diagnosis in orthopaedic

7/30/2019 Diagnosis in Orthopaedic

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Diagnosis in Orthopaedic

David Hariadi Masjhoer

SMF Orthopedi & Traumatologi

RSUD A W Sjahranie


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Information consists of differences that

make difference

gregory bateson

data, give me data!

sherlock holmes

ad sanitatem gradus est movisse morbum

(the first step toward cure is to know what

the disease is)


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Orthopaedic investigation

History taking (symptoms) }subjective

past history,

family history,

social background

Physical examination (signs)}

Radiographic examination }objective

Laboratory examination }


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History Taking

Talking (serves a double purposes); Elicits informations

Therapeutic

Patient need to tell, and need to be heard

Most frequently complaints : Pain

Stiffness

Swelling Deformity

Weakness

Altered sensation

Loss of function


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History Taking

Pain

Most common

Where, when, how often

What make it better or worse

Change in patient life

Remember :

Patient have not learn anatomy

Referred pain


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History Taking

Stiffness : Distinguish from lack of movement due to pain

Totally or partially

Swelling:

Soft tissue, joint or bone

Patient are seldom wrong, even doesnt lookswollen

Patient sense : skin feels tight, ring or shoe

doesnt loosely


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History Taking

Deformity

Any progressive deformity need attention

Weakness

Possibly to neurological disorder

Instability

Patient term giving way

Muscle weakness or dysfunction of ligament


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History Taking

Altered sensation Numbness

Tingling

suggest injury localized pressure,entrapment or ischemia

Loss of function How symptoms interfere with their activity

Past history and family history


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Physical examination

Begin at first moment :

Body build (habitus)

Facial appearances

Walking gait

Sitting or lying position


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Physical examination

Walking gait, consist of four part :

Heel strike

Stance phase

Toe off

Swing phase

Limp ?

simply an abnormal gait


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Examination of the affected part

Patient must suitable undressed

rolling up the trouser leg is not sufficient

Both limb must be exposed Check the normal first

Compared the affected limb with the normal


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Systematic order

1. Look (inspection)

2. Feel (palpation)

3. Move (assesment of joint)4. Listening (auscultation) over joint and

vessels

5. Special physical test6. Neurological examination


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Look

Looking for specific features

Skin : scar, color, pigmentation, abnormal

creases

Shape : atrophy, hypertrophy, swelling,

lump, abnormally bone bent

Position : joint is three dimensional Measures any limb shortening


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Look

Deformity : joint held in natural position

Varus and valgus

Khyposis and lordosis

Scoliosis

Fixed deformity


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Feel

Skin : warm or cold, moist or dry, sensation

Soft tissue : lump ? pulse ? swelling

Bone and joint : outlines normal ? synovium

thickened? excessive joint fluid

Tenderness (watch the patient face)

Abnormal relationship of bone and joint


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Feel

Clinical features of the lump ;

Size

Site

Margin

Consistency

Tenderness

Multiplicity


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Pain


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Move

The range of joint movement from anatomicalposition is recorded in degrees, starting fromzero

The common planes : Flexion /extension Abduction /adduction

External /internal rotation

Pronation / supination (only to forearm and foot) Circumduction


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Move

Active movement: limited by pain, muscle

spasm, muscle weakness, ruptured

tendon or muscles, joint stiffness or

contracture

Passive movement: decreased for any of

the reason above, or increased due to a

lax capsule or torn ligaments


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Listen

Crepitus from fracture

Joint crepitus

Snapping tendon Murmur of the peripheral arteriovenous

fistula


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Special Physical test

Shoulder

Elbow

Wrist Hand

Hip

Knee Foot

spine


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Neurological examination

Muscle weakness

Muscle spasticity

Involuntary movement Altered skin sensation

Loss of balance

motor system, sensory system,reflexes

diagnosis in orthopaedic

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