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INTRODUCTION

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Range of Motion—Temporomandibular Joint and Spine
Patient's Name:___________________________________ Date of Birth_________________
Left   Right
      Date      
      Examiner's Initials      
      Temporomandibular Joint      
      Depression (opening)      
      Protrusion      
      Lateral Excursion      
      Overbite      
      Comments:      
      Cervical Spine      
      Flexion      
      Extension      
      Lateral Flexion      
      Rotation      
      Comments:      
      Thoracolumbar Spine      
      Flexion      
      Extension      
      Lateral Flexion      
      Rotation      
      Comments:      
      Lumbar Spine      
      Flexion      
      Extension      
      Lateral Flexion      
      Comments:      
Range of Motion—Upper Extremity
Patient's Name:___________________________________ Date of Birth_________________
Left   Right
      Date      
      Examiner's Initials      
      Shoulder Complex      
      Flexion      
      Extension      
      Abduction      
      Medial Rotation      
      Lateral Rotation      
      Comments:      
      Glenohumeral      
      Flexion      
      Extension      
      Abduction      
      Medial Rotation      
      Lateral Rotation      
      Comments:      
      Elbow and Forearm      
      Flexion      
      Supination      
      Pronation      
      Comments:      
      Wrist      
      Flexion      
      Extension      
      Ulnar Deviation      
      Radial Deviation      
      Comments:      
Range of Motion—Hand
Patient's Name:___________________________________ Date of Birth_________________
Left   Right
      Date      
      Examiner's Initials      
      Thumb      
      CMC Flexion      
      CMC Extension      
      CMC Abduction      
      CMC Opposition      
      MCP Flexion  

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