Uploaded by Prodosh Chatterjee

Orthopaedic Assessment

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ORTHOPAEDICS ASSESSMENT
Date:
Name:
Age:
Gender:
Occupation:
Address:
Chief Complaint:
History:
Û Present History
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Allowed to narrate history
Date of onset of symptoms
Mechanism of injury
Mode of onset
Condition – Improved, Stationary, Deteriorated
Muscular weakness
Û Pain History
3 Duration of symptoms
3 Type of pain
3 Aggravating and Relieving factors
Û Past History
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Any history of Tuberculosis
Bronchial Asthma
Blood Pressure
Diabetes
Cardiac Problems
Enquiry made for any accidental injury
Û Family History
3 Hereditary?
3 Consanguinity?
1
Û Personal History
3 Cigarettes – Number/day
How long?
3 Alcoholic – Amount/day
Duration
Û Socio-economic History
Û Medical History
3 Present medication patient is on
On Observation:
Û General Condition of patient – Poor, Good, Fair built
Û Wasting
Û Oedema
Û Any bandages, Scars – Area
Extent
Û Attitude of the Limbs – Supine, Sitting, Standing
Type of gait
Bony contours
Deformities
On Palpation:
Û Tenderness
Grading
1 : Patient complains of pain
2 : Patient complains of pain & winces
3 : Patient winces & withdraws
4 : Patient will not allow palpation of the joint
Û D/F tissue tension and texture
Û Temperature variation of skin
Û Spasm
Û Type of skin – Dry or Excessive moisture
Û Scar – Adherent / Non Adherent
Û Swelling
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Comes on soon after injury – Blood
Comes on after 8 to 24 hours – Synovial
Boggy, spongy feeling – Synovial
Harder, tense feeling with warmth – Blood
Tough, dry – Callus
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Leathery thickening – Chronic
Soft fluctuating – Acute
Hard – Bone
Thick, slow-moving – Pitting oedema
Û Crepitus, Abnormal sounds
On Examination:
Û Vital Signs
Û Motor Assessment
Range of Motion (ROM)
Active - When and where pain starts
- Whether movement increases pain
- Pattern of movement
- Trick movements
Passive - When and where pain starts
- Whether movement increases pain
- Pattern of movement
- D/F between range of motion available
- End feel
End Feel
Normal - Bone to Bone
- Soft Tissue Approximation
- Tissue Stretch
Abnormal - Early Muscle Spasm
- Late Muscle Spasm
- Hard Capsular
- Soft Capsular
- Bone to Bone
- Empty
- Springy Block
Capsular Patterns
Manual Muscle Testing
MRC Grading
Resisted Isometrics
- On contraction causes pain and, if it does, pain’s intensity & quality
- Strength of contraction
- Type of contraction causing problem (concentric, isometric,
eccentric)
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Joint movements
- Loose packed position
- Close packed position
Û Sensory Assessment
Superficial Sensations
- Pain, Temperature, Light touch, Pressure
Deep Sensations
- Movement sense, Position sense
Combined Sensations
- Stereognosis, Tactile Localization, Two Point Discrimination,
Grapesthesia
MRC Grading
S0 : No sensation
S1 : Deep Proprioception
S2 : Skin touch, pain thermal sensation
S3 : S2 with accurate localization but deficient stereognosis, cold
sensitivity, hypersensitivity often present
S3+ : Object and texture recognition but not normal sensation, good
but not normal two point discrimination
S4 : Normal sensations
Û Reflexes
Superficial Reflexes
- Corneal, Abdominal, Plantar, Cremasteric
Deep Reflexes
- Biceps, Triceps, Babinski Reflex, Knee Jerk, Ankle Jerk
Clonus
Grading
0 : Absent
1 : Diminished
2 : Normal
3 : Brisk
4 : Exaggerated
Û Dermatomes & Myotomes
Û Limb Length Discrepancies
3 Apparent Length
3 True Length
Û Special Tests
Û Functional Assessment
Ambulation - Gait or Wheel Chair
4
- Independent or Dependent
- Transfers
Û Gait Assessment
3 Type of gait
3 Stride length
3 Step length
Û VAS / NRS Scale
Û ADL
Investigations:
Clinical Impression:
Differential Diagnosis:
Findings to make Final Impression:
Final Diagnosis:
Goals:
3 Short Term
3 Long Term
Treatment Plan:
3 Electric Modalities
3 Manipulation
3 Exercises
3 Splints & Assistive Devices
Home Programme:
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SPECIAL ORTHOPAEDIC TESTS
z Shoulder:
h Speed Test
(Biceps or Straight Arm Test)
h Yergason’s Test
h Lippman’s Test
h Supraspinatus Test
(Empty Can Test)
h Drop Arm Test (Codman’s Test)
h Neer Impingement Test
h Roos Test
h Wright Test
h Adson Test
h Allen’s Test
h Upper Limb Tension Test (ULTT)
ULTT 1
ULTT 2
ULTT 3
ULTT 4
h Apprehension Test
h Rockwood Test
h Dugas Test
h Posterior Apprehension Test
h Push Pull Test
h Sulcus Test
h Clunk Test
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- Bicipital Tendinitis
- Bicipital Tendinitis
- Bicipital Tendinitis
- Supraspinatus Tear
- Rotator Complex
- Supraspinatus & Biceps
Tendon
- Thoracic Outlet Syndrome
- Thoracic Outlet Syndrome
- Thoracic Outlet Syndrome
- Thoracic Outlet Syndrome
- Median nerve & anterior
interosseous nerve
- C5, 6, 7, Median nerve,
Musculocutaneous nerve &
axillary nerve
- Radial nerve
- C8, T1, Ulnar nerve
- Anterior Shoulder Dislocation
- Anterior Shoulder Instability
- Anterior Shoulder Dislocation
- Posterior Shoulder Dislocation
- Posterior Shoulder Dislocation
- Inferior Shoulder Instability
- Labral Tear
z Elbow:
h Ligamentous Instability Tests
h Cozen’s Test
h Mill’s Test
h Golfer’s Elbow Test
h Wartenberg’s Sign
h Elbow Flexion Test
h Pronator Teres Test
- Lateral & Medial Collateral
Ligaments
- Lateral Epicondylitis
- Lateral Epicondylitis
- Medial Epicondylitis
- Ulnar Neuropathy
- Cubital Syndrome
- Pronator Teres Syndrome
z Forearm, Wrist & Hand:
h Finketsein’s Test
- Abductor Pollicis Longus &
Extensor Pollicis Longus
Tenosynovitis
- Ruptured Flexor Digitorum
Profundus
- Tight Intrinsics
- Carpal Tunnel Syndrome
- Carpal Tunnel Syndrome
- Paralysis of Adductor Pollicis
Longus
h Sweater Finger Test
h Bunnel-Litter Test
h Phalen’s Test
h Reverse Phalen’s Test
h Froment’s Sign
z Pelvis:
h Approximation Test
- Possible SI Lesion or Sprain
Posterior SI Ligaments
h Gapping Test
- Sprain Anterior SI Ligaments
h Sacroiliac Rocking Test (SI Strain) - Sacrotuberous Ligaments
h SLR (Lascgucs Test)
- SI Problems
h Gaenslen’s Test
- I/P SI Lesion or Hip Pathology
or Lumbar Pathology
h Prone Knee Bend Test
- For D/F Diagnosis
h Yeoman’s Test
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z Hip:
h Patrick’s Test
(FABER or Figure Four Test)
h Stinchfield Test
h Thomas Test
h Rectus Femoris Contracture Test
h Ober’s Test
h Piriformis Test
- Hip Joint?
Iliopsoas Spasm
- Hip Joint Pathology
- Hip Flexion Contracture
- For Rectus Femoris
- TFL Contracture
- Piriformis Syndrome
z Knee:
h Valgus Stress Test
h Varus Stress Test
h Lachman Test
h Anterior Drawer Sign
h Posterior Drawer Sign
h McMurray Test
h Apley’s Test
h Bounce Home Test
h Mediopatellar Plica Test
h Fluctuation Test
h Patellar Tap Test
h Clarke’s Sign
h McConnell Test
h Q-Angle or Patellofemoral Angle
h Fairbank’s Apprehension Test
- Medial Collateral Ligament
- Lateral Collateral Ligament
- Anterior Cruciate Ligament
- Anterior Cruciate Ligament
- Posterior Cruciate Ligament
- Meniscal Tear
- Meniscal or Ligamentous?
- Meniscal Injury
- Mediopatellar Plica
- Swelling
- Swelling
- Patellofemoral Dysfunction
- Chondromalacia Patella
- Patellofemoral Dysfunction
- Dislocation of Patella
z Ankle:
h Anterior Drawer Test
- Anterior Talofibular Ligament
Injury
- Calcaneofibular Ligament
- Achilles Tendon Rupture
h Talar Tilt
h Thompson’s Test
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z Cervical Spine:
h Foraminal Compression
(Sparling’s Test)
h ULTT’s
h Shoulder Depression Test &
Abduction Test
h Jackson’s Compression Test
h Valsalva Tests
- Cervical Radiculitis
D/F Diagnosis
- Compression of nerve roots or
Brachial Plexus Lesion
- Pressure on nerve root
- Herniated disc / Tumour /
Osteophyte
- Compression of Vertebral
Artery
h Vertebral Artery Test
(Cervical Quadrant Test)
z Thoracic Spine:
h Slump Test
- Impingement of Dura & Spinal
Cord / Nerve Roots
z Lumbar Spine:
h Slump Test
h SLR (Basic), 2, 3, 4, Crossed SLR
h Valsalva Maneuver
h Schober’s Test
h Stoop Test
- For Neuromeningeal Tract
- Sciatic, Tibial, Sural, Common
Peroneal, Disc Prolapse
- Increased Intrathecal Pressure
- Measure Flexion of Lumbar
Spine
- Neurogenic Intermittent
Claudication
z Tests for Malingering:
h Hoover Test
h Burns Test
- Malingering for Back Pain
- Malingering for Back Pain
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