GENERAL PRINCIPLES IN THE ORTHOPAEDIC EXAMINATION

Andre Yanuar, Ghuna A Utoyo, Rizki RahadianDept. of Orthopaedic & TraumatologyHasan Sadikin General HospitalMedical School of Padjadjaran UniversityBandung

Introduction

• Joints of the limbs & spine.• Joints, nerves, muscles• Six distinct steps :

1. Inspection2. Palpation3. Examination of movements4. Conduction of special tests

5. Examination of radiographs6. Arranging further investigations

Inspection

• Is there swelling?

• Is there bruising?

• Is there any discoloration, or edema?

• Is there muscle wasting?

• Is there any alteration in shape or posture, or is there evidence of shortening?

Inspection

Palpation

• Is the joint warm?• Is there tenderness?• How is the artery

pulse?

Movements

• Fixed deformities• R O M• Restriction of ROM• Passive ROM• Active ROM• Movements in abnormal plane• Crepitus• Strength of muscle contraction• Gait

Movements

Conduction of Special Test

• Integrity of certain joint ligaments

• Examination of structures associated with the joint

• Appropriate neurological examination

Examination of Radiographs

• Are the bones of normal shape, size & contour, or are they thicker or thinner than normal, shorter or longer than usual, or abnormally curved or angled?

• At the joints themselves, are the bony components in correct alignment, or are they displaced or angled?

Examination of Radiographs

• Comparison films

• Oblique projections

• Localized views

• Stress films

Arranging Further Investigations

• ESR, CRP

• Full blood count with differential

• Estimation of RF

• Serum calcium, phosphate & AP

• Serum Uric Acid

• Chest X-Ray

Equipment Requirements

• A tape measure

• A goniometer

• A tendon hammer

• A disposable sharp point