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department of athletics policies & procedures - UNC Wilmington ...

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Musculoskeletal Examination<br />

Name<br />

_______<br />

Appearance/ROM<br />

Norm<br />

al<br />

Abnl/Laxi<br />

ty<br />

Findings/comments<br />

Cervical spine/neck<br />

R shoulder<br />

L shoulder<br />

R elbow<br />

L elbow<br />

R wrist/ hand<br />

L wrist/ hand<br />

R hip<br />

L hip<br />

R knee<br />

L knee<br />

R ankle<br />

L ankle<br />

Lumbar/thoracic<br />

spine<br />

hamstring flexibility<br />

heel/toe/duck walk<br />

_________________________________________ Orthopedic evaluation recommended by history or exam? Y N<br />

Examiner Signature<br />

_____________________________________________<br />

Orthopedic Provider Signature<br />

Provider’s Recommendation:<br />

_____ Approved for intercollegiate <strong>athletics</strong> at <strong>UNC</strong>W with no restrictions.<br />

293

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