|
Right Hand Dominant?
|
|
|
Side
|
Location on hand
• • •
|
|
Type of problem
• • •
|
Description
|
|
Injury sustained?
|
Date of Injury
|
|
Physical Examination
|
|
|
Skin Normal
|
|
|
Skin right
• • •
|
Location right
• • •
|
|
Skin left
• • •
|
Location left
• • •
|
|
Skin Comments:
|
|
|
Tenderness Normal
|
|
|
Tenderness Right
|
Tenderness Rt Location
• • •
|
|
Tenderness Left
|
Tenderness Lt Location
• • •
|
|
Ecchymosis Normal
|
|
|
Ecchymosis Right
|
Ecchymosis Rt Location
• • •
|
|
Ecchymosis Left
|
Ecchymosis Lt Location
• • •
|
|
Swelling Normal
|
|
|
Swelling Right
|
Swelling Left
|
|
Thumb UCL/RCL Normal
|
|
|
Instability of UCL/RCL Right
• • •
|
Instability UCL/RCL Left
• • •
|
|
No Pain
|
|
|
Pain Right w/without motion
|
Pain Rt motion
• • •
|
|
Pain left with/without motion
|
Pain Lt motion
• • •
|
|
Pain Comments
|
|
|
ROM Digits Normal
|
|
|
ROM Digits Right
|
ROM Digits Left
|
|
Grip Strength Normal
|
|
|
Grip Strength Right
|
Grip Strength Left
|
|
No Mallet Fingers
|
|
|
Mallet Deformity Right
• • •
|
Mallet Deformity Left
• • •
|
|
Rotational Deformity (NONE)- Normal
|
|
|
Rotational Deformity Right
|
Rotational Deformity Left
|
|
No Trigger Fingers
|
|
|
Trigger Finger Right
|
Trigger Finger Rt Location
• • •
|
|
Trigger Finger Left
|
Trigger Finger Lt Location
• • •
|
|
Tinel's Normal
|
|
|
Tinel's Right
|
Tinel's Left
|
|
Phalen's Test Normal
|
|
|
Phalen's Test Right
|
Phalen's Test Left
|
|
Forearm Compression Test Normal
|
|
|
Forearm Compression Test Right
|
Forearm Compression Test Left
|
|
Thenar Motor Strength Normal
|
|
|
Thenar Motor Strength Left
|
Thenar Motor Strength Right
|
|
Capillary Refill Normal
|
|
|
Capillary Refill Right
• • •
|
Capillary Refill Left
• • •
|
|
Finger Sensation Normal
|
|
|
Finger Sensation Right
• • •
|
Finger Sensation Rt Location
• • •
|
|
Finger Sensation Left
• • •
|
Finger Sensation Lt Location
• • •
|
|
Radial Nerve Normal
|
|
|
Radial Nerve Right
• • •
|
Radial Nerve Left
• • •
|
|
Ulnar Nerve Normal
|
|
|
Ulnar Nerve Right
• • •
|
Ulnar Nerve Left
• • •
|
|
Intrinsic Muscle Weakness
|
|
|
Intrinsic Muscle Weakness Right
|
Intrinsic Muscle Weakness Test Left
|
|
Elbow Flexion Test Normal
|
|
|
Elbow Flexion Test Right
|
Elbow Flexion Test Left
|
|
Dorsal Ulnar Branch Nerve Sensation Normal
|
|
|
Dorsal Ulnar Branch Nerve Sensation Right
|
Dorsal Ulnar Branch Nerve Sensation Left
|
|
Uln Nrve Palpation Cubical Tunnel Normal
|
|
|
Ulnar Nerve Palpation Cubical Tunnel Right
|
Ulnar Nerve Palpation Cubical Tunnel Left
|
|
Median Nerve Normal
|
|
|
Median Nerve Right
• • •
|
Median Nerve Left
• • •
|
|
Atrophy Normal
|
|
|
Atrophy Right
|
Atrophy Rt Location
• • •
|
|
Atrophy Left
|
Atrophy Lt Location
• • •
|
|
Finkelstein's Test
|
|
|
Finkelstein's Test Right
|
Finkelstein's Test Left
|
|
Amputation
|
Amputation Free Text
|
|
STUDY
• • •
|
Results of Study
|
|
hand diagram
|
hand neurovascular anatomy
|
|
Turn on to Create Assessment
|
|
|
Assessment:
|
|
|
Turn on to Create Plan
|
|
|
Plan
|
|
|
Entirely Work Related?
|
Portion of DX Related to Work:
|
