|
GENERAL EXAM
|
|
|
General Physical Exam
|
|
|
Constitutional Normal
|
Constitutional Abnormal
|
|
General Abnormal
• • •
|
General Comments
|
|
HEENT Normal
|
HEENT Abnormal
|
|
HEENT Abnormal
• • •
|
HEENT Comments
|
|
Cardiovascular Normal
|
Cardiovascular Abnormal
|
|
Cardiovascular Abnormal
• • •
|
Cardiovascular Comments
|
|
Lungs Normal
|
Lungs Abnormal
|
|
Lungs Abnormal
• • •
|
Lungs Comments
|
|
Abdomen Normal
|
Abdomen Abnormal
|
|
Abdomen Abnormal
• • •
|
Abdomen Comments
|
|
MSK Normal
|
MSK Abnormal
|
|
MSK Abnormal
• • •
|
MSK Comments
|
|
Neuro Normal
|
Neuro Abnormal
|
|
Neuro Abnormal
• • •
|
Neuromuscular Comments
|
|
CERVICAL EXAM
|
|
|
Cervical Exam
|
|
|
Inspection Normal
|
Inspection Abnormal
|
|
Inspection Abnormal
• • •
|
|
|
Palpation Normal
|
Cervical Palpation Abnormal
|
|
Palpation Right
• • •
|
Palpation Rt location
• • •
|
|
Palpation Left
• • •
|
Palpation Lt location
• • •
|
|
Cervical ROM
|
|
|
Normal Cervical ROM
|
Abnormal Cervical ROM
|
|
ROM Flexion Normal N=60
|
ROM Flexion Abnormal N=60
|
|
ROM Flexion Abn N=60
|
|
|
ROM Passive Flexion Normal N=60
|
ROM Passive Flexion Abnormal N=60
|
|
ROM Passive Flexion Abn N=60
|
|
|
ROM Extension Normal N=45
|
ROM Extension Abnormal N=45
|
|
ROM Extension Abn N=45
|
|
|
ROM Passive Extension Normal N45
|
ROM Passive Extension Abnormal N45
|
|
ROM Passive Extension Abn
|
|
|
ROM Rotation Normal N=60
|
ROM Rotation Abnormal N=60
|
|
ROM Rotation Right
|
ROM Rotation Left N=60
|
|
ROM Sidebending Normal N=45
|
ROM Sidebending Abnormal N=45
|
|
ROM Sidebending Right
|
ROM Sidebending Left N=45
|
|
Musculature Normal
|
Musculature Abnormal
|
|
Musculature Right
• • •
|
Musculature Rt Location
• • •
|
|
Musculature Left
• • •
|
Musculature Lt Location
• • •
|
|
Dermatomes Normal
|
Dermatomes Abnormal
|
|
Dermatomes Right
• • •
|
Dermatomes Left
• • •
|
|
Cervical Special Tests
|
|
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Special Tests
|
|
|
Adson Test Negative
|
Adson Test Positive
|
|
Adson Test Right
|
Adson Test Left
|
|
Adson Test Definition
|
|
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Compression Test Negative
|
Compression Test Positive
|
|
Compression Test Right
|
Compression Test Left
|
|
Compression Definition
|
|
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Spurling Test Negative
|
Spurling Test Positive
|
|
Spurling Test Right
|
Spurling Test Left
|
|
Spurling Test Definition
|
|
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Valsalva Test Negative
|
Valsalva Test Positive
|
|
Valsalva Test Right
|
Valsalva Test Left
|
|
Valsalva Test Definition
|
|
|
L'Hermittes Negative
|
L'Hermittes Positive
|
|
L'Hermitte's Right
|
L'Hermitte's Left
|
|
L'Hermitte's Definition
|
|
|
|
|
|
Previous surgical wound
|
|
|
cervical spine diagram
|
|
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Other Details
|
|
|
LUMBAR EXAM
|
|
|
Lumbar Exam
|
|
|
Inspection Normal
|
Inspection Abnormal
|
|
Inspection Abnormal
• • •
|
|
|
Palpation Normal
|
Palpation Abnormal
|
|
Palpation Right
• • •
|
Palpation Rt Location
• • •
|
|
Palpation Left
• • •
|
Palpation Lt Location
• • •
|
|
Lumbar ROM
|
|
|
Normal Lumbar ROM
|
Abnormal Lumbar ROM
|
|
Active ROM Flexion Normal N=80
|
Active ROM Flexion Abnormal N=80
|
|
ROM Flexion Abn N=80
|
|
|
Active ROM Extension Normal N=25
|
Active ROM Extension Abnormal N=25
|
|
ROM Extension Abn N=25
|
|
|
Active ROM Sidebending Normal N=35
|
Active ROM Sidebending Abnormal N=35
|
|
ROM Sidebending Left
|
ROM Sidebending Right
|
|
Passive ROM Flexion Normal N=80
|
Passive ROM Flexion Abnormal N=80
|
|
ROM Passive Flexion Abn N80
|
|
|
Passive ROM Extension Normal N=25
|
Passive ROM Extension Abnormal N=25
|
|
ROM Passive Extension Abn N25
|
|
|
Musculature Normal
|
Musculature Abnormal
|
|
Musculature Right
• • •
|
Musculature Rt Location
• • •
|
|
Musculature Left
• • •
|
Musculature Lt Location
• • •
|
|
Sacrum Normal
|
Sacrum Abnormal
|
|
Sacrum Left
• • •
|
Sacrum Right
• • •
|
|
Sacroiliac Joint Normal
|
Sacroiliac Joint Abnormal
|
|
Sacroiliac Joint Left
• • •
|
Sacroiliac Joint Right
• • •
|
|
Lower Extremity Strength Normal
|
Lower Extremity Strength Abnormal
|
|
Dermatomes Normal
|
Dermatomes Abnormal
|
|
Dermatomes Left
• • •
|
Dermatomes Right
• • •
|
|
Anterior Tibialis Normal
|
Anterior Tibialis Abnormal
|
|
Anterior Tibialis Left
|
Anterior Tibialis Right
|
|
Gastroc-Soleus Normal
|
Gastroc-Soleus Abnormal
|
|
Gastroc-Soleus Left
|
Gastroc-Soleus Right
|
|
Lumbar Strength
|
|
|
Lumbar Strength Normal
|
Lumbar Strength Abnormal
|
|
Hamstrings Strength Normal
|
Hamstrings Strength Abnormal
|
|
Hamstring Strength Left
|
Hamstring Strength Right
|
|
Quadriceps Strength Normal
|
Quadriceps Strength Abnormal
|
|
Quadriceps Strength Left
|
Quadriceps Strength Right
|
|
Lumbar Sensation
|
|
|
Lumbar Sensation Normal
|
Lumbar Sensation Abnormal
|
|
Anterior Thigh Normal
|
Anterior Thigh Abnormal
|
|
Anterior Thigh Left
• • •
|
Anterior Thigh Right
• • •
|
|
Calf Sensation Normal
|
Calf Sensation Abnormal
|
|
Calf Sensation Left
• • •
|
Calf Sensation Right
• • •
|
|
Foot Sensation Normal
|
Foot Sensation Abnormal
|
|
Foot Sensation Left
• • •
|
Foot Sensation Right
• • •
|
|
|
|
|
Stocking/Glove Distribution
|
|
|
Lumbar Special Tests
|
|
|
Patrick Test
• • •
|
Patrick Test Definition
|
|
Kernig Test
• • •
|
Kernig Test Definition
|
|
Trendelenburg Sign
• • •
|
Trendelenburg Sign Definition
|
|
Milgram Test
• • •
|
Milgram Test Definition
|
|
Hoover Test
• • •
|
Hoover Test Definition
|
|
SLR/Sitting Root Normal
|
SLR/Sitting Root Abnormal
|
|
SLR/Sitting Root Right
|
SLR/Sitting Root Rt Degrees
|
|
SLR/Sitting Root Left
|
SLR/Sitting Root Lt Degrees
|
|
Gait Normal
|
Gait Abnormal
|
|
Gait Right
• • •
|
Gait Left
• • •
|
|
Toe and Heel Walk
|
|
|
Previous surgical wound
|
|
|
lumbar diagram
|
|
|
Other Details
|
|
|
HIP EXAM
|
|
|
Hip Exam
|
|
|
Hip Pain Absent
|
Hip Pain Present
|
|
Hip Pain Left
• • •
|
Hip Pain Right
• • •
|
|
Tenderness Normal
|
Tenderness Abnormal
|
|
Tenderness Right
• • •
|
Tenderness Left
• • •
|
|
Hip ROM
|
|
|
Normal Hip ROM
|
Abnormal Hip ROM
|
|
ROM Flexion Normal N=100
|
ROM Flexion Abnormal N=100
|
|
ROM Flexion Right N=100
|
ROM Flexion Left N=100
|
|
ROM Extension Normal N=30
|
ROM Extension Abnormal N=30
|
|
ROM Extension Right N=30
|
ROM Extension Left N=30
|
|
ROM Abduction Normal N=45
|
ROM Abduction Abnormal N=45
|
|
ROM Abduction Right N=45
|
ROM Abduction Left N=45
|
|
ROM Adduction Normal N=30
|
ROM Adduction Abnormal N=30
|
|
ROM Adduction Right N=30
|
ROM Adduction Left N=30
|
|
ROM Internal Rotation Normal N=40
|
ROM Internal Rotation Abnormal N=40
|
|
ROM Internal Rotation Right N=40
|
ROM Internal Rotation Left N=40
|
|
ROM External Rotation Normal N=45
|
ROM External Rotation Abnormal N=45
|
|
ROM External Rotation Right N=45
|
ROM External Rotation Left N=45
|
|
ROM Knee Flexion Normal
|
ROM Knee Flexion Abnormal
|
|
ROM Knee Flexion Right
|
ROM Knee Flexion Left
|
|
Hip Strength
|
|
|
Normal Hip Strength
|
Abnormal Hip Strength
|
|
Strength Hip Flexion Normal
|
Strength Hip Flexion Abnormal
|
|
Strength Hip Flexion Right
|
Strength Hip Flexion Left
|
|
Strength Hip Extension Normal
|
Strength Hip Extension Abnormal
|
|
Strength Hip Extension Right
|
Strength Hip Extension Left
|
|
Strength Hip Abduction Normal
|
Strength Hip Abduction Abnormal
|
|
Strength Hip Abduction Right
|
Strength Hip Abduction Left
|
|
Strength Hip Adduction Normal
|
Strength Hip Adduction Abnormal
|
|
Strength Hip Adduction right
|
Strength Hip Adduction left
|
|
Strength Knee Flexion Normal
|
Strength Knee Flexion Abnormal
|
|
Strength Knee Flexion Right
|
Strength Knee Flexion Left
|
|
Strength Knee Extension Normal
|
Strength Knee Extension Abnormal
|
|
Strength Knee Extension Right
|
Strength Knee Extension Left
|
|
|
|
|
Gait Normal
|
Gait Abnormal
|
|
Gait Right
|
Gait Left
|
|
Leg Lengths Equal
|
Leg Lengths Unequal
|
|
Leg Length Uneven
|
|
|
Neurovascular Status Normal
|
Neurovascular Status Abnormal
|
|
Neurovascular Status Right
|
Neurovascular Status Rt Location
• • •
|
|
Neurovascular Status Left
|
Neurovascular Status Lt Location
• • •
|
|
Previous Surgical Wound Healed
|
|
|
Previous Surgical Wound Problem
|
Surgical wound signs
• • •
|
|
hip diagram
|
|
|
SHOULDER EXAM
|
|
|
Shoulder Exam
|
|
|
Pain Absent
|
Pain Present
|
|
Pain Right
|
Pain w movement Rt
• • •
|
|
Pain Left
|
Pain w movement Lt
• • •
|
|
Deformity Absent
|
Deformity Present
|
|
Deformity Right
|
Deformity Right Location
• • •
|
|
Deformity Left
|
Deformity Left Location
• • •
|
|
Drop Arm Test Negative
|
Drop Arm Test Positive
|
|
Drop Arm Test Left
|
Drop Arm Test Right
|
|
Ecchymosis Absent
|
Ecchymosis Present
|
|
Ecchymosis Right
|
Ecchymosis Rt Location
• • •
|
|
Ecchymosis Left
|
Ecchymosis Lt Location
• • •
|
|
Impingement Absent
|
Impingement Present
|
|
Impingement Right
• • •
|
Impingement Left
• • •
|
|
Instability Absent
|
Instability Present
|
|
Instability Left
• • •
|
Instability Right
• • •
|
|
Apprehension Test Negative
|
Apprehension Test Positive
|
|
Apprehension Test Right
|
Apprehension Test Left
|
|
Sulcus Sign Negative
|
Sulcus Sign Positive
|
|
Sulcus Sign Right
|
Sulcus Sign Left
|
|
Swelling Absent
|
Swelling Present
|
|
Swelling Left
• • •
|
Swelling Right
• • •
|
|
Tenderness Absent
|
Tenderness Present
|
|
Tenderness Left
• • •
|
Tenderness Right
• • •
|
|
Rotator Cuff Strength Normal
|
Rotator Cuff Strength Abnormal
|
|
Strength Rotator Cuff Right
|
Strength Rotator Cuff Left
|
|
Biceps Strength Normal
|
Bicep Strength Abnormal
|
|
Strength Biceps Right
|
Strength Biceps Left
|
|
Strength Triceps Normal
|
Tricep Strength Abnormal
|
|
Strength Triceps Right
|
Strength Triceps Left
|
|
Deltoid Strength Normal
|
Deltoid Strength Abnormal
|
|
Strength Deltoid Right
|
Strength Deltoid Left
|
|
SHOULDER ROM
|
|
|
Normal ROM Complete
|
Abnormal Shoulder ROM
|
|
ROM Abduction Normal N=180
|
ROM Abduction Abnormal N=180
|
|
ROM Abduction Left N=180
|
ROM Abduction Right N=180
|
|
ROM Adduction Normal N=50
|
ROM Adduction Abormal N=50
|
|
ROM Adduction Left N=50
|
ROM Adduction Right N=50
|
|
ROM Extension Normal N=50
|
ROM Extension Abnormal N=50
|
|
ROM Extension Left N=50
|
ROM Extension Right N=50
|
|
ROM Flexion Normal N=180
|
ROM Flexion Abnormal N=180
|
|
ROM Flexion Left N=180
|
ROM Flexion Right N=180
|
|
ROM External Rotation Normal N=90
|
ROM External Rotation Abnormal N=90
|
|
ROM External Rotation Lt N=90
|
ROM External Rotation Rt N=90
|
|
ROM Internal Rotation Normal N=90
|
ROM Internal Rotation Abnormal N=90
|
|
ROM Internal Rotation Lt N=90
|
ROM Internal Rotation Rt N=90
|
|
Shoulder Special Tests
|
|
|
Shoulder Special Tests
|
|
|
Hawkins Test Normal
|
Hawkins Test Abnormal
|
|
Hawkins Test Right
|
Hawkins Test Left
|
|
Neer's Test Normal
|
Neer's Test Abnormal
|
|
Neer's Test Right
|
Neer's Test Left
|
|
Neer's Definition
|
|
|
Yergason's Test Normal
|
Yergason's Test Abnormal
|
|
Yergason's Test Right
|
Yergason's Test Left
|
|
Yergason's Test Definition
|
|
|
Tinel's Normal
|
Tinel's Abnormal
|
|
Tinel's Right
|
Tinel's Left
|
|
|
|
|
Capillary Refill Normal
|
Capillary Refill Abnormal
|
|
Capillary Refill Right
|
Capillary Refill Left
|
|
Previous surgical wound
|
|
|
shoulder diagram
|
|
|
Other Details
|
|
|
KNEE EXAM
|
|
|
Knee Exam
|
|
|
Negative Effusion
|
Positive Effusion
|
|
Effusion Left Knee
|
Effusion Right Knee
|
|
Negative Tenderness
|
Positive Tenderness
|
|
Tenderness Left
|
Tenderness Right
|
|
Negative Errythema
|
Positive Ecchymosis
|
|
Ecchymosis Left
|
Ecchymosis Lt Location
• • •
|
|
Ecchymosis Right
|
Ecchymosis Rt Location
• • •
|
|
Normal Active ROM
|
ROM Active Abnormal
|
|
ROM Active Left N=0-130
|
ROM Active Right N=0-130
|
|
Normal Passive ROM
|
ROM Passive Abnormal
|
|
ROM Passive Left N=0-130
|
ROM Passive Right N=0-130
|
|
Hamstring Strength Normal
|
Hamstrings Strength Abnormal
|
|
Hamstring Strength Left
|
Hamstring Strength Right
|
|
Quadricep Strength Normal
|
Quadriceps Strength Abnormal
|
|
Quadriceps Strength Left
|
Quadriceps Strength Right
|
|
Negative Valgus Instability
|
Positive Valgus Instability
|
|
Valgus Instability Left
|
Valgus Instability Right
|
|
Negative Varus Instability
|
Varus Instability Abnormal
|
|
Varus Instability Left
|
Varus Instability Right
|
|
Lachmans Test Negative
|
Lachman's Test Positive
|
|
Lachman's Test Postive
|
Lachman's Test Location
• • •
|
|
Posterior Drawer Test Normal
|
Posterior Drawer Test Abnormal
|
|
Posterior Drawer Test Left
|
Posterior Drawer Test Right
|
|
Pivot Shift Normal
|
Pivot Shift Abnormal
|
|
Pivot Shift Left
|
Pivot Shift Right
|
|
McMurray Test Normal
|
McMurray Test Abnormal
|
|
McMurray Test Left
|
McMurray Test Right
|
|
Negative Patellar Instability
|
Positive Patellar Instability
|
|
Patellar Instability Left
• • •
|
Patellar Instability Right
• • •
|
|
Patellar Tilt Normal
|
Patellar Tilt Positive
|
|
Patellar Tilt Left
|
Patellar Tilt right
|
|
Patellar Apprehension Normal
|
Patellar Apprehension Abnormal
|
|
Patellar Apprehension Left
|
Patellar Apprehension Right
|
|
Patellar Tracking Normal
|
Patellar Tracking Abnormal
|
|
Patellar Tracking Left
• • •
|
Patellar Tracking Right
• • •
|
|
Calf Swelling Normal
|
Calf Swelling Positive
|
|
Calf Swelling Left
|
Calf Swelling Right
|
|
Calf Pain Normal
|
Calf Pain Present
|
|
Calf Pain Left
|
Calf Pain Right
|
|
Sensation Normal
|
Sensation Abnormal
|
|
Sensation Left
• • •
|
Sensation Right
• • •
|
|
Weakness Negative
|
Weakness Positive
|
|
Weakness Positive
|
|
|
Gait Normal
|
Gait Abnormal
|
|
Gait Left
• • •
|
Gait Right
• • •
|
|
Previous surgical wound
|
|
|
Surgical wound signs
• • •
|
|
|
knee diagram
|
|
|
Other Details
|
|
|
FOOT/ANKLE EXAM
|
|
|
Foot Exam
|
|
|
Swelling Normal
|
Swelling Abnormal
|
|
Swelling Right
• • •
|
Swelling Rt Location
• • •
|
|
Swelling Left
• • •
|
Swelling Lt Location
• • •
|
|
Ecchymosis Normal
|
Ecchymosis Abnormal
|
|
Ecchymosis Right
• • •
|
Ecchymosis RT Location
• • •
|
|
Ecchymosis Left
• • •
|
Ecchymosis Lt Location
• • •
|
|
Tenderness Normal
|
Tenderness Abnormal
|
|
Tenderness Right
• • •
|
Tenderness Rt Location
• • •
|
|
Tenderness Left
|
Tenderness Lt Location
• • •
|
|
ROM Dorsiflexion Normal N=20
|
ROM Dorsiflexion Abormal N=20
|
|
ROM Dorsiflexion Right N=20
|
ROM Dorsiflexion Left N=20
|
|
Dorsiflexion Strength Normal
|
Dorsiflexion Strength Abnormal
|
|
Dorsiflexion Strength Right
|
Dorsiflexion Strength Left
|
|
ROM Plantar Flexion N=40
|
ROM Plantar Flexion Abnormal N=40
|
|
ROM Plantar Flexion Left N=40
|
ROM Plantar Flexion Right N=40
|
|
Plantar Flexion Strength Normal
|
Plantar Flexion Strength Anormal
|
|
Plantar Flexion Strength Right
|
Plantar Flexion Strength Left
|
|
Heel Cord Tightness Normal
|
Heel Cord Tightness Abormal
|
|
Heel Cord Tightness Left
|
Heel Cord Tightness Right
|
|
Equinus Contracture Normal
|
Equinus Contracture Abormal
|
|
Equinus Contracture Right
|
Equinus Contracture Left
|
|
Inversion Normal
|
Inversion Abormal
|
|
ROM Inversion Left N=30
|
ROM Inversion Right
|
|
ROM Eversion Normal
|
ROM Eversion Abnormal
|
|
ROM Eversion Right
|
ROM Eversion Left N=20
|
|
Inversion Strength Normal
|
Inversion Strength Abnormal
|
|
Inversion Strength Left
|
Inversion Strength Right
|
|
Eversion Strength Normal
|
Eversion Strength Abnormal
|
|
Eversion Strength Right
|
Eversion Strength Left
|
|
Great Toe Raise Normal
|
Great Toe Raise Abormal
|
|
Great Toe dorsi flexion Left N=50
|
Great Toe dorsi flexion Right N=50
|
|
Great toe plantar flexion Left N=50
|
Great toe plantar flexion Right N=50
|
|
Squeeze Test Normal
|
Squeeze Test Abormal
|
|
Squeeze Test Right
|
Squeeze Test Left
|
|
Homans Test Normal
|
Homans Test Abnormal
|
|
Homans Test Left
|
Homans Test Right
|
|
Gait Normal
|
Gait Abnormal
|
|
Gait Right
• • •
|
Gait Left
• • •
|
|
Capillary filling normal
|
Capillary Filling Abnormal
|
|
Capillary filling Left
• • •
|
Capillary filling Right
• • •
|
|
Surgical wound signs
• • •
|
Previous surgical wound
|
|
Foot Diagram
|
|
|
Wrist Exam
|
|
|
Wrist Exam
|
|
|
Swelling Normal
|
Swelling Abnormal
|
|
Swelling Right
|
Swelling Left
|
|
Ecchymosis Normal
|
Ecchymosis Abnormal
|
|
Ecchymosis Right
|
Ecchymosis Left
|
|
Referred Pain Normal
|
Referred Pain Abnormal
|
|
Referred Pain Right
• • •
|
Referred Pain Left
• • •
|
|
Deformity Normal
|
Deformity Abnormal
|
|
Deformity Right
|
Deformity Left
|
|
Tenderness Normal
|
Tenderness Abnormal
|
|
Tenderness Right
• • •
|
Tenderness Left
• • •
|
|
ROM Flexion Normal N=90
|
ROM Flexion Abnormal N=90
|
|
ROM Flexion Right
|
ROM Flexion Left N=90
|
|
ROM Extension Normal N=70
|
ROM Extension Abnormal N=90
|
|
ROM Extension Right
|
ROM Extension Left N=70
|
|
ROM Pronation Normal N=0-90
|
ROM Pronation Abnormal N=0-90
|
|
ROM Pronation Right
|
ROM Pronation Left N=0-90
|
|
ROM Supination Normal N=0-90
|
ROM Supination Abnormal N=0-90
|
|
ROM Supination Right
|
ROM Supination Left N=0-90
|
|
Ulnar Deviation Normal
|
Ulnar Deviation Abnormal
|
|
Ulnar Deviation Right
|
Ulnar Deviation Left N=35
|
|
Radial Deviation Normal N=20
|
Radial Deviation Abnormal N=20
|
|
Radial Deviation Right
|
Radial Deviation Left N=20
|
|
Wrist Flexors Normal
|
Wrist Flexors Abnormal
|
|
Wrist Flexors Right
|
Wrist Flexors Left
|
|
Wrist Extensor Normal
|
Wrist Extensor Abnormal
|
|
Wrist Extensor Right
|
Wrist Extensor Left
|
|
Grip Strength Normal
|
Grip Strength Abnormal
|
|
Grip Strength Right
|
Grip Strength Left
|
|
Tinels Normal
|
Tinels Abnormal
|
|
Tinels Right
|
Tinels Left
|
|
Phalen's Test Normal
|
Phalen's Test Abnormal
|
|
Phalen's Test Right
|
Phalen's Test Left
|
|
Reverse Phalen's Test Normal
|
Reverse Phalen's Test Abnormal
|
|
Reverse Phalen's Test Right
|
Reverse Phalen's Test Left
|
|
Capillary Refill Normal
|
Capillary Refill Abnormal
|
|
Capillary Refill Right
|
Capillary Refill Left
|
|
Previous surgical wound
|
Surgical wound signs
• • •
|
|
wrist diagram
|
|
|
Elbow
|
|
