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Spinal Subluxations
|
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All WNL (There are no Spinal Subluxations)
|
|
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Cervical
|
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Occiput
|
C1
|
|
C2
|
C3
|
|
C4
|
C5
|
|
C6
|
C7
|
|
Thoracic
|
|
|
Rib Left
|
Rib Right
|
|
T1
|
T2
|
|
T3
|
T4
|
|
T5
|
T6
|
|
T7
|
T8
|
|
T9
|
T10
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T11
|
T12
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Lumbar & Lower Structures
|
|
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L1
|
L2
|
|
L3
|
L4
|
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L5
|
Sacrum
|
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Left Pelvis
|
Right Pelvis
|
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Coccyx
|
|
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|
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Extremity Subluxations
|
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All WNL
|
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Upper Extremity
|
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TMJ Left
|
TMJ Right
|
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Left Shoulder
|
Right Shoulder
|
|
Left Elbow
|
Right Elbow
|
|
Left Wrist
|
Right Wrist
|
|
Left Hand
|
Right Hand
|
|
Left Finger
|
Right Finger
|
|
Left Thumb
|
Right Thumb
|
|
Lower Extremity
|
|
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Left Hip
|
Right Hip
|
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Left Knee
|
Right Knee
|
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Left Ankle
|
Right Ankle
|
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Left Foot
|
Right Foot
|
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Left Toe
|
Right Toe
|
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|
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Examination Findings
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EXAM
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No Exam Performed
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Initial Exam
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Re-Exam
|
|
Stage of Care
|
Prognosis
|
|
Patient Progress
|
Patient Goals
• • •
|
|
Vitals
|
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Demeanor
|
Height (Inches)
|
|
Weight (lbs)
|
Pulse Rate (BPM)
|
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Breaths Per Minute
|
Blood Pressure (Systolic / Diastolic)
/
|
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Gait
|
|
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Ambulation
|
Gait
|
|
Ortho / Neuro Exam
|
|
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Spinal Ortho Tests
|
|
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Cervical Ortho Tests
|
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All WNL
|
|
|
Rust's Sign +
|
|
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Shar-Purser Test +
|
|
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Transverse Ligament Stress Test +
|
|
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Barre-Lieou Sign +Left
|
Barre-Lieou Sign +Right
|
|
Vertebral Artery Test +Left
|
Vertebral Artery Test +Right
|
|
Underburg's Test +Left
|
Underburg's Test +Right
|
|
O'Donoghue's Maneuver +Left
|
O'Donoghue's Maneuver +Right
|
|
Foraminal Compression Test + Left
|
Foraminal Compression Test + Right
|
|
Jackson's Test +Left
|
Jackson's Test + Right
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Cervical Distraction Test +Left
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Cervical Distraction Test +Right
|
|
Shoulder Depression Test +Left
|
Shoulder Depression Test +Right
|
|
Soto Hall Test +Left
|
Soto Hall Test +Right
|
|
Valsalva Maneuver - Cervical +Left
|
Valsalva Maneuver - Cervical +Right
|
|
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Thoracic Ortho Tests
|
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All WNL
|
|
|
Beevor's Sign +
|
|
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Spinal Percussion Test - Thoracic +Left
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Spinal Percussion Test - Thoracic +Right
|
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Adam's Forward Bend Test +Left
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Adam's Forward Bend Test +Right
|
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Schepelmann's Sign +Left
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Schepelmann's Sign +Right
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Lumbar and Lower Structure Ortho Tests
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All WNL
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Antalgic Lean Sign +Left
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Antalgic Lean Sign + Right
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Kemp's Test +Left
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Kemp's Test +Right
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Nachlas Test +Left
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Nachlas Test +Right
|
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Straight Leg Raise Test +Left
|
Straight Leg Raise Test +Right
|
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Valsalva Maneuver - Lumbar +Left
|
Valsalva Maneuver - Lumbar +Right
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|
Yeoman's Test + Left
|
Yeoman's Test +Right
|
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Gaenslen's Test +Left
|
Gaenslen's Test +Right
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|
Patrick's Test +Left
|
Patrick's Test +Right
|
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Extremity Ortho Tests
|
|
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Shoulder Ortho Tests
|
|
All WNL
|
|
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Anterior Apprehension Test +Left
|
Anterior Apprehension Test +Right
|
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Posterior Apprehension Test +Left
|
Posterior Apprehension Test +Right
|
|
Apley's Scratch Test +Left
|
Apley's Scratch Test +Right
|
|
Subacromial Sign +Left
|
Subacromial Sign +Left
|
|
Speed's Test +Left
|
Speed's Test +Right
|
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Codman's Drop Arm +Left
|
Codman's Drop Arm +Right
|
|
Clunk Test +Left
|
Clunk Test +Left
|
|
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Elbow Ortho Tests
|
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All WNL
|
|
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Adduction Stress Test +Left
|
Adduction Stress Test +Right
|
|
ABduction Stress Test +Left
|
ABduction Stress Test +Right
|
|
Painful Pronation +Left
|
Painful Pronation +Right
|
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Painful Supination +Left
|
Painful Supination +Right
|
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Cozen's Test +Left
|
Cozen's Test +Right
|
|
Tinel's Sign +Left
|
Tinel's Sign +Right
|
|
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Wrist Ortho Tests
|
|
All WNL
|
|
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Froment's Sign +Left
|
Froment's Sign +Right
|
|
Phalen's Test +Left
|
Phalen's Test +Right
|
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Reverse Phalen's Test +Left
|
Reverse Phalen's Test +Right
|
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Tinel's Sign +Left
|
Tinel's Sign +Right
|
|
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Hip Ortho Tests
|
|
All WNL
|
|
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Patrick's Test +Left
|
Patrick's Test +Right
|
|
Ely's Test +Left
|
Ely's Test +Right
|
|
Ober's Test +Left
|
Ober's Test +Right
|
|
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Knee Ortho Tests
|
|
All WNL
|
|
|
Adduction Test +Left
|
Adduction Test +Right
|
|
ABduction Test +Left
|
ABduction Test +Right
|
|
Anterior Drawer Test +Left
|
Anterior Drawer Test +Right
|
|
Posterior Drawer Test +Left
|
Posterior Drawer Test +Right
|
|
Apley's Compression Test +Left
|
Apley's Compression Test +Right
|
|
Apley's Distraction Test +Left
|
Apley's Distraction Test +Right
|
|
Patellar Apprehension Test +Left
|
Patellar Apprehension Test +Right
|
|
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Ankle Ortho Tests
|
|
All WNL
|
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Anterior Drawer Test +Left
|
Anterior Drawer Test +Right
|
|
Lateral Stability Test +Left
|
Lateral Stability Test +Right
|
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Medial Stability Test +Left
|
Medial Stability Test +Right
|
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Tinel's Sign +Left
|
Tinel's Sign +Right
|
|
Reflexes
|
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All WNL
|
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Bicep Left
|
Bicep Right
|
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Tricep Left
|
Tricep Right
|
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Brachioradialis Left
|
Brachioradialis Right
|
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Patellar Left
|
Patellar Right
|
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Achilles Left
|
Achilles Right
|
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Range of Motion
|
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Spinal ROM
|
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Cervical ROM
|
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ALL WNL
|
|
|
Flexion
|
Limited by...
• • •
|
|
Extension
|
Limited by...
• • •
|
|
Lateral Flexion Left
|
Limited by...
• • •
|
|
Lateral Flexion Right
|
Limited by...
• • •
|
|
Rotation Left
|
Limited by...
• • •
|
|
Rotation Right
|
Limited by...
• • •
|
|
|
Thoracic ROM
|
|
All WNL
|
|
|
Flexion
|
Limited by...
• • •
|
|
Extension
|
Limited by...
• • •
|
|
|
Lumbar ROM
|
|
All WNL
|
|
|
Flexion
|
Limited by...
• • •
|
|
Extension
|
Limited by...
• • •
|
|
Lateral Flexion Left
|
Limited by...
• • •
|
|
Lateral Flexion Right
|
Limited by...
• • •
|
|
Rotation Left
|
Limited by...
• • •
|
|
Rotation Right
|
Limited by...
• • •
|
|
Extremity ROM
|
|
|
|
Shoulder ROM
|
|
All WNL
|
|
|
Flexion Left
|
Limited by...
• • •
|
|
Flexion Right
|
Limited by...
• • •
|
|
Extension Left
|
Limited by...
• • •
|
|
Extension Right
|
Limited by...
• • •
|
|
ABduction Left
|
Limited by...
• • •
|
|
ABduction Right
|
Limited by...
• • •
|
|
Adduction Left
|
Limited by...
• • •
|
|
Adduction Right
|
Limited by...
• • •
|
|
External Rotation Left
|
Limited by...
• • •
|
|
External Rotation Right
|
Limited by...
• • •
|
|
Internal Rotation Left
|
Limited by...
• • •
|
|
Internal Rotation Right
|
Limited by...
• • •
|
|
|
Elbow ROM
|
|
All WNL
|
|
|
Flexion Left
|
Limited by...
• • •
|
|
Flexion Right
|
Limited by...
• • •
|
|
Extension Left
|
Limited by...
• • •
|
|
Extension Right
|
Limited by...
• • •
|
|
Pronation Left
|
Limited by...
• • •
|
|
Pronation Right
|
Limited by...
• • •
|
|
Supination Left
|
Limited by...
• • •
|
|
Supination Right
|
Limited by...
• • •
|
|
|
Wrist ROM
|
|
All WNL
|
|
|
Flexion Left
|
Limited by...
• • •
|
|
Flexion Right
|
Limited by...
• • •
|
|
Extension Left
|
Limited by...
• • •
|
|
Extension Right
|
Limited by...
• • •
|
|
Radial Deviation Left
|
Limited by...
• • •
|
|
Radial Deviation Right
|
Limited by...
• • •
|
|
Ulnar Deviation Left
|
Limited by...
• • •
|
|
Ulnar Deviation Right
|
Limited by...
• • •
|
|
|
Hip ROM
|
|
All WNL
|
|
|
Flexion Left
|
Limited by...
• • •
|
|
Flexion Right
|
Limited by...
• • •
|
|
Extension Left
|
Limited by...
• • •
|
|
Extension Right
|
Limited by...
• • •
|
|
ABduction Left
|
Limited by...
• • •
|
|
ABduction Right
|
Limited by...
• • •
|
|
Adduction Left
|
Limited by...
• • •
|
|
Adduction Right
|
Limited by...
• • •
|
|
|
Knee ROM
|
|
All WNL
|
|
|
Flexion Left
|
Limited by...
• • •
|
|
Flexion Right
|
Limited by...
• • •
|
|
Extension Left
|
Limited by...
• • •
|
|
Extension Right
|
Limited by...
• • •
|
|
|
Ankle ROM
|
|
All WNL
|
|
|
Dorsiflexion Left
|
Limited by...
• • •
|
|
Dorsiflexion Right
|
Limited by...
• • •
|
|
Plantarflexion Left
|
Limited by...
• • •
|
|
Plantarflexion Right
|
Limited by...
• • •
|
|
Inversion Left
|
Limited by...
• • •
|
|
Inversion Right
|
Limited by...
• • •
|
|
Eversion Left
|
Limited by...
• • •
|
|
Eversion Right
|
Limited by...
• • •
|
|
Strength
|
|
|
|
Upper Body
|
|
All WNL
|
|
|
Bicep - Left
|
Bicep - Right
|
|
Tricep - Left
|
Tricep - Right
|
|
Deltoid - Left
|
Deltoid - Right
|
|
Finger Flexors - Left
|
Finger Flexors - Right
|
|
Finger ABductors - Left
|
Finger ABductors - Right
|
|
|
Lower Body
|
|
All WNL
|
|
|
Hip Flexors - Left
|
Hip Flexors - Right
|
|
Knee Extensors - Left
|
Knee Extensors - Right
|
|
Ankle Dorsiflexion - Left
|
Ankle Dorsiflexion - Right
|
|
Big Toe Dorsiflexion - Left
|
Big Toe Dorsiflexion - Right
|
|
Dermatomes
|
|
|
|
Upper Extremity
|
|
All WNL
|
|
|
C2 (Top/back of scalp; front of neck; ears) +Left
|
C2 (Top/back of scalp; front of neck; ears) +Right
|
|
C3 (Cheek/jaw; lat and ant neck) +Left
|
C3 (Cheek/jaw; lat and ant neck) +Right
|
|
C4 (Low neck/shoulder; upper arm) +Left
|
C4 (Low neck/shoulder; upper arm) +Right
|
|
C5 (Outer arm down to elbow) +Left
|
C5 (Outer arm down to elbow) +Right
|
|
C6 (Thumb side hand / forearm) +Left
|
C6 (Thumb side hand / forearm) +Right
|
|
C7 (Shoulder, back of arm, mid finger) +Left
|
C7 (Shoulder, back of arm, mid finger) +Right
|
|
C8 (Pinky side hand / arm / shoulder) +Left
|
C8 (Pinky side hand / arm / shoulder) +Right
|
|
T1 (Upper chest / armpit / front arm) +Left
|
T1 (Upper chest / armpit / front arm) +Right
|
|
Type of Sensation reported...
|
|
|
Type of Tool used...
|
|
|
|
Core
|
|
All WNL
|
|
|
Upper Core (T2-T5 Chest to Xiphoid) +Left
|
Upper Core (T2-T5 Chest to Xiphoid) +Right
|
|
Mid Core (T6-T9 Xiphoid to Navel) +Left
|
Mid Core (T6-T9 Xiphoid to Navel) +Right
|
|
Low Core (T10-T12 Navel to Pubis) +Left
|
Low Core (T10-T12 Navel to Pubis) +Right
|
|
Type of Sensation reported...
|
|
|
Type of Tool used...
|
|
|
|
Lower Extremity
|
|
All WNL
|
|
|
L1 (Over trochanter to groin) +Left
|
L1 (Over trochanter to groin) +Right
|
|
L2 (Front thigh to knee) +Left
|
L2 (Front thigh to knee) +Right
|
|
L3 (Sartorious pattern to groin) +Left
|
L3 (Sartorious pattern to groin) +Right
|
|
L4 (Over knee to medial ankle) +Left
|
L4 (Over knee to medial ankle) +Right
|
|
L5 (Shin area to mid foot / achilles) +Left
|
L5 (Shin area to mid foot / achilles) +Right
|
|
S1 (Back of leg / lat glutes) +Left
|
S1 (Back of leg / lat glutes) +Right
|
|
S2 (Back of leg / med glutes) +Left
|
S2 (Back of leg / med glutes) +Right
|
|
Type of Sensation reported...
|
|
|
Type of Tool used...
|
|
|
Outcomes Assessments
|
|
