MediGraph Testing Facilty

American Academy Of Orthopedic Surgeons Lower Extremity Range Of Motion

Name: _____________________________________________
Left Side
Date of Exams

Right Side
Hip

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Date of Exams
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Flexion (120)
Extension (30)
Abduction (45)
Adduction (30)
Internal Rotation (45)
External Rotation (45)

Left Side
Date of Exams

Right Side
Knee

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Date of Exams
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Flexion (135)
Extension (0)

Left Side
Date of Exams

Right Side
Ankle

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Date of Exams
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Plantar-Flexion (50)
Dorsi-Flexion (20)
Inversion (35)
Eversion (15)

Left Side
Date of Exams
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Right Side
Foot
Subtalar Eversion (5)
Subtalar Inversion (5)

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Date of Exams
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