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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