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Cervical Spine Exam
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Pain = Px Numbness = N Paresthesia = P Muscle Strength Graded 1-5
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Reflexes
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Brachio
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Left
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Right
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Biceps
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Left
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Right
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Triceps
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Left
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Right
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Dermatomes / Muscle strength
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C5 - Deltoid
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Left
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Right
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C6 - Bicep
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Left
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Right
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C7 - Tricep
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Left
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Right
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C8 - Flex
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Left
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Right
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T1 - Extn
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Left
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Right
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ROM
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Flex
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Location of pain
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Extn
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Location of pain
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RLF
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Location of pain
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LLF
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Location of pain
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Rrot
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Location of pain
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Lrot
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Location of pain
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Foraminal Compression
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Shoulder Depression
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Cervical Distraction
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Lumbar Spine Exam
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Reflexes
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Patellar
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Left
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Right
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Achilles
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Left
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Right
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Dermatomes / Muscle Strength
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L2
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Left
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Right
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L3
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Left
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Right
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L4
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Left
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Right
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L5
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Left
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Right
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S1
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Left
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Right
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ROM
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Flex
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Location of pain
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Extn
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Location of pain
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RLF
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Location of pain
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LLF
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Location of pain
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Rrot
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Location of pain
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Lrot
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Location of pain
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Kemps
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Pos right
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Pos left
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Neg right
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Neg left
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SLR
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Pos right
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Pos left
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Neg right
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Neg left
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SSLR
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Pos right
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Pos left
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Neg right
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Neg left
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Nach
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Pos right
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Pos left
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Neg right
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Neg left
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Ely
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Pos right
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Pos left
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Neg right
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Neg left
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Fabere
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Pos right
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Pos left
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Neg right
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Neg left
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Piri
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Pos right
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Pos left
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Neg right
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Neg left
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Leg Lwr
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Pos right
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Pos left
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Neg right
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Neg left
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Palpation Findings
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Cervical Spine
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1
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Left
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Right
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2
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Left
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Right
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3
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Left
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Right
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4
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Left
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Right
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5
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Left
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Right
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6
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Left
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Right
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7
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Left
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Right
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Thoracic Spine
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1
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Left
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Right
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2
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Left
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Right
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3
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Left
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Right
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4
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Left
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Right
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5
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Left
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Right
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6
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Left
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Right
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7
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Left
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Right
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8
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Left
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Right
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9
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Left
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Right
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10
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Left
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Right
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11
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Left
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Right
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12
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Left
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Right
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Lumbosacral Spine
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1
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Left
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Right
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2
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Left
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Right
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3
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Left
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Right
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4
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Left
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Right
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5
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Left
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Right
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SI
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Left
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Right
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Muscle Palpations
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Previous Injury Hx
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Notes
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