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
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Result - Copy and paste this output: