Knee Meniscus Physical Exam Assessment Form
Complete this form to document knee meniscus symptoms, exam findings, and clinical assessment for the affected knee.
Patient and Visit Information
Patient Name
*
First Name
Middle Name
Last Name
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Exam Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Affected Knee
*
Left
Right
Both
Referring Clinician or Clinic Name
Meniscus Symptom Assessment
Injury Onset Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Mechanism of Injury
Twisting injury
Deep squat
Pivoting
Gradual onset
Other
Pain Severity
*
Mild
1
2
3
4
5
6
7
8
9
Severe
10
1 is Mild, 10 is Severe
Swelling Present
Yes
No
Pain Aggravating Activities
Stairs
Squatting
Kneeling
Twisting
Running
Other
Physical Exam Findings
Range of motion limitation
*
None
Mild
Moderate
Severe
Joint line tenderness
*
Absent
Present
McMurray test result
*
Positive
Negative
Not performed
Thessaly test result
*
Positive
Negative
Not performed
Effusion
*
None
Mild
Moderate
Severe
Clinician impression / assessment notes
Submit Assessment
Should be Empty: