Evidence of use despite other claim Discussion
Evidence of use despite claims to the contrary: When a patient has pain,
weakness or other problems which severely restrict normal use of the hand
or arm on a daily basis for a period of several weeks or more, use -
related trophic changes disappear and spontaneous hand gesturing during
speech is affected in a characteristic way. Evidence of continued use
includes maintenance of callus thickness, preservation of symmetric muscle
bulk, and evidence of use - related skin or nail plate trauma.
Discrepancies between descriptions of longstanding severe functional
impairment and objective evidence of current use casts considerable doubt
as to the validity of the patient's story. In this context, the expected
response to treatment is less predictable and the chance of delayed,
temporary or incomplete recovery is increased.
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