R Vizniak L tingling (t) WNL □ 2014-01-19 3:43:26 AM □ (dd/mm/yr) Date: : 0° 30° ache (a), □ Right Left Varus stress Varus Pivot shift Patellar apprehen. Plica tests Pat-femoral grind test Clarke’s Genu recurvatum Apley compression Apley distraction Hyperflexion test Varus stress Varus MFTP (x), (x), MFTP □ WNL □ R : fibrotic (f), L □ R 0° 30° L edema (e), □ www.prohealthsys.com www.prohealthsys.com Signature: Orthopedic Additional procedures Ankle exam: ______Lumbosacral: ______Hip exam: ______DDx: Ballotment/ buldge Bounce home McMurray’s Steinmann’s Anterior drawer Posterior drawer Slocum’s Lachman’s Ober/Renne stress Valgus stress Valgus □ □ □ spasm (s), □ Date of birth: ______M/F ______Date of birth: ______date: ______date: ______Patient: Insurance: ______R R Palpation Saphenous vein Popliteal fossa Gastrocnemius heads Baker’s cyst Lateral hamstrings Iliotibial band (ITB) Popliteus Lateral collateral lig. Lateral joint/meniscus Lat. femoral condyle Lat. tibial condyle R WNL R □ pain (circle), L □ : Refer for X-ray: ______Refer for X-ray: R L □ L WNL □ L WNL, L □ WNL WNL □ : (facets, bursa) www.prohealthsys.com Palpation Quadriceps Patella Patellar ligament tuberosity Tibial Retinaculum/plica Adductor canal Pes anserine Med. joint/meniscus Med. femoral condyle & capsule MCL Medial hamstrings Neurologic: Vascular Screen Vascular Palpation Motor (0-5), □ WNL Med. hamstrings (L4-S1)(sciatic) Lat. hamstrings (L4-S2)(sciatic) Poplteus (L4-S1)(tibial) Hip adductors (L2-L4)(obturator) Sartorius (L2-L3)(femoral) (L4-S1)(superior gluteal) TFL Rectus femorus (L2-L4)(femoral) intermed. (L2-L4)(femoral) Vastus medialis (L2-L4)(femoral) Vastus lateralis (L2-L4)(femoral) Vastus other: Sensation, □ WNL Light touch Sharp/dull Reflexes (0-5), □ WNL Patellar (L4) Hamstring (L5) Patellar (S1) Babinski Pulses (0-4) Popliteal pulse pulse Tibial Dorsal pedial Blanch test Reproduction is permitted for personal use, not for resale or redistribution. R R WNL Check normal, circle & describe abnormal & describe normal, circle  Check □ : poor Passive L □ Knee/Thigh Regional Exam L Comments WNL ______□ R ©2014 by Professional Health Systems Inc. All rights reserved. “Dedicated to Clinical Excellence.” ©2014 by Professional Health Systems Inc. fair, fair, : □ R Each item should be utilized as a diagnostic option based on the patient’s presenting symptoms and the clinical discretion clinical the and symptoms presenting patient’s the on based option diagnostic a as utilized be should item Each within contained information Patient patient. every on performed be to have not does procedure Every examiner. the of this form is considered strictly confidential. Active L L FREE full sized download & printing for personal & classroom use available at FREE full sized download & printing for personal & classroom good, Extremity Manual □ (med, lat, ↑, ↓) |

ROM & Joint Play & Joint ROM Observation Pain at end ROM: ______Abnormal motion: ______Skin (bruising, scars): ______Skin (bruising, scars): Swelling: ______Asymmetry: Posture: ______Joint Play Anterior glide Posterior glide Medial tilt Lateral tilt Patella Internal rotation External rotation tibia/fibula A↔P Superior tib/fib Hamstring stretch Quadricep stretch ROM Flexion (150°) Extension (0°) Internal rotation External rotation Q-angle Genu varum / valgum Femur rotated int. / ext. Iliac crest height Lumbar hyper / hypolordosis Knee hyperextended Leg length Gait analysis Observation □ WNL in / out Toe Arch low / high Patella position □ □ □ □ □ ______test, 5-step test): percussion, torsion (tuning fork, Fracture screen □ CC & significant history: CC & significant

Development: 420 Knee Exam Form Exam Knee

Rapid Review DDx 11-Appendix Index Extremity.indd 420