Orthopaedic Physiotherapy Assessment Chart For Physiotherapists By Dr. Krishna N. Sharma

Orthopaedic Assessment

§ -Designed ByDr. Krishna N. Sharma

§

§ -PublicationOnline Physio Community, India Web: http://www.opcindia.info.ms E-Mail: [email protected] © http://www.opcindia.info.ms

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Orthopaedic Assessment Name

:

Age : Address: Chief Complaints:

Gender:

Occupation:

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:

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Vital Signs:  Heart Rate:  Blood Pressure: 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: Local Observation:  Inflammation:  Swelling:  Scar:

 

Temperature: Respiratory Rate:



o Lordotic Gait: o Scissoring Gait: o Talus Gait: o Trendlenburg Gait: o Valgus Gait: o Varus Gait: o Waddling Gait: o Other: Deformities:

  

Skin Condition: Muscle Wasting: Shape Alteration:

Palpation:  Swelling: Pitting, Non-Pitting  Tenderness: GradeⅠ/ Grade Ⅱ/ Grade Ⅲ/ Grade Ⅳ  Warmth:  Crepitus:  Scar: Heal / Non-Heal / Length Sensory Examination:  Superficial Sensations: o Pain:  Nature:  Mode of Onset:  Course (If Radiates):  Aggravating Factors:  Relieving Factors:  Visual Analogue Scale: 0

1

2

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3

4

5

6

7

8

9

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10

o Touch: Normal, Anesthesia, Hyperesthesia, Hypoesthesia o Temperature:  Hot Test Tube (40-45∘C):  Cold Test Tube (5-10∘C): 



Deep Sensations: o Propioception: o Kinesthesia:

o Vibrations:

Cortical Sensations: o Graphesthesia: o Stereognosis:



Superficial Reflexes: o Corneal Reflexes: o Abdominal Reflexes:  Epigastric Region (T7-T9):  Upper Abdominals (T9-T11):  Lower Abdominals (T11-T12): o Cremastric Reflex (L1-L2): o Anal Reflex (S4-S5): o Planter Reflex:



Deep Tendon Reflexes: o Biceps (C5-C6): o Brachioradialis (C5-C6): o Triceps (C7-C8): o Pectoral (C5-T1): o Finger Flexion (C6-T1):

o Tactile Localization: o 2 Point Discrimination:

o o o o o

Knee (L3-L4): Post. Tibial (L4-L5): Med Hamstring (L5-S1): Lat. Hamstring (S1–S2): Ankle (S1–S2):

Range of Motion: Joint Rt.(Active) Lt.(Active) Rt.(Passive) Lt.(Passive) End Feel

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Pain

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Muscle Power: Muscle

Rt.

Lt.

Limb Length: Rt.

Lt.

Rt.

Lt.

Rt.

Lt.

True Apparent  

Pelvic Square: Segmental Limb Length:

Humeral Ulnar Femoral Tibial Muscle Girth: Arm Forearm Quadriceps Calf Balance:  Static: o Sitting (With eyes open & closed) o Standing (With eyes open & closed) o Tendem Standing (With eyes open & closed)  Dynamic:

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0 – Unable to do 1 – With Human Support 2 – Using Aid 3 – Needs Supervision 4 - Independent

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o Reaching out activities: Able/Unable o Perturbation: Able/Unable Gait Analysis:  Stance Phage:  Swing Phage:  Step Length:  Stride Length: Functional Evaluation of Upper Limb:  Dressing:  Combing:  Washing:  Eating:  Toileting:  Other: Functional Evaluation of Lower Limb:  Stair Climbing:  Cycling:  Other:

  

Base Width: Cadence: Other:

1 - Total Assistance Patient- <25%, Assistant- >75% 2 - Max. Assistance Patient- 25%, Assistant- 75% 3 - Moderate Assistance Patient- 50%, Assistant- 50% 4 - Minimal Assistance Patient- 75%, Assistant- 25% 5 - Supervision Cues without physical contact 6 - Modified Independence Assistive devices, takes more time 7 - Completely Independent

Investigations:  Pathological Findings: 

Radiological Findings:

Special Tests:

Differential Diagnosis: Diagnosis: Physiotherapy Aims:  To relieve pain  To increase ROM  To correct the deformity  To relieve stiffness  To improve muscle power & strength

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      

To improve muscle endurance To maintain tissue extensibility To correct posture To improve balance To train for walking aids Gait training Other

Short Term Goals:

Long Term Goals:

Physiotherapy Plan:

HEP (Home Exercise Program):

Ergonomics:

Instructions by the Therapist:

Date of Evaluation:

Therapist

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