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General Orthopaedic Examination

General Orthopaedic Examination

Summary

  • Systematic approach each time you see patient
  • General Observation on meeting patient
    • Appearance
    • Posture
    • Gait
    • Ambulation
      • Use of any aids
  • Undress & position patient

Look

  • Skin
    • scars, pigmentation, vascular status
    • colour changes – cyanosis, inflammation, erythema
    • oedema & trophic change
  • Shape
    • swelling, wasting, definite lump, deformity
  • Position

Feel

  • Feel for landmarks
  • Skin
    • warm or cold, moist or dry, sensation
  • Soft Tissues
    • characteristics of lump
  • Pulses
  • Bones & Joints
    • deformity, synovial thickening, effusion
  • Tenderness
    • Look at patient’s face & palpate specific structures

Move

  • Active,Passive
  • Record Degree of movement
  • Feel for crepitus
  • Unstable movement
  • Provocative / apprehension tests
  • Joint Stiffness
    • Arthrodesis: surgical fusion
    • Ankylosis: pathological fusion
  • Joint Laxity
    • Persistent generalized joint hypermobility
      • 5% of population
      • Autosomal dominant
    • Features
      • Hyperextension of knees
      • Hyperextension of elbow
      • MCP joints pass 90deg
      • Thumb able to touch forearm
    • Also look for connective tissue disorders
      • Marfan’s, Ehlers-Danlos, Larsen’s, Osteogenesis imperfecta
  • Deformity
    • Varus
      • part distal to joint is displaced towards midline
    • Valgus
      • away from it
    • Joint Deformity
      • Causes
        • contracture of overlying soft tissues
        • muscle imbalance
        • dislocation
        • joint destruction
  • Bony Lumps
    • Features
      • size
      • shape
      • site
      • margin
      • consistency
      • tenderness
      • multiplicity