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Palpation & Inspection
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Findings
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Orthopedic Tests
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Findings
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Elbow/Wrist ROM
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(L) Elbow Ext/Flex
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(R) Elbow Ext/Flex
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(L) Forearm Sup/Pro
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(R) Forearm Sup/Pro
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(L) Wrist Ext/Flex
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(R) Wrist Ext/Flex
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(L) Wrist Uln/Rad
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(R) Wrist Uln/Rad
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Notes
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Digit ROM
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(L) 1st
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(R) 1st
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(L) 2nd
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(R) 2nd
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(L) 3rd
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(R) 3rd
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(L) 4th
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(R) 4th
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(L) 5th
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(R) 5th
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Notes
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Grip Strength (3 attempts)
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(L) 1st/2nd/3rd Attempts
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(R) 1st/2nd/3rd Attempts
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Notes
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Pinch Strength
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(L) 2pt/3pt/lateral
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(R) 2pt/3pt/lateral
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Notes
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Additional UE Objective Findings
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add findings here
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TREATMENT PERFORMED
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Manual Therapies
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Technique & Location
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Time (minutes)
• • •
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Therapeutic Exercises
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Exercises include:
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Time (minutes)
• • •
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Taping
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Technique & Location:
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Splinting
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Technique & Location:
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Modalities
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Technique & Location
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Additional Procedures
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Technique & Location (time if applicable)
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