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Inspection Normal
Inspection Abnormal
Sensory
Sensory Right
• • •
sensory Rt Location
• • •
Sensory Left
• • •
sensory Lt Location
• • •
Motor strenght Left
• • •
Motor strengt Rt
• • •
ROM Flexion Normal
ROM Flexion Abn N=80
ROM passive flexion normal
ROM passive flexion Abn
ROM Extension Normal
ROM Extension Abn
ROM Passive Extension
ROM Passive Extension Abn
ROM Rotation Normal N=60
ROM Rotation Right
ROM Rotation Left N=60
passive rotation normal
ROM Passive Rotation Right
ROM Passive Rotation Left N60
ROM Sidebending Normal
ROM Sidebending Right
ROM Sidebending Left
Passive Sidebending Normal
Passive Sidebending Right
Passive Sidebending Left
Musculature Normal
Musculature Right
• • •
Musculature Rt Location
• • •
Musculature Left
• • •
Musculature Lt Location
• • •
Sacrum Normal
Sacrum Right
• • •
Sacrum Left
• • •
Coccyx Normal
Coccyx Right
• • •
Coccyx Left
• • •
Sacroiliac Joint Normal
Sacroiliac Joint Right
• • •
Sacroiliac Joint Left
• • •
Knee Reflex Normal
Knee Reflex Right
Knee Reflex Left
Ankle Reflex Normal
Ankle Reflex Right
Ankle Reflex Left
EHL Strength Normal
EHL Strength Right
EHL Strength Left
FHL Strength Normal
FHL Strength Right
FHL Strength left
Dermatomes Normal
Dermatomes Right
• • •
Dermatomes Left
• • •
Anterior Tibialis Normal
Anterior Tibialis Right
Anterior Tibialis Left
Gastroc-Soleus Normal
Gastroc-Soleus Right
Gastroc-Soleus Left
Hamstrings Strength Normal
Hamstring Strength Right
Hamstring Strength Left
Quadriceps Strength Normal
Quadriceps Strength Right
Quadriceps Strength Left
Anterior Thigh Normal
Anterior Thigh Right
• • •
Anterior Thigh Left
• • •
Calf Sensation Normal
Calf Sensation Right
• • •
Calf Sensation Left
• • •
Foot Sensation
Foot Sensation Right
• • •
Foot Sensation Left
• • •
Stocking/Glove Distribution
Patrick Test
• • •
Patrick Test Definition
Kernig Test
• • •
Kernig Test Definition
Trendelenburg Sign
• • •
Trendelenburg Sign Definition
Milgram Test
• • •
Milgram Test Definition
Hoover Test
• • •
Hoover Test Definition
SLR/Sitting Root Normal
SLR/Sitting Root Right
SLR/Sitting Root Rt Degrees
SLR/Sitting Root Left
SLR/Sitting Root Lt Degrees
Gait Normal
Gait Right
• • •
Gait Left
• • •
Toe and Heel Walk
Long Tract/Clonus Normal
Long Tract/Clonus Right
Long Tract/Clonus Left
Medial/Malleolar Tinel's Norm
Medial/Malleolar Tinel's Right
Medial/Malleolar Tinel's Left
Capillary Filling Normal
Capillary Filling Right
• • •
Capillary Filling Left
• • •
Previous surgical wound
Surgical wound signs
• • •
other
lumbar diagram

Lumbar Spine Examination Medical Form

Pain Management Specialist

lumber spine exam

There are 4 copies in use.
Published: April 17, 2015, 9:14 p.m.
Doctor: Dr. History Physical
Rating: 0   /

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