1st seminar done by-: Ruba Alathwari

orthopaedic

Orthopedic surgeons-:deal with deformity, diseases of bone and joints, and injuries to the musculoskeletal system.

Generally Dx depend on:-

1-Hx taking.

2-Physical examination.

3-Investigation

1-personal Hx2-chief complain(symptoms)

3-present Hx4-past Hx

5-family Hx6-social Hx

History taking of orthopedic pt-:

*The most common complaints in orthopaedic: 1 -pain

2- swelling3- stiffness4- deformity5- weakness

6- instability7- change in sensibility

8 -loss of function

*Personal history: N A S O M R AName-Age-Sex-Occupation-Marital state-Residence-Address and date of Admission.

*Present history: analysis for chief complaint.

1 -Pain-: analysis by SOCRATES

-the most common symptom. -ask pt to point to where it hurts.

- -pain in or near the skin is localized ,but in deep structure is more diffuse as hip disease

manifest with pain in the knee.- -autonomic pain affect the autonomic nerves

is more vague associate with vasomotor and tropic changes.

-Pain is sharp, sudden onset, exaggerated by movement, relived by rest and immobilization, usually not referred.

2-stiffness-: -May be : generalized as in rheumatoid arthritis

or ankylosing spondylitis or localized to a particular joint.

-Limited movement should never be assumed until verified by examination.

-Ask when it occur:- early morning stiffness of many joint is rheumatoid arthritis, transient stiffness 1 or 2 joint after period of inactivity is osteoarthritis.

-locking:- sudden inability to complete a certain movement suggest mechanical block .

3 -swelling-:

-May be in soft tissue, joint, or the bone. -If appear rapidly following injury is hematoma

or haemarthrosis.- -If appear slowly is tissue inflammation or joint

effusion . -If it is painful , may due inflammation.

4 -deformity-:

- -Some is variation of normal as: wide hips.

- -Some disappear spontaneously with growth as: flat feet.

-Some is progressive if appear on only one side of body.

5-weakness-: -If affecting single of muscles suggest

neurologic disorder. -Prolong joint dysfunction will lead to weakness.

6-instability-: -Due to ligamentious deficiency, recurrent subluxation .

7-change in sensiblity-: Tingling or numbness interference with nerve

function may due to pressure from neighboring structure as in prolapse intervertebral disc.

8 -loss of function.

*Past Hx-:ASK about previous accident,illness,operation and drug therapy.

*Family Hx-:ASK about MSS in pt’s family help in Dx and counseling.

*Social Hx-:ASK about detail of work, smoking…

*Systemic review.