|
Sleep
|
|
|
Objective
|
|
|
Observation:
• • •
|
Gait
• • •
|
|
Cervical AROM:
|
Palpation:
• • •
|
|
Flexion
|
With Pain?
|
|
Extension
|
With Pain?
|
|
Rt. Rot
|
With Pain?
|
|
Lt. Rot
|
With Pain?
|
|
Lt.Lat. Flex
|
With Pain?
|
|
Rt.Lat. Flex
|
With Pain?
|
|
U.E. Strength
|
|
|
All Strength Normal
|
|
|
Left C5 shoulder abduction
|
Rt. C5 Shoulder Abduction
|
|
Left C6 elbow flexion/wrist extension
|
Rt. C6 Elbow flexion and wrist extension
|
|
Left C7 elbow extension/wrist flexion
|
Rt. C7 Elbow extension and wrist flexion
|
|
Left C8 finger flexion
|
Rt. C8 Finger flexion
|
|
Left T1 finger abduction
|
Rt. T1 Finger abduction
|
|
L.E. Strength
|
|
|
Left Hip Flexion: L2/3
|
Right Hip Flexion: L2/3
|
|
Left Knee Extension: L3/4
|
Right Knee Extension: L3/4
|
|
Left Ankle Dorsiflexion: L4/L5
|
Right Ankle Dorsiflexion: L4/L5
|
|
Left Great Toe Dorsiflexion: L5
|
Right Great Toe Dorsiflexion: L5
|
|
Left Ankle Dorsiflexion: S1
|
Right Ankle Dorsiflexion: S1
|
|
DTRs
|
|
|
All Normal DTR?
|
|
|
Lt C5
|
Rt. C5
|
|
Lt. C6
|
Rt. C6
|
|
Lt. C7
|
Rt. C7
|
|
|
|
|
Lt. L4
|
Rt. L4
|
|
Lt. S1
|
Rt. S1
|
|
Cervical Spine Orthopedic Tests
|
|
|
Cervical Compression Test
|
|
|
C/S Max compression
|
|
|
Shoulder Depression Test
|
|
|
Cervical Distraction
|
|
|
Adsons
|
|
|
Comments
|
|
|
Thoracic:
|
|
|
Lt. Rot
|
Rt. Rot
|
|
Visual:
|
Palpation
• • •
|
|
Adams Sign
|
Spinous Percussion
|
|
Comments
|
|
|
L/S:
|
|
|
Lumbar AROM:
|
|
|
Flexion
|
|
|
Extension
|
|
|
Lt. Rot
|
|
|
Rt. Rot
|
|
|
Lt.Lat. Flex
|
|
|
Rt.Lat. Flex
|
|
|
Lumbar Spine Orthopedic Tests
|
|
|
Kemps Test
• • •
|
|
|
Becterew Test
|
Palpation
• • •
|
|
SLR
|
Palpation (Spasm)
• • •
|
|
Braggards
|
Heel Walk
|
|
Milgram's
|
Toe Walk
|
|
Comment
|
|
|
Pelvis
|
|
|
Pelvis
• • •
|
|
|
Yeomans
|
Patrick FABER
|
|
Nachlas Test
|
Trendelenburg
|
|
Ely's Test
|
Comment
|
|
|
|
|
Shoulder Exam
|
|
|
Shoulder orthopedic exams
|
|
|
Neer's test
• • •
|
Palpation
|
|
Speeds Test
• • •
|
Palpation (Trigger Points)
• • •
|
|
Empty Can
• • •
|
|
|
Dawburns Test
• • •
|
|
|
Yergason's Test
• • •
|
|
|
Hawkin's - Kennedy
• • •
|
|
|
Elbow/Wrist/Hand
|
|
|
Observation:
• • •
|
|
|
Palpation (Spasm)
• • •
|
|
|
Elbow/Wrist/Hand AROM
|
|
|
Right Elbow Extension
|
Right Elbow Flexion
|
|
Left Elbow Extension
|
Left Elbow Flexion
|
|
Right Forearm Pronation
|
Right Forearm Supination
|
|
Left Forearm Pronation
|
Right Forearm Supination
|
|
Right Wrist Extension
|
Right Wrist Flexion
|
|
Left Wrist Extension
|
Left Wrist Flexion
|
|
|
|
|
Knee/Ankle/Foot
|
|
|
Observation:
• • •
|
|
|
Palpation (Spasm)
• • •
|
|
|
Knee/Ankle/Foot AROM
|
|
|
Right Knee Extension
|
Right Knee Flexion
|
|
Left Knee Extension
|
Left Knee Flexion
|
|
Right Ankle Dorsiflexion
|
Right Ankle Plantarflexion
|
|
Left Ankle Dorsiflexion
|
Left Ankle PlantarFlexion
|
|
Assessment
|
|
|
Diagnosis
• • •
|
|
|
Comments on DX
|
|
|
Prognosis
• • •
|
|
|
Plan:
|
|
|
PT Treatment Frequency month:
• • •
|
PT Treatment Duration Month
|
|
Treatment Frequency Weeks:
• • •
|
Treatment Duration week
|
|
Re-examination:
|
|
|
Supplies
• • •
|
|
|
Radiology
• • •
|
|
|
Records reviewed
• • •
|
|
