History - These include, but are not limited to: Total ___/8 (1 pt each) 1 1 1 1 1 1 1 1 (quick mark offs)
| _____ What happened? | _____ Varus or valgus force? | _____ Medication(s) |
| _____ Direction of force applied | _____ When is pain worse? | _____ Changes in daily routine |
| _____ Rate pain level | _____ How did it happen? | _____Sounds/sensations |
| _____ Length of symptoms | _____ Location of pain | _____ Type of pain |
| _____ Movement ↑ or ↓ pain | _____ Radiating pain | _____ Referred pain |
| _____ Onset (acute or chronic) | _____ Pain constant/intermittent | _____ Sleeping Problems |
| _____ Is this your dominant arm | _____ Previous Rx | _____ Altered Sensations |
| _____ Did you fall on an outstretched hand | _____ Previous history (shoulder/wrist/hand problems/pain) | |
Inspection/Observation - These include, but are not limited to: Total ___/ 8 (1 pt each) 1 1 1 1 1 1 1 1 (quick)
| _____ Bilateral comparison | _____ Deformity | _____ Swelling |
| _____ Arm Swing | _____ Skin color | _____ Scars/lacerations |
| _____ Atrophy/hypertrophy | _____ Clothing removal | _____ Apley's scratch test |
| _____ Facial expressions | _____ Varus | _____ Valgus |
| _____ Cubitus recurvatum | _____ Triangle alignment | _____ Olecranon bursitis |
Palpations ***Total___/8 (Palpations)***
Bony Palpation - Reasons for bony palpation AT palpates for: 2 points (.5 each)_______
| _____ Point tenderness | _____ Deformity | _____ Crepitus | _____ Symmetry |
Bony Palpations:
| _____ Radial Styloid Process | _____Auatomic Snuff Box | _____Ulnar Styloid Process |
| _____ Pisiform | _____1st Metacarpal | _____MCP Joint |
Soft Tissue Palpation - Reasons for soft tissue palpation: AT palpates for: 2 points (.5 each)_______
| _____ Point tenderness | _____ Symmetry | _____ Spasm/tone | _____ Swelling/warmth |
Soft Tissue Palpations:
| _____Thenar Eminence | _____Hypothenar Eminence |
Range of Motion ***Total____/3 (ROM)***
| ___ Active ROM (F, E, UD, RD, Opposition) | |
| ___ Passive ROM (F, E, UD, RD, Opposition) | Bi-Lateral _________ 1 pt |
| ___ Manual muscle (F, E, UD, RD, Opposition) | |
Special Tests ***Total_____/16 (Special tests) (1 each)***
| Phalen's | Finkelstein's |
| ___ Name | ___ Name |
| ___ + Test | ___ + Test |
| ___ Testing for (CTS) | ___ Testing for (De Quervain’s Tenosynovitis) |
| ___ Proper Mechanics | ___ Proper Mechanics |
| Tinel’s Sign | Allen |
| ___ Name | ___ Name |
| ___ + Test | ___ + Test |
| ___ Testing for (CTS/Median nerve compres.) | ___ Testing for (Occlusion in Radial/Ulnar arteries) |
| ___ Proper Mechanics | ___ Proper Mechanics |
Action: 6 points _______
What are three modalities you could use for treatment on the first visit to the clinic. Explain why you picked those modalities. (Modality each 1 pt explain the why for each modality 1 pt) Total 6 pts
Tape Job: 4 points________
| ___ Correct Tape Job |
| ___ Proper application/mechanics |
| ___ Clean and Comfortable |
| ___ Timely |
Plan: 10 points________ (2 points each phase)
Correctly and clearly describes what they would do
| Phase 1: | Phase 2: | Phase 3: | Phase 4: | Phase 5: |
- Manage pain ____
- Swelling PRICE____
- Tools:
| - Begin ROM____
- Resume cardiovascular training____
- Tools:
| - Restore ROM____
Improve strength and endurance____ - Proprioception____
- Continued cardiovascular training____
- Tools:
| - Restore strength____
- Sport specific exercise____
- Tools:
| - Return to sport and check in with coordinators____
- Tools:
|