Tendon Transfer Recovery Tracker Form
Monitor your recovery progress following tendon transfer surgery by completing this form.
Date of Assessment
*
 -
Month
 -
Day
Year
Date
Current pain level at surgical site
*
No pain
Mild pain
Moderate pain
Severe pain
Swelling at or near the surgical site
*
None
Mild
Moderate
Severe
Redness or warmth at surgical site
*
None
Mild
Moderate
Severe
Wound condition
*
Clean, dry, intact
Mild drainage
Moderate drainage
Open or infected
Signs of infection (fever, chills, pus)
*
None
Mild
Moderate
Severe
Range of motion in affected limb
*
Full range
Slightly limited
Moderately limited
Severely limited
Strength in affected limb
*
Normal
Slightly weak
Moderately weak
Severely weak
Ability to perform daily activities
*
No difficulty
Mild difficulty
Moderate difficulty
Severe difficulty
Adherence to prescribed rehabilitation exercises
*
Always
Most of the time
Sometimes
Rarely or never
Any new or worsening symptoms since last assessment
*
No new symptoms
Mild new symptoms
Moderate new symptoms
Severe new symptoms
Submit Recovery Update
Should be Empty: