Código:

FICHA DE AVALIAÇÃO EM TRAUMATO

REUMATO CLI-FOR-10
APROVADO: DATA: PÁGINA: REVISÃO:

Raquel Porto – Diretor Adj. de Estágios 20/03/2017 1/2 00

IDENTIFICAÇÃO:
Nome:_____________________________________________ Sexo__________ Cor____________
Data de Nasc.___/___/_____ Idade _______Est. Civil ______________ Peso_______ Altura_________
Grau de Instrução_________________ Profissão ___________________Data entrevista ___/___/____
Avaliador:__________________________________________ Supervisor:_______________________
Encaminhado por: ____________________________ Diagnóstico de origem:_____________________

DADOS CLÍNICOS:

MEMBROS INFERIORES
Q.P________________________________________________________________________________
___________________________________________________________________________________TORNOZELO
JOELHO
___________________________________________________________________________________ Direito
Direito Esquerdo
Esquerdo
___________________________________________________________________________________
HDA________________________________________________________________________________ PP NN PP NN
Gaveta
Gaveta Abterior
___________________________________________________________________________________
Estresse varo
___________________________________________________________________________________
Gaveta Posterior
EXAME FÍSICO:
___________________________________________________________________________________
Estresse valgo
Mcmurray
___________________________________________________________________________________
MOBILIDADE ARTICULAR/ GONIOMETRIA Thompson
Lachman
___________________________________________________________________________________
___________________________________________________________________________________
Apley Compressão
___________________________________________________________________________________
___________________________________________________________________________________
Apley tração
___________________________________________________________________________________
___________________________________________________________________________________
HPP________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Medicação:__________________________________________________________________________
COLUNA
___________________________________________________________________________________
PALPAÇÃO:
Doença Cardíaca( ) Diabetes( ) HAS ( ) LOMBAR /Epilepsia
CERVICAL ASI
___________________________________________________________________________________ ( )
Outras: ( ) Direito
Direito Esquerdo
Esquerdo
________________________________________________________________________
___________________________________________________________________________________
Histórico familiar: _____________________________________________________________________
P P NN P P NN
___________________________________________________________________________________
Tumores ( ) _______________________________________________________________________
Lasègue
Compressão
___________________________________________________________________________________
Cirurgia Recente ( ) _________________________________________________________________
___________________________________________________________________________________
Braggard
Tração
Já fez fisioterapia? ____________________________________________________________________
Milgran Rot. D
Copressão
Tipo de dor__________________________________________________________________________
FORÇA: Patrick-Fabere
Compressão E
O que piora a dor?: ___________________________________________________________________
Gaenslen
Adson
___________________________________________________________________________________
O que melhora a dor?: _________________________________________________________________
___________________________________________________________________________________
Limitação Funcional: Valsalva
Slump
___________________________________________________________________________________
___________________________________________________________________
TESTES ESPECIFICOS: PELVE / QUADRIL
___________________________________________________________________________________
___________________________________________________________________________________
SENSIBILIDADE: Direito Esquerdo
MEMBROS SUPERIORES
___________________________________________________________________________________
P N P N
___________________________________________________________________________________
TFP
COTOVELO
___________________________________________________________________________________
OMBRO
Direito Esquerdo Direito Esquerdo TFS
P N P N Gillet PUNHO/ MÃO
PRINCIPAISPALTERAÇÕES
N P POSTURAIS:
N
Estresse valgo Trendelemburg
Neer Direito
___________________________________________________________________________________ Esquerdo
Estresse varo P
___________________________________________________________________________________
Jobe N P N
Tínel Phalen
___________________________________________________________________________________
Patte
___________________________________________________________________________________
Epicondilite Allen
Gerber
___________________________________________________________________________________
Lateral
Speed Filkenstein
___________________________________________________________________________________
Sulco Epicondiite Medial
___________________________________________________________________________________
 Código:
FICHA DE AVALIAÇÃO EM TRAUMATO
REUMATO CLI-FOR-10
APROVADO: DATA: PÁGINA: REVISÃO:

Raquel Porto – Diretor Adj. de Estágios 20/03/2017 2/2 00

OBSERVAÇÃO_____________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

EXAMES COMPLEMENTARES:____________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

_____________________, ______ de ________________ de ______.

____________________________ ___________________________
Acadêmico Fisioterapeuta