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Inspection Normal
Inspection
• • •
Palpation Normal
Palpation Right
• • •
Palpation Rt Location
• • •
Palpation Left
• • •
Palpation Lt Location
• • •
ROM Flexion Normal N=80
ROM Flexion Abn N=80
ROM Passive Flexion Normal N80
ROM Passive Flexion Abn N80
ROM Extension Normal N=25
ROM Extension Abn N=25
ROM Passive Extension Normal N25
ROM Passive Extension Abn N25
ROM Rotation Normal N=60
ROM Rotation Right
ROM Rotation Left N=60
ROM Passive Rotation Normal N60
ROM Passive Rotation Right
ROM Passive Rotation Left N60
ROM Sidebending Normal N=35
ROM Sidebending Right
ROM Sidebending Left N=35
ROM Passive Sidebending Normal
ROM Passive Sidebending Right
ROM Passive Sidebending Left N35
Musculature Normal
Musculature Right
• • •
Musculature Rt Location
• • •
Musculature Left
• • •
Musculature Lt Location
• • •
Sacrum Normal
Sacrum Right
• • •
Sacrum Left
• • •
Coccyx Normal
Coccyx Right
• • •
Sacroiliac Joint Normal
Sacroiliac Joint Left
• • •
Sacroiliac Joint Right
• • •
Knee Reflex Normal
Knee Reflex Left
Knee Reflex Right
Ankle Reflex Normal
Ankle Reflex Left
Ankle Reflex Right
EHL Strength Normal
EHL Strength Left
EHL Strength Right
FHL Strength Normal
FHL Strength left
FHL Strength Right
Dermatomes Normal
Dermatomes Left
• • •
Dermatomes Right
• • •
Anterior Tibialis Normal
Anterior Tibialis Left
Anterior Tibialis Right
Gastroc-Soleus Normal
Gastroc-Soleus Left
Gastroc-Soleus Right
Hamstrings Strength Normal
Hamstring Strength Left
Hamstring Strength Right
Quadriceps Strength Normal
Quadriceps Strength Left
Quadriceps Strength Right
Anterior Thigh Normal
Anterior Thigh Left
• • •
Anterior Thigh Right
• • •
Calf Sensation Normal
Calf Sensation Left
• • •
Calf Sensation Right
• • •
Foot Sensation
Foot Sensation Left
• • •
Foot Sensation Right
• • •
Stocking/Glove Distribution
Patrick Test Definition
Patrick Test
• • •
Kernig Test Definition
Kernig Test
• • •
Trendelenburg Sign Definition
Trendelenburg Sign
• • •
Milgram Test Definition
Milgram Test
• • •
Hoover Test Definition
Hoover Test
• • •
SLR/Sitting Root Normal
SLR/Sitting Root Rt Degrees
SLR/Sitting Root Right
SLR/Sitting Root Lt Degrees
SLR/Sitting Root Left
Gait Normal
Gait Left
• • •
Gait Right
• • •
Toe and Heel Walk
Long Tract/Clonus Normal
Long Tract/Clonus Rt Degree
Long Tract/Clonus Right
Long Tract/Clonus Lt Degree
Long Tract/Clonus Left
Medial/Malleolar Tinel's Norm
Medial/Malleolar Tinel's Left
Medial/Malleolar Tinel's Right
Capillary Filling Normal
Capillary Filling Left
• • •
Capillary Filling Right
• • •
Surgical wound signs
• • •
Previous surgical wound
lumbar diagram

Lumbar Spine Examination Medical Form

Pain Management Specialist

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Published: Dec. 24, 2016, 4:12 p.m.
Doctor: Dr. History Physical
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