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