Definition
- Localises the problem and identifies the pathology
- Gauges function and screens for serious disease
- FRACS examination expects a consistent routine adapted to region and scenario
Clinical Features
History
- Presenting complaint of pain, stiffness, swelling, deformity, instability, weakness, locking or functional loss
- Pain site, onset, character, radiation, timing, modifiers, and night or rest pain
- Mechanism of injury, energy and limb position in trauma
- Impact on work, sport, sleep, walking distance and self care
- Previous injections, physiotherapy and surgery
- Diabetes, inflammatory arthritis, malignancy, cardiorespiratory disease and bleeding disorders
- Anticoagulants, steroids and bisphosphonates
- Occupation, hand dominance, smoking, alcohol, home supports and patient goals
- Family history of skeletal dysplasia, connective tissue or inflammatory disease
Examination
- Expose both sides, obtain consent and attend to pain
- Examine the joint above, the joint below and the spine where referred pain is possible
- Look at gait, posture, alignment, swelling, wasting, scars, skin, sinuses and deformity
- Feel for temperature, structure-specific tenderness, effusion, crepitus and masses
- Move actively then passively, comparing sides and noting end feel and fixed deformity
- Special tests for the region, such as Lachman, impingement or instability tests
- Neurovascular check of dermatomes, myotomes, reflexes, pulses and capillary refill
Children
- Birth history, milestones and non-accidental injury screen
- Play based examination with the painful area last
Differential Diagnosis
Red flags for infection, malignancy, fracture or neurological compromise
- Fever, rigors, recent sepsis, intravenous drug use or immunosuppression
- Previous malignancy, unexplained weight loss, night pain or rest pain
- Progressive neurological deficit, saddle anaesthesia or sphincter disturbance
- Pain out of proportion, especially with tense compartments
- Hot swollen joint with inability to bear weight
- Significant trauma in osteoporosis, or minor trauma with disproportionate pain
Investigations
- Selective, guided by history and examination
- Plain radiographs in two orthogonal planes first
- Blood tests, ultrasound, MRI, CT and nerve conduction studies as indicated
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.