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Observations
Swelling Normal
Swelling Left
• • •
Swelling Right
• • •
Ecchymosis Normal
Ecchymosis Location (s)
Pain Normal
Pain w movement Left
• • •
Pain w movement Right
• • •
Previous surgical wound
Surgical wound signs
• • •
Other Observations
Palpation
Tenderness Normal
Tenderness Left
• • •
Tenderness Right
• • •
Range of Motion
ROM ABDuction Normal N=180
ROM ABDuction Left N=180
ROM ABDuction Right N=180
ROM Flexion Normal N=180
ROM Flexion Left N=180
ROM Flexion Right N=180
ROM ADDuction Normal N=50
ROM ADDuction Left N=50
ROM ADDuction Right N=50
ROM Extension Normal N=50
ROM Extension Left N=50
ROM Extension Right N=50
ROM Internal Rotation N=90
ROM Internal Rotation Left N=90
ROM Internal Rotation Right N=90
ROM External Rotation N=90
ROM External Rotation Left N=90
ROM External Rotation Right N=90
Motor Exam
Strength Biceps Normal
Strength Bicep Left
Strength Bicep RIght
Strength Triceps Normal
Strength Tricep Left
Strength Tricep Right
Strength Deltoid Normal
Strength Deltoid Left
Strength Deltoid Right
Tests
Cross-arm Adduction Test (AC joint)
Cross-arm Adduction Test Left
Cross-arm Adduction Test Right
Hawkin's Test (Supraspinatus) Normal
Hawkins' Test Left
Hawkins' Test Right
Yergason's Test (Biceps Tendon) Normal
Yergason's Test Left
Yergason's Test Right
Misc
shoulder diagram

Shoulder Examination Medical Form

Pain Management Specialist

There are 2 copies in use.
Published: March 8, 2022, 2:32 p.m.
Doctor: Dr. History Physical
Rating: 0   /

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Sunnyvale, CA 94089

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