Knee Front Appearance NormalSwellingRednessErythemaDeformityScars Palpation 1. MCL R L 2. LCL R L 3. Pes Anserine R L 4. Lateral Tibial Plateau R L 5. Medial Tibial Plateau R L 6. Inferior Pole of the Patella R L 7. Superior Pole of the Patella R L 8. Other Observed Abnormality? Yes No Sensation Intact? Yes No Moves Extremities w/o Deficit? Yes No Strength - Select - 1 2 3 4 5 Range of Motion Valgus Stress FullLimited LevelPainExplain Varus Stress FullLimited LevelPainExplain Anterior Drawer FullLimited LevelPainExplain Posterior Drawer FullLimited LevelPainExplain Other FullLimited LevelPainExplain Procedure Note Consent Skin Cleaned with Chlohexadine Other Tender Points Injected with:Dextrose PRP Joint Injection:Dextrose PRP Stem Cell Resolution of Symptoms? Yes No Tolerated Well? Yes No Procedural Sedation: Medication 1: - Select - Ativan Dilaudid Demerol Fentanyl Ketamine Morphine Valium Verscel Dose Medication 2: - Select - Ativan Dilaudid Demerol Fentanyl Ketamine Morphine Valium Verscel Dose Medication 3: - Select - Ativan Dilaudid Demerol Fentanyl Ketamine Morphine Valium Verscel Dose
