Single-Hand Extension Assessment
Evaluate and document the extension capabilities of a single hand in a structured format.
Participant Full Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
First Name
Last Name
Hand Assessed
*
Left
Right
Extension Ability Rating (0 = No extension, 5 = Full extension)
*
Rows
Rating (0-5)
Thumb
1
Index Finger
2
Middle Finger
3
Ring Finger
4
Little Finger
5
Wrist
6
Overall Functional Use of Hand
*
No functional use
Limited use with assistance
Independent functional use
Pain During Extension
*
No pain
0
1
2
3
4
5
6
7
8
9
Severe pain
10
0 is No pain, 10 is Severe pain
Observed Limitation(s)
Muscle weakness
Joint stiffness
Swelling
Pain
Other
Describe any compensatory movements or strategies observed
Additional Notes or Recommendations
Would you recommend further assessment or therapy?
Yes
No
Submit Assessment
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