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Medicamentos em uso: ______________________________________________________________________________
Alguma patologia associada:_____________________________________________________
Realizou alguma cirurgia: _____________________________________________.
Faz algum tratamento conservador: _______________________________________________.
( ) movimento
( ) outro: ______________________________.
Fatores que aliviam:
( ) repouso
( ) calor local
( ) fisioterapia
( ) medicao
( ) movimento
( ) exerccio/alongamento
( )outro: _____________________________.
Palpao:
Partes Moles:
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Partes sseas:
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Goniometria Membro Superior:
Ombro
Flexo
Extenso
Abduo
Aduo
Rotaes
Normalidade
0 - 180
180 - 0
0 - 90
0 - 40
0 - 90
Paciente
Cotovelo
Flexo
Extenso
Normalidade
0 - 145
145 - 0
Paciente
Radio Ulnar
Pronao
Supinao
Normalidade
0 - 80
0 - 90
Paciente
Punho
Flexo
Extenso
Desvio Ulnar
Normalidade
0 - 80
0 - 70
0 - 45
Paciente
Desvio Radial
0 - 15
Cervical
Flexo
Extenso
Rotao
Latero-flexo
Normalidade
0 - 65
0 - 50
0 - 55
0 - 40
Paciente
Joelho
Flexo
Extenso
Normalidade
0 - 140
140 - 0
Paciente
Quadril
Extenso
Flexo
Rotaes
Abduo
Aduo
Normalidade
0 - 10
0 - 125
0 - 45
0 - 45
0 - 15
Paciente
Edema:____________ Local:________________Grau:______________________.
PERIMETRIA:
Brao
Direito
Esquerdo
Direito
Esquerdo
7cm
14cm
Antebrao
5cm
10cm
Punho
Local
Medida
Trax
Abdomen
Quadril
Coxa
Direita
Esquerda
7cm
14cm
21cm
Patela
Direita
Esquerda
7cm
14cm
GRAU DE FORA
Msculo
Grau 1
Grau 2
Grau 3
Grau 4
Grau 5
Podoscpio:
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Teste especfico:
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Avaliao Postural :
Vista Anterior
Cabea: ( ) Alinhada
( ) Inclinada a D
) Desvio esquerda
( ) Direito + alto
( ) Esquero + alto
Diagnstico Fisioteraputico:
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Objetivo:
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TRATAMENTO:__________________________________________________________________________________
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