Patient:
Date:
DOB:
Vitals:
BP: ____________ Pain: __________ Temperature: ___________
O2: ____________ Pulse: __________Respirations: ___________
Musculoskeletal Assessment
Joint:
TMJ
Movement:
Muscles:
ROM:
Resistance:
Smooth:
L: Yes: ______ No: ______
R: Yes: ______ No: ______
Pain:
L: Yes: ______ No: ______
R: Yes: ______ No: ______
Symmetrical: Yes: ______ No: ______
Firm:
Yes: ______ No: ______
Opens: ______________
Strength:
Yes: ______ No: ______
Notes:
Shoulders
Height:
Equal:
Yes: ______ No: ______
Clavicles:
Equal size/location: Yes: _____ No: ______
Scapulae:
Equal size/location: Yes: _____ No: ______
Acromioclavicular Joints:
Symmetrical:
Yes: ______ No: ______
Firm:
Yes: ______ No: ______
Tender:
Yes: ______ No: ______
ROM:
Full:
Yes: ______ No: ______
Active:
Yes: ______ No: ______
Muscles:
Equal/strong:
Yes: ______ No: ______
Notes:
Wrists/hands Size:
Symmetrical:
Shape:
Deformity:
Interphalangeal Joints:
Smooth:
Tender:
ROM:
Full:
Active:
Yes: ______ No: ______
Yes: ______ No: ______
Yes: ______ No: ______
Yes: ______ No: ______
Yes: ______ No: ______
Yes: ______ No: _______
Yes: ______ No: _______
Muscles:
Equal/strong:
Yes: ______ No: _______
Stable:
Firm:
Tender:
ROM:
Muscles:
Yes: ______ No: ______
Yes: ______ No: ______
Yes: ______ No: ______
Full:
Yes: _______ No: _______
Active:
Yes: _______ No: _______
Equal/strong:
Yes: _______ No: _______
Patella:
Central:
ROM:
Muscles:
Tender:
Aligned:
Full:
Equal/strong:
L: Yes: _______ No: _______
R: Yes: _______ No: _______
Yes: _______ No: _______
Yes: _______ No: _______
Yes: _______ No: _______
Yes: _______ No: _______
Symmetrical:
Shape:
Deformity:
Smooth:
Tender:
Smooth:
Active:
Equal/strong
Yes: ______ No: _______
Yes: ______ No: _______
Yes: ______ No: _______
Yes: ______ No: _______
Yes: ______ No: _______
Yes: ______ No: _______
Yes: ______ No: _______
Yes: ______ No: _______
Notes:
Hips:
Notes:
Knees:
Notes:
Feet and Ankles: Size
Joints:
ROM:
Muscles:
Notes:
Spine:
Midline:
Yes: _______ No: _______
Cervical curve:
Concave:
Yes: ______ No: _______
Thoracic curve:
Convex:
Yes: ______ No: _______
Lumbar curve:
Concave:
Yes: ______ No: _______
Iliac crests:
Level:
Gluteal folds:
Level:
Vertebral processes:
Aligned:
Uniform size:
Stable:
Tender:
ROM:
Full:
Muscles:
Smooth:
Firm:
Symmetrical:
Notes/:
Yes: ______ No: _______
Yes: ______ No: _______
Yes: ______ No: _______
Yes: ______ No: _______
Yes: ______ No: _______
Yes: ______ No: _______
Yes: _______ No: _______
Yes: _______ No: _______
Yes: _______ No: _______
Yes: _______ No: _______