Examination

1
Examination
9
Patient Name
Date
AOCC
See DD
Vital Signs
Temp.
F
Resp.
BPM
Blood Pres.
Sit
Lay
Rt.
Lt.
Dynamometer Grip
Lt.
Rt.
(Circle Handedness)
A Abnormal
F Facial Grimace
C No Complaint
D Edema
E Eye Wincing
N Normal
S Spasm
V Verbal Upset
O Omitted
R Rigidity
3 Fair
2 Poor
1 Trace
0 Zero
4 Good
5 Normal
Static
Motion
Musculature
AEWNL
Pinwheel
AEWNL
Vibration
AEWNL
Percussion
2
Left
Right
Right
Left
Heel Walk Toe Walk Adams Support.
Adams Reversal Sign Kemps Sd/Sit Lasegues Sicar
ds Leg Lowering Kernigs Braggards Goldthwaits
Gaenslens Thomas Patricks Dbl Leg
Raise Hoovers Milgrams Libmans Soto-Halls Lind
ners SH-SBs Jacksons Foraminal
Cp MRCCT Cervical Distr Shoulder Depr Magnusons
Mankopffs Burns Bench Elys Yeomans Springs Gi
llets Codmans Dawbarns Dugas Supra
PR Impingement East Costclav McMurrays McIntoshs
Lachmans Pat Tap Pat Scrape Mills T Cozens
T Phalens Tinels Finkels Adsons Valgus
Stress Varus Stress AP Drawer Sign PA Drawer Sign
Deg.
Deg.
Deg.
Deg.
Deg.
Sec.
ROM
Location
C/TH
Norm
Deg.
Pain
TH/L
Norm
Deg.
Location
Pain
FLX EXT LR RR LLF RLF
45 45 80 80 45 45
FLX EXT LR RR LLF RLF
90 30 30 30 30 30
Norm
L
R
L
Should
Norm
Norm
Elbow
Wrist
R
L
R
Notes
Notes
Notes
ABD ADD FLX ER IR
150 30 150 40 90
FLX EXT PRO SUP
150 0 80 80
F E RD UD
60 70 20 30
FLX EXT IR ER
150 10 15 20
FLX EXT AB DA IR ER
100 30 40 20 90 50
DF PF EV IN
20 40 20 30