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Home Care Kit
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Fracture screen
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Date of Exam
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Inspection:
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Comments
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WNL
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Development
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Antalgia
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Skin (bruising, scars)
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Asymmetry:
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Observation-WNL
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Head position
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Comment
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Shoulder position
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Comment
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Elbow position
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Comment
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Hand pronated/supinated
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Comment
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Fingers flexed/extended
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Comment
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Boutonniere deformity
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Comment
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Swan neck deformity
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Comment
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Mallet finger
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Comment
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Heberden’s nodes
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Comment
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Bouchard’s nodes
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Comment
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Other
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Comment
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Palpation
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WNL, texture, tenderness, pain referral
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Wrist flexors
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Comment
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Pronator teres
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Comment
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Wrist extensors
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Comment
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Supinator
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Comment
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Thumb extensors
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Comment
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Interossei
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Comment
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Thenar pad
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Comment
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Hypothenar pad
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Comment
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Carpal tunne
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Comment
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Tunnel of Guyon
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Comment
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Anatomic snuff box
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Comment
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Metacarpals
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Comment
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Thumb (#1)
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Comment
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Index finger (#2)
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Comment
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Middle finger (#3)
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Comment
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Ring finger (#4)
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Comment
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Little finger (#5)
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Comment
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Scaphoid
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Comment
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Lunate
|
Comment
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Triquetrum
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Comment
|
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Pisiform
|
Comment
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Hamate
|
Comment
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Capitate
|
Comment
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Trapezoid
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Comment
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Trapezium
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Comment
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Ulnar/radial styloids
|
Comment
|
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Triangular complex
|
Comment
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Collateral ligaments
|
Comment
|
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Diagram
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ROM & Joint Play
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WNL
|
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Wrist
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|
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Flexion (80°): Active
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Passive
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Comment
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Extension (70°): Active
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Passive
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Comment
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Ulnar flexion (30°): Active
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Passive
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Comment
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Radial flexion (20°): Active
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Passive
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Comment
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MP joint
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Flexion (90°): Active
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Passive
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Comment
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|
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Extension (40°): Active
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Passive
|
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Comment
|
|
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Abduction (20°): Active
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Passive
|
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Comment
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|
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Adduction (20°): Active
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Passive
|
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Comment
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PIP
|
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Flexion (70°): Active
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Passive
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Comment
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|
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Extension (0°): Active
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Passive
|
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Comment
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|
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DIP
|
|
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Flexion (80°): Active
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Passive
|
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Comment
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Extension (20°): Active
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Passive
|
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Comment
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Thumb
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|
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MP flexion (60°): Active
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Passive
|
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Comment
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|
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MP extension (20°): Active
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Passive
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Comment
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|
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IP flexion (90°): Active
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Passive
|
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Comment
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|
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IP extension (20°): Active
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Passive
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Comment
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Joint Play
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Distal radioulnar
|
Comment
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Individual carpals
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Comment
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Vascular Screen
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|
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WNL
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Pulses (0-4)
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Radial pulse
|
Comment
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Ulnar pulse
|
Comment
|
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Blanch test
|
Comment
|
|
Allen’s test
|
Comment
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Temperature
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Comment
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Neurologic
|
|
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WNL
|
|
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Reflexes (0-5), □ WNL
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|
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Biceps (C5)
|
Comment
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Brachioradialis (C6)
|
Comment
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Triceps (C7)
|
Comment
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General grip strength
|
Comment
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Motor (0-5), □ WNL
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|
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Pronator teres (median)
|
Comment
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Pronator quadratus (median)
|
Comment
|
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Supinator (radial)
|
Comment
|
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Wrist extensors (C6)
|
Comment
|
|
Wrist flexors (C7)
|
Comment
|
|
Finger extensors (C7)
|
Comment
|
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Finger flexors (C8)
|
Comment
|
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Finger abductors (T1)
|
Comment
|
|
Finger adductors (T1)
|
Comment
|
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Orthopedic
|
|
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WNL
|
|
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Neuro-injury
|
|
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Phalen’s (median)
|
Comment
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Wrist drop (radial)
|
Comment
|
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Froment’s cone (uln)
|
Comment
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Opposition (median)
|
Comment
|
|
Thumb adduction
|
Comment
|
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Pinch grip test
|
Comment
|
|
Tinel’s (median)
|
Comment
|
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Tinel’s (ulnar)
|
Comment
|
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Tourniquet test
|
Comment
|
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Wartenberg’s sign
|
Comment
|
|
Other injury
|
|
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Scaphoid fracture test
|
Comment
|
|
Thumb abd. stress
|
Comment
|
|
Thumb grind test
|
Comment
|
|
Finger stress test
|
Comment
|
|
Bracelet test
|
Comment
|
|
Lunotriquetral ballot.
|
Comment
|
|
Bunnel-Littler test
|
Comment
|
|
Retinaculum test
|
Comment
|
|
Finkelstein’s
|
Comment
|
|
Wringing test
|
Comment
|
|
Dynamometer
|
|
|
Repeat 3 times
|
Comment
|
|
Repeat 3 times
|
Comment
|
|
Repeat 3 times
|
Comment
|
|
Serial #
|
Setting:
|
|
Neck evaluation:
|
Shoulder eval:
|
|
Elbow evaluation:
|
DDx:
|
|
DDX Impressions
|
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