Slocum Enterprises, Inc.
Quality Veterinary Equipment, Implants and Diagnostic Aids

 

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Sample Form 

Slocum Stifle Exam
  Client Name: Case #:
  Patient: Date:
  Breed: Age:
  Use: Sex:
  Complaint:
  Duration: AM Pain:
  Right Left Comments
  Foregait: Incomplete Wt Bearing 1 2 3 4 5 1 2 3 4 5 ____________________
  Elbows Out 1 2 3 4 5 1 2 3 4 5 ____________________
  Ext. Rotation Antebrachium 1 2 3 4 5 1 2 3 4 5 ____________________
  Valgus Deformity 1 2 3 4 5 1 2 3 4 5 ____________________
  Hindgait: Incomplete Wt Bearing 1 2 3 4 5 1 2 3 4 5 ____________________
  Ext. Rotation Hip 1 2 3 4 5 1 2 3 4 5 ____________________
  Knock Kneed 1 2 3 4 5 1 2 3 4 5 ____________________
  Cow Hocked 1 2 3 4 5 1 2 3 4 5 ____________________
  Hyper Ext. Hock 1 2 3 4 5 1 2 3 4 5 ____________________
  Jumping:

Yes     Difficulty     No

  
  Stairs:

Yes     Difficulty     No

  
  Physical Exam:
  Head  ____________________________  
  Eyes  ____________________________  
  Ears  ____________________________  
  Mouth  ____________________________  
  Chest  ____________________________  
  Abdomen  ____________________________  
  Lymph Nodes  ____________________________  
  Shoulder:
  Flexion 1 2 3 4 5 1 2 3 4 5 ____________________
  Extension 1 2 3 4 5 1 2 3 4 5 ____________________
  Biceps Brachii 1 2 3 4 5 1 2 3 4 5 ____________________
  Infraspinatus 1 2 3 4 5 1 2 3 4 5 ____________________
  Internal Rotation 1 2 3 4 5 1 2 3 4 5 ____________________
  Humerus:
  Panosteitis 1 2 3 4 5 1 2 3 4 5 ____________________
  Elbow:
  Two Finger Test 1 2 3 4 5 1 2 3 4 5 ____________________
  Lateral Capsule Palpation 1 2 3 4 5 1 2 3 4 5 ____________________
  Carpus:
  Flexor Stress Test 1 2 3 4 5 1 2 3 4 5 ____________________
  Spine:
  Cervical Palpation 1 2 3 4 5 1 2 3 4 5 ____________________
  T-L Palpation 1 2 3 4 5 1 2 3 4 5 ____________________
  L7-S1 Palpation 1 2 3 4 5 1 2 3 4 5 ____________________
  Proprioceptive Deficit 1 2 3 4 5 1 2 3 4 5 ____________________
  Panniculus Reflex 1 2 3 4 5 1 2 3 4 5 ____________________
  Lordosis Test 1 2 3 4 5 1 2 3 4 5 ____________________
  Stand Test 1 2 3 4 5 1 2 3 4 5 ____________________
  Hip:
  Subluxation Test 1 2 3 4 5 1 2 3 4 5 ____________________
  Trochanteric Compression Test 1 2 3 4 5 1 2 3 4 5 ____________________
  Abduction/External Rotation 1 2 3 4 5 1 2 3 4 5 ____________________
  Deep Femoral Palpation 1 2 3 4 5 1 2 3 4 5 ____________________
  Stifle:
  Straight Stifle 1 2 3 4 5 1 2 3 4 5 ____________________
  External Tibial Torsion 1 2 3 4 5 1 2 3 4 5 ____________________
  Sit Test 1 2 3 4 5 1 2 3 4 5 ____________________
  Stifle Hyperextension Test 1 2 3 4 5 1 2 3 4 5 ____________________
  Peritrochlear Osteophytes 1 2 3 4 5 1 2 3 4 5 ____________________
  Cranial Drawer Sign 1 2 3 4 5 1 2 3 4 5 ____________________
  TCT - Extension 1 2 3 4 5 1 2 3 4 5 ____________________
  TCT - Flexion 1 2 3 4 5 1 2 3 4 5 ____________________
  Medial Meniscus Palpation 1 2 3 4 5 1 2 3 4 5 ____________________
  Excessive Inflammation 1 2 3 4 5 1 2 3 4 5 ____________________
  Biceps Femoris Atrophy 1 2 3 4 5 1 2 3 4 5 ____________________
  Patellar Luxation (Grade) 1 2 3 4 5 1 2 3 4 5 ____________________
  Stifle Trauma:
  Rotary Instability 1 2 3 4 5 1 2 3 4 5 ____________________
  Medial Instability 1 2 3 4 5 1 2 3 4 5 ____________________
  Lateral Instability 1 2 3 4 5 1 2 3 4 5 ____________________
  Cranial Cruciate Ligament 1 2 3 4 5 1 2 3 4 5 ____________________
  Caudal Cruciate Ligament 1 2 3 4 5 1 2 3 4 5 ____________________
  Medial Joint Capsule 1 2 3 4 5 1 2 3 4 5 ____________________
  Caudal Joint Capsule 1 2 3 4 5 1 2 3 4 5 ____________________
  Medial Meniscus 1 2 3 4 5 1 2 3 4 5 ____________________
  Lateral Meniscus 1 2 3 4 5 1 2 3 4 5 ____________________
  Hock:
  Standing Angle 1 2 3 4 5 1 2 3 4 5 ____________________
  Hyperextension 1 2 3 4 5 1 2 3 4 5 ____________________
  Popping 1 2 3 4 5 1 2 3 4 5 ____________________
  Stifle Radiographs:
  Tibial Plateau Slope _______ _______  
  Fat Pad Inflammation 1 2 3 4 5 1 2 3 4 5 ____________________
  SPT Inflammation 1 2 3 4 5 1 2 3 4 5 ____________________
  Cranial Tibial Luxation 1 2 3 4 5 1 2 3 4 5 ____________________
  Osteophytes 1 2 3 4 5 1 2 3 4 5 ____________________
  Caudal Meniscus Inflammation 1 2 3 4 5 1 2 3 4 5 ____________________
  Distal Pole of Patella 1 2 3 4 5 1 2 3 4 5 ____________________
  Pagoda Sign 1 2 3 4 5 1 2 3 4 5 ____________________ 
  Diagnosis: ____________________________________________
  Rec. Treatment: ____________________________________________
  Function: ____________________________________________
  Result: ____________________________________________
  Right Left  
  Limb Size: _______ _______  
  Stifle Angle: _______ _______  
  Hock Angle: _______ _______  
 

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To place an order with Slocum Enterprises, Inc. please phone: (800) 346-5489, if calling from outside the US: (541) 689-8441, or fax: (541) 689-1448.  Or email us at orders@slocumenterprises.com

Slocum Enterprises, Inc. products are available to or on the order of a licensed veterinarian.