PART 1

GENERAL ORTHOPAEDICS
DIAGNOSIS IN ORTHOPAEDICS
• Symptoms: Pain, Stiffness, Swelling, Deformity, and Disability
• Pain
Grade I : Trivial
Grade II : Moderate
Grade III : Severe
Grade IV : Incapacitating
• Examination of a Joint
• Deformity
Varus and Valgus
Kyphosis and lordosis
Scoliosis
“Fixed” deformity
Hysterical deformity
• Gait and Limp
Heel strike
Stance phase
Toe off
Swing phase

• Stiffness
All movements absent
All movement limited
Some movements limited
• Joint laxity
Increased movement at a single joint
Increased movement at a few joints
Generalized joint hypermobility
• Examination of a bone
Look (skin, shape, size)
Feel (Skin, soft tissue, the bone itself)
Move
• Bent bones
• Bony lumps
Size
Site
Shape
Tenderness
Edge
Consistency
X-ray examination

• How to read an x-ray

Patient
The soft tissue (Shape, density)
The bones (Shape, density, architecture)
The Joint (shape, density)
Radiographic techniques
• Tomography
• Xeroradiography
• X-rays using contrast media (sinography, arthrography, myelography)
• Computerized tomography
• Radionuclide imaging
Electrodiagnosis
• Nerve and muscle stimulation
• Measurement of nerve conduction velocity
• Electromyography
Bone Infections
Acute Osteomyelitis
• Pathology (suppuration, necrosis, new bone formation)
• Clinical features (look, feel, move)
• Differential diagnosis (acute suppurative arthritis, acute rheumatism, sickle
cell crisis, gaucher’s disease)
• Treatment (antibiotics, analgesics, splintage, drainage)
• Complication (metastatic infection, suppurative arthritis, altered length of
bone)
Chronic osteomyelitis
• Post traumatic and post operative
• Chronic osteomyelitis: the sequel to acute
• Chronic osteomyelitis of insidious onset
Brodie’s abcess
Tuberculous osteomyelitis
Periostitis
• Following injury
• Chronic from the start (syphilitic periostitis)
Acute suppurative arthritis
• Cause and pathology (infection)
• Clinical features (wound, severe pain, high fever, skin looks red and swollen,
all movements are restricted)
• Differential diagnosis (acute osteomyelitis, rheumatic fever, acute non-
suppurative arthritis, haemarthrosis)
• Immediate treatment (aspiration, antibiotics, splintage)
 PART 2
REGIONAL ORTHOPAEDICS
The shoulder joint
• Examination
Symptoms (Pain, stiffness, deformity, loss of function)
Signs
Look (skin, shape, position)
Feel (Skin, soft tissue, bony points)
Move (active movements, Passive movements, power)
X-ray
Scapular disorders
• Congenital undescended scapula (Sprengel’s shoulder)
• Winged scapula
• Grating scapula
Rotator cuff lesions
• Pathology (degeneration, trauma, reaction, wear, tear and repair, the vicious
spiral)
• Acute tendinitis (acute calcification)
• Chronic tendinitis (the painful arc syndrome)
• Adhesive capsulitis (frozen shoulder)
Differential diagnosis
• Post traumatic stiffness
• Post inactivity stiffness
• Reflex symphatetic dystrophy
• Tuberculosis
• Rotator cuff tears
• Lesions of the biceps tendon
Tendinitis
Ruptured biceps tendon
• Tuberculosis of the shoulder
• Rheumatoid arthritis
The Elbow Joint
Examination
• Symptoms (pain, stiffness, swelling)
• Signs (look, feel, move, x-ray)
Elbow deformity
• Cubitus varus
• Cubitus valgus
• Dislocated head of radius
• Tuberculosis

• Rheumatoid arthritis

• Osteoarthritis
Stiffness of the elbow (Both elbows, One elbow)
• Post traumatic stiffness
• Flailness of the elbow (gunshot wound, charcot’s disease, poliomyelitis)
• Tennis elbow
Treatment (injection, physiotherapy, manipulation, rest, operation)
• Loose bodies
Injury
Degeneration
Inflammation
Idiopathic
Nerve lesions
• Ulnar nerve
• Posterior interosseus nerve