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SPINAL EXAM
CERVICAL AROM
Flexion (60)
With pain?
Extension (60)
With pain?
L Rotation (80)
With pain?
R Rotation (80)
With pain?
L Lat Flexion (45)
With pain?
R Lat. Flexion (45)
With pain?
Cervical AROM all WNL
THORACIC AROM
Flexion (60)
With pain?
Extension (25)
With pain?
L Rotation (50)
With pain?
R Rotation (50)
With pain?
L Lat Flexion (35)
With pain?
R Lat. Flexion (35)
With pain?
Thoracic AROM all WNL
LUMBAR AROM
Flexion (60)
With pain?
Extension (30)
With pain?
L Rotation (30)
With pain?
R Rotation (30)
With pain?
L Lat. Flexion (30)
With pain?
R Lat. Flexion (30)
With pain?
Lumbar AROM all WNL
ORTHOPEDIC TESTING
Foraminal Compression (LOCAL) (+)
Foraminal Compression (RADIC) (+)
Location
• • •
Cervical Distraction (LOCAL) (+)
Cervical Distraction Test (RADIC) (+)
Left Shoulder Depression Test (+)
L Depression Radic Location
• • •
Right Shoulder Depression Test (+)
R Depression Radic Location
• • •
O'Donahue's Manuever Strain (+)
O'Donahue's Manuever Sprain (+)
Cervical Exam Comments
Farfan Torsion (Left) (+)
Farfan Torsion (Right) (+)
Schepelmann's (Left) (+)
Schepelmann's (Right) (+)
Thoracic Spinous Percussion (+)
Location
• • •
Adam's Test (L Rib Hump) (+)
Adam's Test (R Rib Hump) (+)
Thoracic Exam Comments
Straight Leg Raise (local) (+)
Straight Leg Raise (radic) (+)
Location
• • •
Bragard's (radic) (+)
Location
• • •
Kemp's (local) (+)
Kemp's (radic) (+)
Location
• • •
Heel Walk Test (+)
Toe Walk Test (+)
Minor's Sign (+)
Valsalva
• • •
Lumbar Exam Comments
Yeoman's (Left) (+)
Yeoman's (Right) (+)
Hibb's (Left) (+)
Hibb's (Right) (+)
Pelvis Exam Comments
BASIC SPINAL NEURO
REFLEXES
L C5 (bicep)
R C5 (bicep)
L C6 (brachioradialis)
R C6 (brachioradialis)
L C7 (tricep)
R C7 (tricep)
Upper extrem reflexes WNL
L L4 (patellar)
R L4 (patellar)
L L5 (hamstring)
R L5 (hamstring)
L S1 (Achilles)
R S1 (Achilles)
Lower extrem reflexes WNL
MOTOR STRENGTH (MYOTOMES)
L C5 (deltoid)
R C5 (deltoid)
L C6 (bicep / wrist extension)
R C6 (bicep / wrist extensors)
L C7 (tricep / wrist flexors)
R C7 (tricep / wrist flexors)
L C8 (finger flexors)
R C8 (finger flexors)
L T1 (finger add / abd)
R T1 (finger add / abd)
Upper Extrem WNL
L L1-L2 (hip flexion)
R L1-L2 (hip flexion)
L L3 (knee extension)
R L3 (knee extension)
L L4 (tib anterior)
R L4 (tib anterior)
L L5 (great toe extension)
R L5 (great toe extension)
L S1-S2 (plantar flexion)
R S1-S2 (plantar flexion)
Lower Extrem WNL
ADDITIONAL NEURO
CRANIAL NERVES
CN I: (olfactory)
• • •
CN 2/3 (optic / oculomotor) RIGHT
CN2/3 Right Eye (acuity, eye movement)
• • •
CN 2/3 (optic / oculomotor) LEFT
CN 2/3 LEFT
• • •
Oculomotor CN 3, 4, 6 WNL
Abnormal how? (oculomotor, trochlear, abducens)
CN 5 (trigeminal) WNL
CN 5 (sensory of face, chewing)
• • •
CN 7 (facial) WNL
CN 7 Grading (movements & taste)
• • •
CN 8 (acoustic / vestibulocochlear) WNL
CN 8 Grading (sound / balance)
• • •
CN 9 (glossopharyngeal) WNL
CN 9 Grading (gag / swallow)
• • •
CN 10 (vagus) WNL
CN 10 Grading (gag, swallow, speech)
• • •
CN 11 (spinal accessory)
CN 11 Grading (shrugs + head rotation)
• • •
CN 12 (hypoglossal) WNL
CN 12 (tongue straight & in cheek)
• • •
DERMATOMES
C5 dermatome
• • •
C6 dermatome
• • •
C7 dermatome
• • •
C8 dermatome
• • •
T1 dermatome
• • •
Upper Extrem Dermatomes WNL
L1-L2 dermatome
• • •
L3 dermatome
• • •
L4 dermatome
• • •
L5 dermatome
• • •
S1 dermatome
• • •
Lower Extrem Dermatomes WNL
Babinski Reflex (+)
Clear of contraindications?
PARQ performed?

DrChrono Chiropractic | Spinal & Neuro Exam Medical Form

Chiropractor

DrChrono's spinal & neuro exam form, customizable for your Chiropractic practice.

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Published: Dec. 11, 2018, 12:39 p.m.
Doctor: Dr. History Physical
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