Range of motion

I used a Dualer Digital Inclinometer?

Doctor's signature....

Date of Report....
Date of Exam......
Date of Accident.

the patient's sex... MALE FEMALE Ms. Miss Mr. Mrs.

First name.. Last name..

Cervical measurement normal % of Normal
Flexion 50
Extension 60
Left Lat Flex 45
Right Lat Flex 45
Left Rotation 80
Right Rotation 80

Lumbar ROM Table

Lumbar Spine Range of Motion:

Measurement Normal % of Normal
Lumbar
Flexion 60
Extension 25
Left Lat Flex 25
Right Lat Flex 25

ROM pain

  Pulling Pain pain
Cervical

cervical pulling pain

cervical pain
Lumbar

Lumbar pulling pain

Lumbar pain

RESULTS OF ROENTGENOMETRIC EVALUATION - PENNING'S METHOD:

date of xrays

Penning's Measurement Normal % of Normal
C1/C2 Not Established Not Applicable
C2/C3

12.5
C3/C4

18
C4/C5

20
C5/C6

21.5
C6/C7

15.5

George s line

loss of cervical lordosis

Kyphotic cervical spine

Enter any further comments: