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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
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C1
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C2
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C3
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C4
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C5
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C6
|
C7
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Thoracic
|
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Rib Left
|
Rib Right
|
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T1
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T2
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T3
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T4
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T5
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T6
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T7
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T8
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T9
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T10
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T11
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T12
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Lumbar & Lower Structures
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L1
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L2
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L3
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L4
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L5
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Sacrum
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Left Pelvis
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Right Pelvis
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Coccyx
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Extremity Subluxations
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All WNL
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Upper Extremity
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TMJ Left
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TMJ Right
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Left Shoulder
|
Right Shoulder
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Left Elbow
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Right Elbow
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Left Wrist
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Right Wrist
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Left Hand
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Right Hand
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Left Finger
|
Right Finger
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Left Thumb
|
Right Thumb
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Lower Extremity
|
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Left Hip
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Right Hip
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Left Knee
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Right Knee
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Left Ankle
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Right Ankle
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Left Foot
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Right Foot
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Left Toe
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Right Toe
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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
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Stage of Care
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Prognosis
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Patient Progress
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Patient Goals
• • •
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Vitals
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Demeanor
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Height (Inches)
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Weight (lbs)
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Pulse Rate (BPM)
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Breaths Per Minute
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Blood Pressure (Systolic / Diastolic)
/
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Gait
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Ambulation
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Gait
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Ortho / Neuro Exam
|
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Spinal Ortho Tests
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Cervical Ortho Tests
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All WNL
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Rust's Sign +
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Sharp-Purser Test +
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Transverse Ligament Stress Test +
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Barre-Lieou Sign +Left
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Barre-Lieou Sign +Right
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Vertebral Artery Test +Left
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Vertebral Artery Test +Right
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Underburg's Test +Left
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Underburg's Test +Right
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O'Donoghue's Maneuver +Left
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O'Donoghue's Maneuver +Right
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Foraminal Compression Test + Left
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Foraminal Compression Test + Right
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Jackson's Test +Left
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Jackson's Test + Right
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Cervical Distraction Test +Left
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Cervical Distraction Test +Right
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Shoulder Depression Test +Left
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Shoulder Depression Test +Right
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Soto Hall Test +Left
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Soto Hall Test +Right
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Valsalva Maneuver - Cervical +Left
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Valsalva Maneuver - Cervical +Right
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Thoracic Ortho Tests
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All WNL
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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
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Straight Leg Raise Test +Right
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Valsalva Maneuver - Lumbar +Left
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Valsalva Maneuver - Lumbar +Right
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Yeoman's Test + Left
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Yeoman's Test +Right
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Gaenslen's Test +Left
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Gaenslen's Test +Right
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Patrick's Test +Left
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Patrick's Test +Right
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Extremity Ortho Tests
|
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Shoulder Ortho Tests
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All WNL
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Anterior Apprehension Test +Left
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Anterior Apprehension Test +Right
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Posterior Apprehension Test +Left
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Posterior Apprehension Test +Right
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Feagin Test +Left
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Feagin Test +Right
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Apley's Scratch Test +Left
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Apley's Scratch Test +Right
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Subacromial Sign +Left
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Subacromial Sign +Right
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Speed's Test +Left
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Speed's Test +Right
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Codman's Drop Arm +Left
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Codman's Drop Arm +Right
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Clunk Test +Left
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Clunk Test +Right
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Elbow Ortho Tests
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All WNL
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Mill's Test +Left
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Mill's Test +Right
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Golfer's Elbow Test +Left
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Golfer's Elbow Test +Right
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Adduction Stress Test +Left
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Adduction Stress Test +Right
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ABduction Stress Test +Left
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ABduction Stress Test +Right
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Painful Pronation +Left
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Painful Pronation +Right
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Painful Supination +Left
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Painful Supination +Right
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Cozen's Test +Left
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Cozen's Test +Right
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Tinel's Sign +Left
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Tinel's Sign +Right
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Wrist Ortho Tests
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All WNL
|
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Pinch Test +Left
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Pinch Test +Right
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Phalen's Test +Left
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Phalen's Test +Right
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Reverse Phalen's Test +Left
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Reverse Phalen's Test +Right
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Tinel's Sign +Left
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Tinel's Sign +Right
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Hip Ortho Tests
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All WNL
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Patrick's Test +Left
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Patrick's Test +Right
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Ely's Test +Left
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Ely's Test +Right
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Ober's Test +Left
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Ober's Test +Right
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Knee Ortho Tests
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All WNL
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Adduction Test +Left
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Adduction Test +Right
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ABduction Test +Left
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ABduction Test +Right
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Anterior Drawer Test +Left
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Anterior Drawer Test +Right
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Posterior Drawer Test +Left
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Posterior Drawer Test +Right
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Apley's Compression Test +Left
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Apley's Compression Test +Right
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Apley's Distraction Test +Left
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Apley's Distraction Test +Right
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Patellar Apprehension Test +Left
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Patellar Apprehension Test +Right
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Ankle Ortho Tests
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All WNL
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Anterior Drawer Test +Left
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Anterior Drawer Test +Right
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Lateral Stability Test +Left
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Lateral Stability Test +Right
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Medial Stability Test +Left
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Medial Stability Test +Right
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Tinel's Sign +Left
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Tinel's Sign +Right
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Reflexes
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All WNL
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Bicep Left
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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
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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
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Flexion
|
Limited by...
• • •
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Extension
|
Limited by...
• • •
|
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Lateral Flexion Left
|
Limited by...
• • •
|
|
Lateral Flexion Right
|
Limited by...
• • •
|
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Rotation Left
|
Limited by...
• • •
|
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Rotation Right
|
Limited by...
• • •
|
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Thoracic ROM
|
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All WNL
|
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Flexion
|
Limited by...
• • •
|
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Extension
|
Limited by...
• • •
|
|
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Lumbar 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...
• • •
|
|
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
|
|
|
Additional Comments
|
|
|
Insert any additional comments here....
|
|
