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CS Flexion (80-90°)
|
Pain with CS flexion?
|
|
CS Extension (70°)
|
Pain with CS extension?
|
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CS LR (90°)
|
Pain with CS LR?
|
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CS RR (90°)
|
Pain with CS RR?
|
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CS RLF (20-45°)
|
Pain with CS RLF?
|
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CS LLF (20-45°)
|
Pain with CS LLF?
|
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ROM WNL
|
ROM comments
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Upper Dermatomes Intact
|
Dermatome Deficit
• • •
|
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Upper DTR's
|
Upper DTR deficit
• • •
|
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Shoulder Depression
• • •
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Cervical Compression
• • •
|
|
Cervical Distraction Positive?
|
Max CS Compression
• • •
|
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Hypertonic Muscles - Neck Area
• • •
|
|
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Notes
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LS Flexion (60°)
|
Pain with LS flexion?
|
|
LS Extension (25°)
|
Pain with LS extension?
|
|
LS RR
|
Pain with LS RR?
|
|
LS LR
|
Pain with LS LR ?
|
|
LS RLF
|
Pain with LS RLF?
|
|
LS LLF
|
Pain with LS LLF ?
|
|
ROM WNL
|
ROM comments
|
|
Lower Dermatomes Intact
|
Lower Dermatome Deficit
• • •
|
|
Lower DTR's
|
Lower DTR deficit
• • •
|
|
Straight Leg Raise Test
|
|
|
Hibbs Test
|
Kemp's Test
|
|
Yoeman's Test
|
|
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FABRE Patrick Test
|
|
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Hypertonic Muscles
• • •
|
|
|
|
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Imaging
• • •
|
Additional Imaging
|
|
Lab Work
• • •
|
Additional Lab Work
|
|
|
|
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Treatment Plan
|
Treatment to include as necessary:
• • •
|
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Treatment Today
|
Treatment
• • •
|
