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DOC Left Elbow Exam
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Inspection (swelling, erythema, ecchymosis, warmth, wounds, deformity)
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Inspection Abnormal?
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Inspection ALL NORMAL?
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Swelling?
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Ecchymosis?
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Erythema?
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Increased Warmth?
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Masses?
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Open Wounds?
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Deformity?
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Normal Carry Angle?
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Inspection Comments
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Tenderness (med/lat epicondyle, olecranon, rad head, ant elbow, bicep)
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Tenderness Abnormal?
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Tenderness ALL NORMAL?
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Lateral Epicondyle?
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Medial Epicondyle?
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Olecranon?
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Radial Head?
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Anterior Elbow?
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Biceps Insertion?
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Tenderness Comments
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Range of Motion (flexion, extension, pronation, supination)
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ROM Abnormal?
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ROM ALL NORMAL?
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Limited Flexion?
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Limited Extension?
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Limited Pronation?
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Limited Supination?
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ROM Comments
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Strength (Biceps, Triceps, Pro/Sup)
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Strength Abnormal?
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Strength ALL NORMAL?
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Bicep Strength
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Tricep Strength
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Pronation Strength
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Supination Strength
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Strength Comments
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Stability (varus/valgus stress)
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Stability Abnormal?
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Stability ALL NORMAL?
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Valgus Stress Stable?
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Varus Stress Stable?
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Stability Comments
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Tendonitis (wrist flexion/extension, resisted pro/supination)
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Tendonitis Abnormal?
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Tendonitis ALL NORMAL?
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Pain with Resisted Wrist Flexion?
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Pain with Resisted Wrist Extension?
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Pain with Resisted Wrist Pronation?
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Pain with Resisted Wrist Supination?
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Tendonitis Comments
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Cubital Tunnel (tinels, elbow flex, ulnar nerve)
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Cubital Tunnel Abnormal?
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Cubital Tunnel ALL NORMAL?
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Tinels Test Positive at Elbow?
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Elbow Flexion Test Positive?
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Ulnar Nerve Subluxes over Medial Condyle?
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Stability Comments
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Neurologic (med, rad, ulnar, axil sensation and motor)
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Neurologic Abnormal?
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Neurologic ALL NORMAL?
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Decreased Median Nerve Sensation?
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Comments
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Decreased Median Nerve Motor Function?
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Comments
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Decreased Radial Nerve Sensation?
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Comments
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Decreased Radial Nerve Motor Function?
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Comments
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Decreased Ulnar Nerve Sensation?
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Comments
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Decreased Ulnar Nerve Motor Function?
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Comments
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Decreased Axillary Nerve Sensation?
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Comments
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Decreased Axillary Nerve Motor Function?
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Comments
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Neurologic Comments
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Vascular
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Radial Pulse Palpable?
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Vascular Comments
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***Overall Exam Comments***
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Exam Comments
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Imaging and Labs
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Elbow X-Ray?
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X-Ray Views
• • •
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Comparison
• • •
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Comparison Date and Comments
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Normal Findings
• • •
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Normal Comments
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Abnormal Findings
• • •
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Abnormal Comments
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Impression:
• • •
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Impression comments
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Comments:
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Forearm X-Ray?
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X-Ray Views
• • •
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Comparison
• • •
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Comparison Date and Comments
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Normal Findings
• • •
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Normal Comments
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Abnormal Findings
• • •
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Abnormal Comments
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Impression:
• • •
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Impression comments
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Comments:
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Ultrasound Utilized?
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Normal US Findings
• • •
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Normal US Comments
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Abnormal US Findings
• • •
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Abnormal US Comments
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Impression:
• • •
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Impression comments
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Ultrasound Comments:
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