Orthopedic Assessment Form: Sharp Bright Burning Well-Localized Shooting Diffuse Referring Achy
Orthopedic Assessment Form: Sharp Bright Burning Well-Localized Shooting Diffuse Referring Achy
Orthopedic Assessment Form: Sharp Bright Burning Well-Localized Shooting Diffuse Referring Achy
Observation of Gait:
2. Texture
3. Tenderness
4. Tone:
Range of Motion
Legend
l = some limitation TS=tissue stretch P = mild pain
ll= mod limitation STA=soft tissue approx.
P+ = mod pain
lll= sig. limitation B=bony P++ = severe pain
A=abnormal (describe)W = mild weak
W+ =mod weak
W ++ = severe weak
Joint tested: ___________________________________________________________
Record only those movements that are significant.
Joint Movement Active Free Passive Relaxed Active Resisted
Clinical Impression
1. signs and symptoms (ALL your findings from your assessment must be included
here):
2. location: _________________________________________________________
3. stage of healing: ___________________________________________________
4. condition: ________________________________________________________
5. cause: __________________________________________________________
Hydrotherapy:
Massage:
Remedial Exercise:
Goals Homecare
Hydrotherapy:
Massage:
Remedial Exercise: