History ***Total____/8 (1 pt each) 1 1 1 1 1 1 1 1 (quick mark offs)
_____ MOI/How did it happen? | _____ When did it happen? | _____ What happened? |
_____ Direction of forces | _____ Sport/position | _____ Any sounds |
_____ Location of pain | _____ Type of pain | _____ Rate pain level |
_____ Radiating pain | _____ Referred pain | _____ Overuse/acute |
_____ Movement ↑ or ↓ pain | _____ Previous injury | _____ Previous treatment |
_____ Length of symptoms | _____ Sounds and sensations | _____ Tingling/numbing |
_____ Changes in training | _____ Age of shoes | _____ Type of track |
_____ Other intrinsic/extrinsic factors | _____ Medications |
Observation ***Total____/8 (Observation) (1 pt each) 1 1 1 1 1 1 1 1 (quick mark offs)
_____ Deformities | _____ Symmetry of gait | _____ Symmetry/alignment |
_____ Scars/lacerations | _____ Skin color | _____ Swelling |
_____ Shoe/sock removal | _____ Shoe wear | _____ Pain/guarding |
_____ Blisters | _____ Callus patterns | _____ VMO atrophy |
_____ VMO hypertrophy | _____ Flexibility of foot/LL | _____ Foot deformities |
Posture
_____ Pes cavus | _____ Pes planus | _____ Achilles t. angle |
_____ WB vs. NWB posture | _____ Camel sign | _____ Genu recurvatum |
_____ Genu valgus | _____ Genu varum | _____ Shoe creases |
_____ Shoe pattern (e.g., pronation vs. supination) | _____ Valgus/Varus orientation of forefoot/rearfoot |
Palpations ***Total___/8 (Palpations) (1 pt each)
Bony Palpation - Reasons for bony palpation: AT palpates for: Total 2 points (.5 each) ______
_____ Point tenderness | _____ Deformity | _____ Crepitus | _____ Symmetry |
Bony Palpations:
___ Patella | ___Fibula Head | ___ Joint line |
___ Tibial Tuberosity | ___ Tibial Plateau |
Soft tissue Palpation - Reasons for bony palpation: AT palpates for Total 2 points (.5 each) ____
_____Point tenderness | ____ Symmetry | ____ Spasm/tone | ____ Swelling/ warmth |
Soft Tissue Palpations
___ Patellar Tendon | ___ Medial Collateral Ligament | |
___ Lateral Collateral Ligament |
Range of Motion ***Total____/3 (ROM)**
___ Active ROM (F, E) | |
___ Passive ROM (F, E) | Bi Lateral ________ 1 pt |
___ Manual muscle (F, E) |
Special tests ***Total_____/26 (Special Tests) ( 1 pt each)
Name: | ___ Anterior Drawer | ___Posterior Drawer | __Lachman's |
Mechanics: | ___ | ___ | ___ |
Testing for: | ___ ACL tear/sprain | ___ PCL tear/sprain | ___ ACL tear/sprain |
Positive test: | ___ Anterior Translation | ___ Posterior Translation | ___ Anterior Trans. |
Name: | ___Valgus | ___Varus | ___Apley’s Com. |
Mechanics: | ___ | ___ | ___ |
Testing for: | ___ MCL tear/sprain | ___ LCL tear/sprain | ___ Meniscus tear |
Positive test: | ___ Hypermobility/Pain | ___ Hypermobility/Pain | ___ Pain |
___ 0 & 30 |
___ 0 & 30
|
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