GENERAL PRINCIPLES IN THE ORTHOPAEDIC EXAMINATION

Andre Yanuar, Ghuna A Utoyo, Rizki Rahadian

Dept. of Orthopaedic & Traumatology Hasan Sadikin General Hospital Medical School of Padjadjaran University Bandung

Introduction
Joints of the limbs & spine. Joints, nerves, muscles Six distinct steps : 1. Inspection 2. Palpation 3. Examination of movements 4. Conduction of special tests 5. Examination of radiographs 6. 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?

Inspection

Palpation
Is the joint warm? Is there tenderness? How is the artery pulse?

Movements
Fixed deformities ROM Restriction of ROM Passive ROM Active ROM Movements in abnormal plane Crepitus Strength of muscle contraction Gait

Movements

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

Equipment Requirements
A tape measure A goniometer A tendon hammer A disposable sharp point