finger (as if employee is holding a key). Employee should be encouraged to continue squeezing until a brachioradialis (major forearm muscle) muscle contraction is observed and/or the dynamometer reading begins to decrease. Employee gave maximum effort if brachioradialis (major forearm muscle) contraction was noted and dynamometer reading began to decrease. Employee’s facial expressions should be observed during the test, and employee comments during and after the test should be recorded.

Dynamometer results should be read in pounds on the outer dial. Retest if there is a five pound or greater difference between the left and right side with the pinch dynamometer and/or if examiner feels employee did not comprehend instructions. The average of three attempts should be recorded.

When an employee pinches close to 30 pounds, care should be taken to reset the needles correctly. This is done by turning the small silver knob counter-clockwise so that the red and black needles move in conjunction during instrument use. If employee pinches 30 pounds or greater, results should be recorded as "at least 30 pounds".

Refer to norms as guidelines for interpretation. If an individual falls below the norms, it does not necessarily mean there is weakness. Significant information is provided by the left/right comparison rather than a comparison to the norms. Standard deviations from the norm are an indication of individual status.

Contraindications:

If the individual is presently under a doctor’s care or is seeing a therapist due to a hand or wrist injury or he/she is unable to grip the dynamometer.

Findings:

Abnormal: Five pound or greater difference between the average of the left and right sides.

Within Normal Limits: First attempt or the average of left and right is within five pounds.

Maximum Static 3 Point Pinch

The 0-30 pound Pinch Dynamometer is used for this test and should be supported by the examiner. The outside silver dial of the Pinch Dynamometer can be moved to reset the black needle on zero (0). The elbow should be held at the employee’s side and bent to 90 or more with forearm in pronation. This pinch is performed with the index and middle fingers on top against the pulp of the thumb. Employee should be encouraged to continue squeezing until a brachioradialis (major forearm muscle) muscle contraction is observed and/or the dynamometer reading begins to decrease. Employee gave maximum effort if brachioradialis (major forearm muscle) contraction was noted and dynamometer reading began to decrease. Employee’s facial expressions should be observed during the test, and employee comments during and after the test should be recorded.

Dynamometer results should be read in pounds on the outer dial. Retest if there is a five pound or greater difference between the left and right side with the pinch dynamometer and/or if examiner feels employee did not comprehend instructions. The average of three attempts should be recorded.

When an employee pinches close to 30 pounds, care should be taken to reset the needles correctly. This is done by turning the small silver knob counter-clockwise so that the red and black needles move in conjunction during instrument use. If employee pinches 30 pounds or greater, results should be recorded as "at least 30 pounds".

Refer to norms as guidelines for interpretation. If an individual falls below the norms, it does not necessarily mean there is weakness. Significant information is provided by the left/right comparison rather than a comparison to the norms. Standard deviations from the norm are an indication of individual status.

Contraindications:

If the individual is presently under a doctor’s care or is seeing a therapist due to a hand or wrist injury or he/she is unable to grip the dynamometer.

Findings:

Abnormal: Five pound or greater difference between the average of the left and right sides.

Within Normal Limits: First attempt or the average of left and right is within five pounds.

Maximum Static Pulp Pinch

The 0-30 pound Pinch Dynamometer is used for this test and should be supported by the examiner. The outside silver dial of the Pinch Dynamometer can be moved to reset the black needle on zero (0). The elbow should be held at the employee’s side and bent to 90 or more with forearm in pronation. This pinch is performed with the index finger on top against the pulp of the thumb. Employee should be encouraged to continue squeezing until a brachioradialis (major forearm muscle) muscle contraction is observed and/or the dynamometer reading begins to decrease. Employee gave maximum effort if brachioradialis (major forearm muscle) contraction was noted and dynamometer reading began to decrease. Employee’s facial expressions should be observed during the test, and employee comments during and after the test should be recorded. Repeat test if employee supinates forearm during the test.

Dynamometer results should be read in pounds on the outer dial. Retest if there is a five pound or greater difference between the left and right side with the pinch dynamometer and/or if examiner feels employee did not comprehend instructions. The average of three attempts should be recorded.

When an employee pinches close to 30 pounds, care should be taken to reset the needles correctly. This is done by turning the small silver knob counter-clockwise so that the red and black needles move in conjunction during instrument use. If employee pinches 30 pounds or greater, results should be recorded as "at least 30 pounds".

Refer to norms as guidelines for interpretation. If an individual falls below the norms, it does not necessarily mean there is weakness. Significant information is provided by the left/right comparison rather than a comparison to the norms. Standard deviations from the norm are an indication of individual status.

Contraindications:

If the individual is presently under a doctor’s care or is seeing a therapist due to a hand or wrist injury or he/she is unable to grip the dynamometer.

Findings:

Abnormal: Five pound or greater difference between the average of the left and right sides.

Within Normal Limits: First attempt or the average of left and right is within five pounds.

PINCH NORMS IN POUNDS*

Norms at Age (yr.):		20	30	40	50	60	70	75+
Lateral
Male	R	26	26	25	27	23	19	20
	L	26	26	25	26	22	19	19
Female	R	17	19	17	17	15	14	12
	L	16	18	16	16	14	14	11
3 Point Pinch
Male	R	26	25	24	24	22	18	19
	L	26	25	25	24	21	19	18
Female	R	17	19	17	17	15	14	12
	L	16	18	16	16	14	14	11
Pulp Pinch
Male	R	18	17	18	18	16	14	14
	L	17	17	18	18	15	13	14
Female	R	11	12	11	12	10	10	9
	L	10	12	11	11	10	10	9

WorkHab Functional Capacity Evaluation

As part of your Program, a WorkHab Functional Capacity Evaluation has been recommended. This is a comprehensive evaluation of your ability to perform a variety of activities and tasks. The information supplied by the FCE is helpful in providing the best program or safest work return for your needs.

The evaluation will take approximately 2 � hours to perform. A few suggestions that may help you before the evaluation.

Eat a good breakfast or lunch
Avoid fatty foods
Drink plenty of fluids

Wear – Loose comfortable clothing (gym clothes are ideal).

Men -

Shorts, shirt or T-shirt

Sports shoes or comfortable rubber soled shoes.

NO tight jeans

NO bare feet, sandals

Women -

Shorts, bike pants, blouse or T-shirt

Sports shoes or comfortable rubber soled shoes

NO bare feet, sandals or heeled shoes

NO long dresses or tight jeans

Each section of the evaluation will be explained prior to beginning the test.

The evaluation will be performed by ___________________________who is the ______________at _________________.

Your appointment is scheduled on __________________________at _____________ .
If you are unable to attend for any reason, please telephone John Smith Services at (123) 456-7890.

"SAMPLE LETTER TO CLIENT"

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