TheraPaws Orthopedic Assessment Form
917 West Foothill Boulevard, Upland California 91759 (909) 300-5264
Date
-
Month
-
Day
Year
Date
Owner(s) Name(s)
First Name
Last Name
Pet's Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Veterinarian
First Name
Last Name
Lameness Score
Stance Analysis Percentages
Body Condition Score
Muscle Condition Score
Thigh Girth
Diagnostics and Veterinary Diagnoses
Scan of Posture: check all that are NOT within normal limits
topline
limb offloading
balance on displacement
pacing reflex
muscle tone throughout
Other
Posture scan comments
Scan of Gait: check all that are NOT within normal limits
walk
trot
turns
3-leg stands
Other
Gait scan comments
Scan of Pelvis: check all that are NOT within normal limits
level cranial-caudal
level dorso-ventral
tender piriformis
tender dorsal sacroiliac joint
Other
Pelvis scan comments
Scan of lumbar: check all that are NOT within normal limits
tender dorsal-ventral pressures
tender side-side pressures
muscle tone
Other
Lumbar scan comments
Scan of Thoracic: check all that are NOT within normal limits
tender dorsal-ventral pressures
tender side to side pressures
muscle tone
Other
Thoracic scan comments
Scan of Ribs: check all that are NOT within normal limits
tender at the 'angles'
Other
Ribs scan comments
Scan of Cervical: check all that are NOT within normal limits
palpation C1-7
side glides C2-7
C1 position
muscle tone brchiocephalicus
muscle tone sub occipitals
Other
Cervical scan comments
Scan of Temporal Mandibular Joint: check all that are NOT within normal limits
muscle tone masseters
Other
TMJ scan comments
Scan of Hips: check all that are NOT within normal limits
strong palpation pectineus
deep palpation deep gluteal
full flexion
full extension
Other
Hips scan comments
Scan of Stifle: check all that are NOT within normal limits
parapatellar tendon swelling
postero-medial joint line sulcus
medial buttress
patellar laxity
full flexion
full extension
Other
Stifle scan comments
Scan of Tarsus: check all that are NOT within normal limits
posterior joint line swelling
calcaneal tendon thickening
hyperextension test
full flexion
full extension
Other
Tarsus scan comments
Scan of Rear Digits: check all that are NOT within normal limits
joint thickenings
full flexion
full extension
cuts/abrasions/etc
Other
Rear digits scan comments
Scan of Shoulder: check all that are NOT within normal limits
full flexion
full extension - with scapula
full extension - with pure glenohumeral
abduction
biceps palpation
teres major palpation
medial joint line palpation
Other
Shoulder scan comments
Scan of Elbow: check all that are NOT within normal limits
full flexion
full extension
elbow crease deep palpation
medial joint line palpation
lateral joint line palpation
Other
Elbow scan comments
Scan of Carpus: check all that are NOT within normal limits
full flexion
full extension
tendons/ligaments palpation
Other
Carpus scan comments
Scan of Fore Digits: check all that are NOT within normal limits
joint thickenings
full flexion
full extension
cuts/abrasions/etc
Other
Fore Digits scan comments
Shoulder Joint Evaluation: check all that are NOT within normal limits
bony margins of scapula palpation
spine of scapula palpation
supra glenoid tubercle palpation
humerus firm palpation
joint line palpation
subscapularis palpation
supraspinatus palpation
infraspinatus/teres minor palpation
long head of triceps palpation
teres major/lats palpation
prescapular lymph node
flexion end feel
abduction end feel
internal rotation end feel
external rotation end feel
goniometry
stretch subscapularis
stretch subscapularus
stretch biceps
stretch supraspinatus
stretch teres major/lat dorsi
stretch long head of triceps
stretch infraspinatus
stretch brachiocephalicus
cranio-caudal joint glides
medio-lateral joint glides
joint distractions
joint compression (neutral)
joint compression in flexion
scapular glides
Other
Shoulder Joint Evaluation comments
Elbow Joint Evaluation: check all that are NOT within normal limits
epicondyles palpation
olecranon palpation
radial head palpation
coronoid process palpation
anconeal process palpation
joint line palpation
medial coronoid ligament palpation
lateral coronoid ligament palpation
distal biceps/brachialis palpation
triceps tendon palpation
carpal/digit extensor palpation
carpal/digit flexor muscles palpation
flexion end feel
extension end feel
supination end feel
pronation end feel
goniometry
stretch biceps
stretch brachialis
stretch triceps - medial-lateral-accessory
stretch long head of triceps
stretch carpal extensors
stretch carpal flexors
glide - olecranon wobbles
medial and lateral glides
radial head glides
joint distraction at 90 degrees
joint compression
medial condyle ligament stress test
lateral condyle stress test
anconeal compression test
coronoid process compression test
Other
Elbow joint evaluation comments
Carpus and Digits Joint Evaluation: check all that are NOT within normal limits
styloid process palpation
distal radius/ulna palpation
carpals palpation
metatarsals palpation
flexor tendons palpation
extensor tendon palpation
flexion end feel
extension end feel
medial deviation end feel
Medial and lateral coronoid ligaments stress tests
muscle of manus palpation
goniometry
distal radio-ulnar joint glide
accessory carpal bone wobble
radial carpal/radial ulnar glide
ulnar carpal/radial ulnar glide
radial carpal/ulnar carpal glide
proximal and distal carpal row glides
carpo-metacarpal joint glides
carpus traction
intermetacarpals glide
metacarpal/intercarpal joints and ligaments test
flexor, extensor, traction of digits
sesamoid palpation
Other
Carpus and Digits Joint Evaluation comments
Hips Joint Evaluation: check all that are NOT within normal limits
greater trochanter palpation
deep gluteal palpation
pectineus palpation
iliopsoas palpation
sartorius/rectus femoris palpation
vastus lateralis palpation
tensor fascia lata palpation
biceps femoris, semitendinosus, semimembranosus palpation
gracilis palpation
vastus medialis palpation
inguinal lymph nodes palpation
flexion end feel
extension end feel
internal rotation end feel
external rotayion end feel
abduction end feel
block pelvis + pure hip flexion
block pelvis + pure hip extension
goniometry
stretch iliopsoas
stretch sartorius/rectus femoris
stretch hamstrings
stretch gracilis
stretch adductors/pectineus
lateral distraction joint glide
long leg traction glide
joint scouring at different ranges
joint compression at different ranges
side to side displacements
thumb tests = hip external rotation
Other
Hip Joint Evaluation comments
Stifle Joint Evaluation: check all that are NOT within normal limits
patella palpation
trochlear ridges palpation
patellar tendon palpation
fabellae palpation
medial/lateral epicondyles palpation
distal femur palpation
proximal tibia palpation
medial/lateral tibial condyles palpation
tibial tuberosity and crest palpation
fibular head and neck palpation
joint line palpation
parapatellar region palpation
posteromedial joint line sulcus palpation
medial buttress palpation
medial and lateral collateral ligaments palpation
long digital flexor tendon palpation
polpliteal lymph nodes palpation
distal quadriceps and palpation
distal tensor fascia lata and adductors palpation
gastrocnemius palpation
cranial tibial palpation
peronei palpation
flexion end feel
extension end feel
rotational end feel
goniometry
medial/lateral patellar glides
cranial/caudal glide
medial and lateral glide/medial and lateral collateral ligaments tests
rotational glides
superior tibial-fibialglide
joint compressions - different ranges
joint distration
patellar stability test
cranial drawer
tibial compression
meniscal derangement tests
Other
Stifle Joint Evaluation comments
Tarsus and Pes Joint Evaluation: check all that are NOT within normal limits
medial and lateral malleoli palpation
calcaneal process palpation
talus and central tarsal palpation
tarsal bones 1-4 palpation
cranial and caudal joint line palpation
medial and lateral collateral ligaments palpation
cranial tendons palpation
flexion end feel
extension end feel
medial and lateral deviation end feels
medial and lateral collateral ligaments stress tests
goniometry
muscles of the pes (gracilis, sartorius, semitendinosus) palpation
stretch gastrocnemius and superficial digital flexor tendon
glide distal tibial-fibular joint
wobble calcaneus and glide central tarsal
caudal glide of talus with flexion
distraction at 90 degrees
distraction of length of metatarsals
joint compressions
hyperextension test in standing
digit flexion, extension, glides, and stress tests
sesamoids palpation
Other
Tarsus and Pes Evaluation comments
Temporal Mandibular Joint Evaluation: check all that are NOT within normal limits
TMJ palpation
masseters palpation
temporalis and frontalis palpation
tartar and plaque build up
mandibular lymph nodes palpation
lateral deviation glides
lateral PULL glides
rostral glides
Other
TMJ Joint Evaluation comments
Cervical Spine Joint Evaluation: check all that are NOT within normal limits
wings of atlas palpation
nuchal ligament palpation
adjacent muscle tone palpation
C1-C7 Transverse Processes for pain palpation
assess C1 side bend position
assess C1 rotation position
assess occipital-atlanto joint flexion/extension
assess atlanto-axial joint rotation
assess side glides C2-C7
Other
Cervical Spine Joint Evaluation comments
Thoracic Spine Joint Evaluation: check all that are NOT within normal limits
T1-T13 palpation
epaxial muscle tone palpation
multifidus muscle tone palpation
bilateral dorsal-ventral pressures T1-T9
bilateral dorsal-ventral pressures T10-T13
side bend/rotations T1-T13
rib 1 position and pain palpation
ribs 2-13 ventral glides
ribs 2-13 dorsal glides
hypaxials palpation
intercostals palpation
sternum and xiphoid palpation
assess three-leg stands
Other
Thoracic Spine Evaluation comments
Lumbar Spine Joint Evaluation: check all that are NOT within normal limits
L1-L7 Spinous Processes for pain palpation
epaxial muscle tone palpation
multifidus muscle tone palpation
quadratus lumborum tone palpation
iliopsoas tone and pain palpation
bilateral dorsal-ventral pressures L1-7
unilateral dorsal-ventral pressures L1-7
sidebend/rotation glides L1-7
isolated flexion glides L1-7/S1
assess 3-leg stands
Other
Lumbar Spine Joint Evaluation comments
Pelvis/Sacroiliac Spine Joint Evaluation: check all that are NOT within normal limits
body of ilia/ischia palpation
sacrum palpation
piriformis palpation/strum
sacrotuberous ligament palpation/strum
dorsal sacroiliac joint region palpation
assess for assymetry caudal-cranial
assess for assymetry rotational
assess for passive mobility
assess 3-leg stands
thigh thrust technique
sacroiliac traction technique
coccygeal vertebrae palpation
assess coccygeal vertebrae side bends
Other
Pelvis/Sacroiliac Joint Evaluation comments
Summary of Assessment, Recommendations, Other Comments
Therapist/Examiner
First Name
Last Name
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