Low Back Appearance NormalSwellingRednessErythemaDeformityScars R1R2R3R4R5 L1L2L3L4L5Palpation 1. Iliolumbar Ligament Right 2. Iliolumbar Ligament Left 3. SI Right 4. SI Left 5. Right Ilium 6. Left Ilium 7. Right Lateral Sacral Border 8. Left Lateral Sacral Border 9. Other Observed Abnormality? Yes NoSensation Intact? Yes NoMoves Extremities w/o Deficit? Yes NoStrength - Select -12345 Deep Tendon Reflexes - Select -01234 Range of MotionFlexion FullLimited LevelPainExplain Extension FullLimited LevelPainExplain Sidebending Right FullLimited LevelPainExplain Sidebending Left FullLimited LevelPainExplain Rotation 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 -AtivanDilaudidDemerolFentanylKetamineMorphineValiumVerscel DoseMedication 2: - Select -AtivanDilaudidDemerolFentanylKetamineMorphineValiumVerscel DoseMedication 3: - Select -AtivanDilaudidDemerolFentanylKetamineMorphineValiumVerscel Dose
