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Clinical examination in orthopaedics

Clinical examination in orthopaedics. Z. Rozkydal L. Pazourek. Clinical examination The aim- establish the diagnosis 1. History 2. Objective examination - general 3. Objective examination - local 4. Laboratory tests 5. Imaging methods. History Family Personal Pharmacological Social

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Clinical examination in orthopaedics

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  1. Clinical examination in orthopaedics Z. Rozkydal L. Pazourek

  2. Clinical examination The aim- establish the diagnosis 1. History 2. Objective examination - general 3. Objective examination - local 4. Laboratory tests 5. Imaging methods

  3. History Family Personal Pharmacological Social Occupation Epidemiological Current problems Analysis of pain

  4. Family • Congenital abnormalities • Important diseases in family (heart, DM, haemophilia, oncological diseases, neurological diseases, TB • Birth, miscarriage

  5. Personal • Importantgeneraldiseases (hypertension, DM, heart, tumors, lungproblems • Coagulopathies • Infections • Injuries: consequences, complications • In children- pregnancy psychomotordevelopment

  6. Current symptoms Local Pain, motor function, limping, deformity, ROM, swelling, loss of sensation General: fever, shivering, cachexia Cause of theproblem • injury • overloading • Infection • systemicdiseases (endocrine,metabolic, inflammation, neurological, haemotological.)

  7. Development of symptoms • Onset, duration • Intensity • Aleviation, increasing factors • Present management • Examination in the past time • Conservative therapy • Operative therapy • Mobility, occupation • Emotions, psychological condition • Simulation, dissimulation, aggravation

  8. Analysis of pain Intensity, frequence, duration Acute, chronic Local, irradiating Visceral Type- sharp, blunt, burning, stubbing Neuralgia Nerve root pain Phantom pain Neurogenic claudication

  9. Analysis of pain Localised, diffuse Psychological background Durig activity or in rest VAS – visual analogue scale Scale of ten degrees 0 - no pain 10 - the most sever pain not bearable Pain 5 or more- change of management

  10. Pharmacology • Medicines used currently • Important medecines: warfarin, heparin, other anticoagulants, antiepileptics, cytostatics, immunosuppresives, NSA, corticoids, biological treatment, • Alcohol, smoking, drugs • Alergy (antibiotics, metal, dissinfections)

  11. Occupation and social • Occupation, type of work, manual labor • Rent • Social situation (living, marriage) • Subsequent management

  12. Gynecological history • Cycles, gravidity, menopause, currentgynecologicalproblems • Epidemiologiocalhistory influenza, viralinfections, herpes simplex, focalinfections (UTI, stomatologicalinfections, ulcers, erysipel)

  13. Objective examination General examination General orthopaedic examination Local orthopaedic examination Posture and gait

  14. Somatotype asthenic pycnic normosthenic

  15. Gigantisms Fröhlich syndrom Marfan syndrom Achondroplasia Nanisms

  16. Nutrition • Body mass index: weight kg (BMI) height2 m2 • Below 20 - cachexia • 20-25 - normal weight • 25-30 - overweight • 30-35 - obesity • Over 35 - severe obesity

  17. Skin • Colour

  18. pigmentation, naevus • Trophicity, turgor

  19. Subcutaneusnodes • nails • Fistulas, ulcers • Lymfadenopathy, soft tumors, inflammations

  20. Swelling • Local • General • Anasarca • Decollement Local signs of inflammations: readness, swelling, pain, warm, limited function, soft mass, effusion, discharge

  21. Soft mass

  22. Haematoma • Lymphonodes • Tumor

  23. Effusion

  24. Congenital deformity • 1. Shape, size • 2. Differential • 3. Duplicity • 4. Gigantisms • 5. Hypoplasia

  25. Malalignment • varus x valgus • antecurvation x recurvation • rotation deformity odchylka

  26. Deformity of spine • Scoliosis • Hyperkyphosis, hyperlordosis

  27. Hand deformities RA OA Boutonniere deformity Swan neck deformity

  28. Foot deformities

  29. Length of extremity Lower extremity • Spinomaleolar distance • Umbilicomaleolar distance • Support duringstanding • X- rayofthe hip, knee, ankle joint Upper extremity: acromion- 3. finger • Circumferentialmeasurement

  30. ROM • Active and passive movements • Sagital • Frontal • Transversal = horizontal • Rotation

  31. Shoulder S: extenze - 0 - flexe 50 - 0 - 180 F: abdukce - 0 - addukce 180 - 0 - 25 T: abdukce - 0 - addukce 110 - 0 - 30 R: ZR - 0 - VR 90 - 0 - 90

  32. Elbow S: extenze - 0 - flexe 10 - 0 - 150 R: supinace - 0 - pronace 90 - 0 - 90

  33. Wrist F: rad. dukce - 0 - uln. dukce 20 - 0 - 40 S:extenze (dorz. flexe) - 0 – flexe (palm. flexe) 80 - 0 - 80

  34. S: extenze - 0 - flexe 15 - 0 - 140 F: abdukce - 0 - addukce 60 - 0 - 40 T: abdukce - 0 - addukce 80 - 0 - 30 R: ZR - 0 - VR 50 - 0 - 40 Hip

  35. Knee S: extenze - 0 - flexe 0 - 0 - 140

  36. Ankle S: extenze (dorziflexe) - 0 - flexe (plantiflexe) 20 - 0 - 50

  37. Ancylosis • Extrarticular • Intraarticular

  38. Stability of joints • Stable joint • Unstable joint • Instability • acute • chronic • habitual

  39. Shoulder Apperhension test Drawer sign

  40. Knee

  41. Laxity • test

  42. Maneuvers • Maneuvers

  43. Sound phenomenons • Crepitus

  44. Contracture • Lumbago, torticollis • Cerebral palsy

  45. Muscles • Trophicity • Tonus • Cramps • Power

  46. Muscle test 0 - no activity 0 % 1 - trace 10 % 2 - motion without gravity 25 % 3 - motion against gravity 50 % 4 - motion against gravity and slight resistance 75 % 5 - normal activity 100 %

  47. Posture Correct Wrong

  48. Gait • 1. heel strike 2. standing 3. toe off 4. swing phase

  49. Limping • Antalgic gait • Shortening of a lower extremity • Ancylosis • Trendeleburg sign and gait • Hemiparetic gait • Spastic gait • Drop foot gait • Parkinson gait

  50. Imaging methods • X-ray, artrography • Angiography • Ultrasonography • CT, MRI • Scintigraphy • DEXA • Biopsy

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