Upper Extremity Pain/Injury History

Injury & Poisoning, Musculoskeletal & Rheumatology, Subjective/History Elements
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Upper Extremity Pain/Injury
Onset [text] prior to evaluation
Onset while: [text]
Injury at: [text]

Associated Pain (0=none, 10=severe)
Location: [text]
Radiation: [text]
Severity now (0-10): [text]
Severity at worst (0-10): [text]
Duration: [text]
Characterized as [text].

Relieved with [text]
Worse with [text]

Associated Joint Symptoms
Location: [text]
[select value="no|YES"] <-- Stiffness
[select value="no|YES"] <-- Redness
[select value="no|YES"] <-- Swelling
[select value="no|YES"] <-- Locking or catching
[select value="no|YES"] <-- Giving way or unstable sensation

Dominant hand: [text]

Pitfall evaluation:
[select value="no|YES"] <-- distal numbness
[select value="no|YES"] <-- distal weakness
[select value="no|YES"] <-- distal cold sensation, pallor, or cyanosis
[select value="no|YES"] <-- fever
[select value="no|YES"] <-- neck pain
[select value="no|YES"] <-- chest pain

Pertinent PMH:
[select value="no|YES"] <-- arthritis history
[select value="no|YES"] <-- prior extremity pain/injury history
[select value="no|YES"] <-- cervical disc history
[select value="no|YES"] <-- heart disease history
[html]<hr>[/html][checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"][html]
reference: contributed by Dr. Scott Moses, creator/author of the <a href="http://www.fpnotebook.com" target="_blank">Family Practice Notebook</a>[/html][/conditional]
Upper Extremity Pain/Injury
Onset prior to evaluation
Onset while:
Injury at:

Associated Pain (0=none, 10=severe)
Location:
Radiation:
Severity now (0-10):
Severity at worst (0-10):
Duration:
Characterized as .

Relieved with
Worse with

Associated Joint Symptoms
Location:
<-- Stiffness
<-- Redness
<-- Swelling
<-- Locking or catching
<-- Giving way or unstable sensation

Dominant hand:

Pitfall evaluation:
<-- distal numbness
<-- distal weakness
<-- distal cold sensation, pallor, or cyanosis
<-- fever
<-- neck pain
<-- chest pain

Pertinent PMH:
<-- arthritis history
<-- prior extremity pain/injury history
<-- cervical disc history
<-- heart disease history

display/hide references
Result - Copy and paste this output:

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