TheraPaws Orthopedic Assessment Form

TheraPaws Orthopedic Assessment Form

917 West Foothill Boulevard, Upland California 91759 (909) 300-5264
Date

MonthDay 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

toplinelimb offloadingbalance on displacementpacing reflexmuscle tone throughoutOther
Posture scan comments
Scan of Gait: check all that are NOT within normal limits

walktrotturns3-leg standsOther
Gait scan comments
Scan of Pelvis: check all that are NOT within normal limits

level cranial-caudallevel dorso-ventraltender piriformistender dorsal sacroiliac jointOther
Pelvis scan comments
Scan of lumbar: check all that are NOT within normal limits

tender dorsal-ventral pressurestender side-side pressuresmuscle toneOther
Lumbar scan comments
Scan of Thoracic: check all that are NOT within normal limits

tender dorsal-ventral pressurestender side to side pressuresmuscle toneOther
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 C1-7side glides C2-7C1 positionmuscle tone brchiocephalicusmuscle tone sub occipitalsOther
Cervical scan comments
Scan of Temporal Mandibular Joint: check all that are NOT within normal limits

muscle tone massetersOther
TMJ scan comments
Scan of Hips: check all that are NOT within normal limits

strong palpation pectineusdeep palpation deep glutealfull flexionfull extensionOther
Hips scan comments
Scan of Stifle: check all that are NOT within normal limits

parapatellar tendon swellingpostero-medial joint line sulcusmedial buttresspatellar laxityfull flexionfull extensionOther
Stifle scan comments
Scan of Tarsus: check all that are NOT within normal limits

posterior joint line swellingcalcaneal tendon thickeninghyperextension testfull flexionfull extensionOther
Tarsus scan comments
Scan of Rear Digits: check all that are NOT within normal limits

joint thickeningsfull flexionfull extensioncuts/abrasions/etcOther
Rear digits scan comments
Scan of Shoulder: check all that are NOT within normal limits

full flexionfull extension - with scapulafull extension - with pure glenohumeralabductionbiceps palpationteres major palpationmedial joint line palpationOther
Shoulder scan comments
Scan of Elbow: check all that are NOT within normal limits

full flexionfull extensionelbow crease deep palpationmedial joint line palpationlateral joint line palpationOther
Elbow scan comments
Scan of Carpus: check all that are NOT within normal limits

full flexionfull extensiontendons/ligaments palpationOther
Carpus scan comments
Scan of Fore Digits: check all that are NOT within normal limits

joint thickeningsfull flexionfull extensioncuts/abrasions/etcOther
Fore Digits scan comments
Shoulder Joint Evaluation: check all that are NOT within normal limits

bony margins of scapula palpationspine of scapula palpationsupra glenoid tubercle palpationhumerus firm palpationjoint line palpationsubscapularis palpationsupraspinatus palpationinfraspinatus/teres minor palpationlong head of triceps palpationteres major/lats palpationprescapular lymph nodeflexion end feelabduction end feelinternal rotation end feelexternal rotation end feelgoniometrystretch subscapularisstretch subscapularusstretch bicepsstretch supraspinatusstretch teres major/lat dorsistretch long head of tricepsstretch infraspinatusstretch brachiocephalicuscranio-caudal joint glidesmedio-lateral joint glidesjoint distractionsjoint compression (neutral)joint compression in flexionscapular glidesOther
Shoulder Joint Evaluation comments
Elbow Joint Evaluation: check all that are NOT within normal limits

epicondyles palpationolecranon palpationradial head palpationcoronoid process palpationanconeal process palpationjoint line palpationmedial coronoid ligament palpationlateral coronoid ligament palpationdistal biceps/brachialis palpationtriceps tendon palpationcarpal/digit extensor palpationcarpal/digit flexor muscles palpationflexion end feelextension end feelsupination end feelpronation end feelgoniometrystretch bicepsstretch brachialisstretch triceps - medial-lateral-accessorystretch long head of tricepsstretch carpal extensorsstretch carpal flexorsglide - olecranon wobblesmedial and lateral glidesradial head glidesjoint distraction at 90 degreesjoint compressionmedial condyle ligament stress testlateral condyle stress testanconeal compression testcoronoid process compression testOther
Elbow joint evaluation comments
Carpus and Digits Joint Evaluation: check all that are NOT within normal limits

styloid process palpationdistal radius/ulna palpationcarpals palpationmetatarsals palpationflexor tendons palpationextensor tendon palpationflexion end feelextension end feelmedial deviation end feelMedial and lateral coronoid ligaments stress testsmuscle of manus palpationgoniometrydistal radio-ulnar joint glideaccessory carpal bone wobbleradial carpal/radial ulnar glideulnar carpal/radial ulnar glideradial carpal/ulnar carpal glideproximal and distal carpal row glidescarpo-metacarpal joint glidescarpus tractionintermetacarpals glidemetacarpal/intercarpal joints and ligaments testflexor, extensor, traction of digitssesamoid palpationOther
Carpus and Digits Joint Evaluation comments
Hips Joint Evaluation: check all that are NOT within normal limits

greater trochanter palpationdeep gluteal palpationpectineus palpationiliopsoas palpationsartorius/rectus femoris palpationvastus lateralis palpationtensor fascia lata palpationbiceps femoris, semitendinosus, semimembranosus palpationgracilis palpationvastus medialis palpationinguinal lymph nodes palpationflexion end feelextension end feelinternal rotation end feelexternal rotayion end feelabduction end feelblock pelvis + pure hip flexionblock pelvis + pure hip extensiongoniometrystretch iliopsoasstretch sartorius/rectus femorisstretch hamstringsstretch gracilisstretch adductors/pectineuslateral distraction joint glidelong leg traction glidejoint scouring at different rangesjoint compression at different rangesside to side displacementsthumb tests = hip external rotationOther
Hip Joint Evaluation comments
Stifle Joint Evaluation: check all that are NOT within normal limits

patella palpationtrochlear ridges palpationpatellar tendon palpationfabellae palpationmedial/lateral epicondyles palpationdistal femur palpationproximal tibia palpationmedial/lateral tibial condyles palpationtibial tuberosity and crest palpationfibular head and neck palpationjoint line palpationparapatellar region palpationposteromedial joint line sulcus palpationmedial buttress palpationmedial and lateral collateral ligaments palpationlong digital flexor tendon palpationpolpliteal lymph nodes palpationdistal quadriceps and palpationdistal tensor fascia lata and adductors palpationgastrocnemius palpationcranial tibial palpationperonei palpationflexion end feelextension end feelrotational end feelgoniometrymedial/lateral patellar glidescranial/caudal glidemedial and lateral glide/medial and lateral collateral ligaments testsrotational glidessuperior tibial-fibialglidejoint compressions - different rangesjoint distrationpatellar stability testcranial drawertibial compressionmeniscal derangement testsOther
Stifle Joint Evaluation comments
Tarsus and Pes Joint Evaluation: check all that are NOT within normal limits

medial and lateral malleoli palpationcalcaneal process palpationtalus and central tarsal palpationtarsal bones 1-4 palpationcranial and caudal joint line palpationmedial and lateral collateral ligaments palpationcranial tendons palpationflexion end feelextension end feelmedial and lateral deviation end feelsmedial and lateral collateral ligaments stress testsgoniometrymuscles of the pes (gracilis, sartorius, semitendinosus) palpationstretch gastrocnemius and superficial digital flexor tendonglide distal tibial-fibular jointwobble calcaneus and glide central tarsalcaudal glide of talus with flexiondistraction at 90 degreesdistraction of length of metatarsalsjoint compressionshyperextension test in standingdigit flexion, extension, glides, and stress testssesamoids palpationOther
Tarsus and Pes Evaluation comments
Temporal Mandibular Joint Evaluation: check all that are NOT within normal limits

TMJ palpationmasseters palpationtemporalis and frontalis palpationtartar and plaque build upmandibular lymph nodes palpationlateral deviation glideslateral PULL glidesrostral glidesOther
TMJ Joint Evaluation comments
Cervical Spine Joint Evaluation: check all that are NOT within normal limits

wings of atlas palpationnuchal ligament palpationadjacent muscle tone palpationC1-C7 Transverse Processes for pain palpationassess C1 side bend positionassess C1 rotation positionassess occipital-atlanto joint flexion/extensionassess atlanto-axial joint rotationassess side glides C2-C7Other
Cervical Spine Joint Evaluation comments
Thoracic Spine Joint Evaluation: check all that are NOT within normal limits

T1-T13 palpationepaxial muscle tone palpationmultifidus muscle tone palpationbilateral dorsal-ventral pressures T1-T9bilateral dorsal-ventral pressures T10-T13side bend/rotations T1-T13rib 1 position and pain palpationribs 2-13 ventral glidesribs 2-13 dorsal glideshypaxials palpationintercostals palpationsternum and xiphoid palpationassess three-leg standsOther
Thoracic Spine Evaluation comments
Lumbar Spine Joint Evaluation: check all that are NOT within normal limits

L1-L7 Spinous Processes for pain palpationepaxial muscle tone palpationmultifidus muscle tone palpationquadratus lumborum tone palpationiliopsoas tone and pain palpationbilateral dorsal-ventral pressures L1-7unilateral dorsal-ventral pressures L1-7sidebend/rotation glides L1-7isolated flexion glides L1-7/S1assess 3-leg standsOther
Lumbar Spine Joint Evaluation comments
Pelvis/Sacroiliac Spine Joint Evaluation: check all that are NOT within normal limits

body of ilia/ischia palpationsacrum palpationpiriformis palpation/strumsacrotuberous ligament palpation/strumdorsal sacroiliac joint region palpationassess for assymetry caudal-cranialassess for assymetry rotationalassess for passive mobilityassess 3-leg standsthigh thrust techniquesacroiliac traction techniquecoccygeal vertebrae palpationassess coccygeal vertebrae side bendsOther
Pelvis/Sacroiliac Joint Evaluation comments
Summary of Assessment, Recommendations, Other Comments
Therapist/Examiner

First Name Last Name
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