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DOC Left Knee Exam
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Inspection (swelling, erythema, ecchymosis, warmth)
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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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Inspection Comments
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Alignment (valgus, varus)
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Alignment Abnormal?
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Alignment ALL NORMAL?
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Valgus Alignment?
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Varus Alignment?
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Alignment Comments
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Tenderness (med/lat joint, tib tub, med/fib col, med/lat fem con)
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Tenderness Abnormal?
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Tenderness ALL NORMAL?
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Medial Joint Line?
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Lateral Joint Line?
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Tibial Tubercle?
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Medial Collateral Ligament?
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Fibular Collateral?
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Medial Femoral Condyle?
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Lateral Femoral Condyle?
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Tenderness Comments
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Range of Motion (limited extension/flexion)
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ROM Abnormal?
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ROM ALL NORMAL?
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Limited Extension?
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Limited Flexion?
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ROM Comments
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Stability (lachman, varus/valgus stress, dial/post draw/pivot shift tests)
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Stability Abnormal?
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Stability ALL NORMAL?
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Lachman Positive?
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Varus Stress with Increased Excursion?
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Valgus Stress with Increased Excursion?
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Dial Test Positive?
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Posterior Drawer Test Positive?
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Pivot Shift Test Positive?
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Stability Comments
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McMurray (medial and lateral)
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McMurray Abnormal?
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McMurray ALL NORMAL?
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Medial McMurray Positive?
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Lateral McMurray Positive?
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McMurray Comments
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Patella (medial glide, patella tilt, patellofemoral crepitus)
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Patella Abnormal?
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Patella ALL NORMAL?
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Decreased Medial Glide Present?
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Decreased Patella Tilt Present?
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Patellofemoral Crepitus Present?
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Patella Comments
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Gait (reciprocal heel-toe, asst device used?)
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Gait Abnormal?
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Gait ALL NORMAL?
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Reciprocal Heel-Toe Gait?
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Assistive Devices Used for Mobility?
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Assistive devices
• • •
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Assistive devices
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Gait Comments
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Neurologic (sensation/motor function)
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Neurologic Abnormal?
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Neurologic ALL NORMAL?
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Decreased Sensation?
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Comments
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Decreased Motor Function?
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Comments
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Imaging and Labs
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Knee 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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Comments:
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Bilateral Knee 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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Comments:
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Pelvis 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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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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Ultrasound Comments:
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