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Orthopaedic Physiotherapy Assessment Chart for Physiotherapists by Dr. Krishna N. Sharma

Orthopaedic Physiotherapy Assessment Chart for Physiotherapists by Dr. Krishna N. Sharma

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Orthopedic Physiotherapy Assessment Chart for Physiotherapists designed by Dr. Krishna N. Sharma. You can use this chart to assess your patient and condition.
Orthopedic Physiotherapy Assessment Chart for Physiotherapists designed by Dr. Krishna N. Sharma. You can use this chart to assess your patient and condition.

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Published by: Dr. Krishna N. Sharma on Apr 05, 2009
Copyright:Attribution Non-commercial

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11/30/2014

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© http://www.opcindia.info.ms Page of 60
 
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Web: http://www.opcindia.info.ms E-Mail: dr.krisharma@gmail.com
 
© http://www.opcindia.info.ms Page of 61
Orthopaedic Assessment
Name:
Age:Gender:Occupation:Address:Chief Complaints:Present History:
Mode of Onset:
Duration:
Associated Problem:Past Medical History:
Birth History:
History of other diseases & injuries:
Operations & Hospitalizations:
Medications:
Physiotherapy Treatment:Personal History:
Personal Habits:
Marital Status:Family History:
Similar Problem in relatives:
Hereditary Diseases:
Consanguinity:
Infections:Economical History:
Income:
Source:
Expenditure:Social History:
Social Status:
Educational Status:Environmental History:
Environment of Home:
Environment of Workplace:
 
© http://www.opcindia.info.ms Page of 62Vital Signs:
Heart Rate:
Blood Pressure:
Temperature:
Respiratory Rate:General Observation:
Built:
Posture:
Gait:
o
Antalgic Gait:
o
Ataxic Gait:
o
Calcaneal Gait:
o
Circumductory Gait:
o
Hand to Knee Gait:
o
High Stepping Gait:
o
Jack Knifing Gait:
o
Lordotic Gait:
o
Scissoring Gait:
o
Talus Gait:
o
Trendlenburg Gait:
o
Valgus Gait:
o
Varus Gait:
o
Waddling Gait:
o
Other:
Deformities:Local Observation:
Inflammation:
Swelling:
Scar:
Skin Condition:
Muscle Wasting:
Shape Alteration:Palpation:
Swelling:Pitting, Non-Pitting
Tenderness:Grade
/
Grade
/
Grade
/
Grade
Warmth:
Crepitus:
Scar: Heal / Non-Heal / LengthSensory Examination:
Superficial Sensations:
o
Pain:
Nature:
Mode of Onset:
Course (If Radiates):
Aggravating Factors:
Relieving Factors:
Visual Analogue Scale:0 1 2 3 4 5 6 7 8 9 10

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