Finger Extension Lag Assessment Form
Complete this form to assess finger extension lag, including symptoms, context, and functional impact.
Which hand is affected?
*
Left
Right
Both
Which finger(s) are affected?
*
Thumb
Index
Middle
Ring
Little
Other
When did the extension lag begin?
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How long have you experienced the extension lag?
*
Please Select
Less than 1 week
1–4 weeks
1–3 months
More than 3 months
What was the mechanism or context of onset?
*
Gradual/overuse
Sudden injury/trauma
Post-surgery
Unknown
Other
Please rate the severity of the extension lag.
*
1
2
3
4
5
How much does the extension lag impact your daily activities?
*
No impact
1
2
3
4
Severe impact
5
1 is No impact, 5 is Severe impact
How would you rate your level of pain related to the extension lag?
*
1
2
3
4
5
6
7
8
9
10
Range of Motion Assessment
*
Rows
Full extension possible
Partial extension
No extension
Thumb
1
2
3
Index
4
5
6
Middle
7
8
9
Ring
10
11
12
Little
13
14
15
Have you received any prior treatment or made any observations regarding this condition?
Submit Assessment
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