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Pain Diagram
Observation
Observation WNL
Antalgia
[+] Antalgia Comments
• • •
Bruising
[+] Bruising Comments
• • •
Swelling
[+] Swelling Comments
• • •
Redness
[+] Redness Comments
• • •
ABN Posture
• • •
Scoliosis
[+] Scoliosis Comments
• • •
Cervical Spine ROM Exam
ROM WNL
Flexion (60)
Flexion Symptoms
• • •
Extension (60)
Extension Symptoms
• • •
Left Lateral Flexion (45)
LLF Symptoms
• • •
Right Lateral Flexion (45)
RLF Symptoms
• • •
Left Rotation (80)
LR Symptoms
• • •
Right Rotation (80)
RR Symptoms
• • •
DTR
DTR WNL
Left C5
Right C5
Left C6
Right C6
Left C7
Right C7
Light Touch
Light Touch WNL
Left C5 Dermatome
Right C5 Dermatome
Left C6 Dermatome
Right C6 Dermatome
Left C7 Dermatome
Right C7 Dermatome
Left C8 Dermatome
Right C8 Dermatome
Left T1 Dermatome
Right T1 Dermatome
Motor Function
Motor Function WNL
Left C5 Myotome - Shoulder ABD
Right C5 Myotome - Shoulder ABD
Left C6 Myotome - Wrist Ext
Right C6 Myotome - Wrist Ext
Left C7 Myotome - Wrist Flex
Right C7 Myotome - Wrist Flex
Left C8 Myotome - Finger Flex
Right C8 Myotome - Finger Flex
Left T1 Myotome - Finger ABD
Right T1 Myotome - Finger ABD
Othopedic Tests
Valsalva Maneuver
L'hermitte's Sign
Bakody's Sign
Spinous Percussion
[+] Spinous Percussion
• • •
Cervical Distraction
[+] Cervical Distraction Comments
• • •
LEFT Jackson's Comp.Test
[+] LEFT Jackson's Test Comments
• • •
RIGHT Jackson's Comp.Test
[+] RIGHT Jackson's Test Comments
• • •
LEFT Max. Foraminal Comp.Test
[+] LEFT MFC Comments
• • •
RIGHT Max. Foraminal Comp.Test
[+] RIGHT MFC Comments
• • •
LEFT Shoulder Depression Test
[+] LEFT Shoulder Depression
• • •
RIGHT Shoulder Depression Test
[+] RIght Shoulder Depression
• • •
LEFT O'Donoghue's Maneuver
[+] LEFT O'Donoghue's Maneuver
• • •
RIGHT O'Donoghue's Maneuver
[+] RIGHT O'Donoghue's Maneuver
• • •

Cervicothoracic Exam Medical Form

Chiropractor

Chiro Cervicothoracic Orthopedic Exam

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Published: Aug. 7, 2015, 5:13 p.m.
Doctor: Dr. History Physical
Rating: +32   /

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