WRIST/HAND R L
Injury_____________________________________________________________________________________(Date)________
Noninjury_____ How long has the problem been active ___________________________________________
Sharp (when) _______________ Dull/Ache (when) __________ Constant (at rest) __________
Stiffness_____ Weakness______ Swelling _____ Numbness_____ (when) _______ Mass/cyst____
Wake from sleep _____
Pain Level (rest)____/10 (activity)____/10 Maximum point of pain_____
What makes it worse: ______________________ Better: _____________________
Been seen for this in the past: ______________________ What tests or treatment_____________________
Inspection: Ecchymosis Erythema/warmth Edema/Swelling Effusion Wound Nails Deformity Atrophy
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Pain Location/Palpation: Hand/Wrist. Radial ____ Dorsal ____ Ulnar ____ Volar ____
Phalanges/Phalangeal joint: DIP___ PIP___ MCP___ CMC ___
Wrist: Flexion_______ Extension _____ Resisted wrist flexion _____ Resisted wrist extension _____ Pronation/supination _____
Radial deviation ______ Ulnar deviation ______ Snuff Box ____ Piano Key _____ TFCC compression test (ulnar dev) _______
Grip: _____ Tinel’s _____ Durkan Carpal Compression ______ Finkelstein ____
Phalen (gravity flex x 60 sec) _____ Froment (paper)
Fingers: Abd _____ Add ____ Mallet (active ext) ______
Thumb opp ______ Thumb Flex/Exten _________ Thumb resisted abd strength ______ Thumb MCP/UCL ____
Grind ________ CMC relocat test ________ Crepitus ________
Sensation: ________
Imagining: _______________________________________________________________________________________________
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MRI:
