ORTHOPAEDICS ASSESSMENT FOR PHYSIOTHERAPY

 

ORTHOPAEDICS ASSESSMENT FOR PHYSIOTHERAPY:-

PATIENT NAME:                                                                                                                                                                                                          

REG. NO.-

AGE:- ________ YRS________ SEX: M/F       PROVISIONAL DIAGNOSIS:______________

 

HEIGHT:_____CMS            WEIGHT:_______KG                MARITAL STATUS:  M/S/D

 

OCCUPATION:

ADDRESS:

 

CHIEF COMPLAINT:

 

HISTORY OF PRESENT ILLNESS:

 

PAST MEDICAL /SURGICAL HISTORY:

 

PERSONAL HISTORY:

 

FAMILY HISTORY:

 

OCCUPATIONAL HISTORY:

 

ON EXAMINATION

ON OBSERVATION

>GAIT

>POSTURE

>DEFORMITY

>ATTITUDE

>PHYSIQUE

>SKIN

>RESPIRATION

 

ON PALPATION

>TENDERNESS

>LOCAL RISE IN TEMPRATURE

>MUSCLE TONE

>CONTOUR

>PULSE

 

TESTING

>SENSATION

>ROM

>MUSCLE POWER

>MUSCLE TONE

>REFLEX

>CLONUS

>LIMB GIRTH

>LIMB LENGTH

>CONTRACTURE

>BLADDER & BOWL CONTROL

 

LAB. INVESTIGATION

 

SPECIAL TESTS

 

PAIN ASSESSMENT

>ONSET

>TYPE

>DIURNAL VARIATION

>AGGREVATING FACTORS

>SIN FACTORS

>VAS SCALE

NIL     VERY MILD     MILD     MODERATE      SEVERE   VERY SEVERE    INTOLERABLE

         I_______I_________I_________I_________I_________I_________I

0                            25                                        50                                  75                              100

 

FUNCTIONAL IMPAIRMENT

 

TREATMENT PLAN

PAIN & SENSATION TESTING CHART(according to dermatomes)

 

ORTHOPAEDICS ASSESSMENT FOR PHYSIOTHERAPY

 

 

 

 

 

 

 

 

 

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