SlideShare a Scribd company logo
1 of 29
ORTHOPAEDIC ASSESSMENT
(SOAP notes: subjective ,objective , assessment and plan )
Subjective assessment
Name:
Age:
Sex:
Occupation:
Address:
OPD NO / IPD NO:
DOE;
Dominant side:
Chief complaint:
HISTORY
Present history
Date of onset of injury:
Mechanism of injury:
 Road side accident
 Direct injury
 Indirect injury
 Bending / twisting injury
 Rotational injury
Mode of onset:
 Sudden
 Gradual
 Insidious
 Periodic
Duration : that help to determine the condition
 Acute: present since 7 to 10 days
 Sub acute : present since 10 days to 7 weeks
 Chronic: present for longer than 7 weeks
Condition:
 Improved
 Stationary
 Worsen
Current treatment:
Pain assessment
Site:
Side;
Type: nerve pain, muscle pain etc.
Different type of pain and related structure
TYPES OF PAIN STRUCTURE
Cramping, dull aching Muscle
Dull aching Ligament, joint
capsule
Sharp shooting Nerve root
Sharp bright , lightening -
like
Nerve
Burning pressure like ,
stinging , aching
Sympathetic nerve
Deep nagging, dull Bone
Sharp severe, intolerable Fracture
Throbbing, diffuse Vasculature
Frequency:
Nature: constant / periodic / episodic
Pain aggravating factor & pain relieving factor:
Intensity:
Intensity of pain can be assessed with the help of VAS (visual
analogue scale) or numerical rating scale .
VAS:
Numerical rating scale:
Past medical history
Relevant previous medical problem to present condition
History of other disease & injuries
Operation & hospitalization
Medication
Personal history
Personal habits:
 Sleeping habits
 Tobacco: duration, frequency, amount
 Cigarette smoking: duration, frequency, amount
 Alcohol: duration, frequency , amount
PHYSICAL ACTIVITIES:
 Occupational
 Recreational
 Exercises
 Other
Family history
Similar problem in relatives
Hereditary diseases
Consanguinity
Social history
Social status:
Educational status:
Environmental history
Environment of home
Environment of work place
FUNCTIONAL HISTORY
 Previous
 Current
Objective assessment
SENSORIUM:
 Alert: awake and attentive to normal stimulation
 Lethargic: drowsy, may fall asleep if not stimulated
 Stupor: responds only to strong, noxious stimuli , returns to
unconscious state
 Coma: can not be aroused
AMBULATORY STATUS:
Note patient’s mode of locomotion such as on wheel chair, ambulatory
with or without assistive device, bedridden, etc.
General condition of patient: poor / good / medium
Body Built:
 ectomorphic :: thin prominence of structure from ectoderm
 mesomorphic : muscular , prominence of structure from
mesoderm
 endomorphic : heavy , fat body built , prominence of structures
from endoderm
Posture (Attitude of limbs) :
 Standing, sitting , lateral views
 Anterior, posterior and lateral view
 The posture should be taken from maximum possible position
 Deviations at diff region should be checked
Assessment of posture in saggital plane (normal)
Frontal plane analysis
anterior view
Posterior view
Deformity
 Congenital anomalies – such as CTEV
 Acquired deformity – fixed flexion deformity , knock knes , bow
leg etc
External appliances
 functional aids including walking aids , catheters etc .
 protective aids such as orthotic and prosthesis
Gait analysis
OBSERVATION-
• Perform a general overview of patients posture
• Observe walking at normal speed ,then slow and fast speed
• The examiner must watch the lumbar spine ,pelvis ,hips ,knees
,feet and ankle during walking
• Patient should walk bare foot.
• Also examine the pt. Walking with and without aids.
OBSERVATION IN ANTERIOR VIEW
The examiner should note-
 Any lateral tilt of pelvis
 Sideways swinging of trunk
 Rotation of pelvis
 Movements of hip
 Ankle and foot movements-amount of toe out and toe in
 Note bowing of femur on tibia
 This view is best used to examine the wt. Loading period of
gait cycle.
 Note any abduction or circumduction of swing leg
 Any atrophy of musculature of ant. Thigh and leg
 Width of base
OBSERVATION IN LATERAL VIEW
• Rotation of shoulder and thorax
• Reciprocal swing
• Spinal posture
• Pelvic rotation
• Movements at jts .of lower limb
• Step length ,stride length, cadence
• Check adequate knee extension and flexion at phases of stance
and swing phase.
• Any hyperextension of knee
• Check coordination
• Gait parameters.
FOOTWEAR
• Patient asked to walk in normal footwear as well as in barefoot
• Observe patients footwear
• Observe wearing down of heels and socks
• Condition of shoe uppers and creases
• Examine the feet for callus formation , blisters ,corns and bunions
• Different shoes can modify a patients gait and amount of energy
necessary to perform gait.
PATHOLOGICAL GAIT
 Antalgic gait
 Ataxic gait
 Calcaneal gait
 Circumductory gait
 Hand to knee gait
 High stepping gait
 Lordotic gait
 Scissoring gait
 Trendlenburd gait
 Valgus gait
 Waddling gait
TROPHYC CHANGES / SURGICAL SCAR
Trophical or skin vhnges like texture , bruising , color and presence of
scar , wounds or pressuresores etc .
ON PALPATION:
Tenderness:
A state in which pain is felt on the release of pressure over a
part
Grading tenderness when palpating
Grade 1 – patient complains of pain
Grade 2 – patient complains of pain and winces
Grade 3 – patient winces and withdraws the joint
Grade 4 – patient will not allow palpation of the joint
TONE : flabby(hypotonia , wasting) ;hard (hypertonia)
Crepitation :
crepitus is palpable cruching sensation present throughout the
movement of the involved joint or enthesis structure .
 Fine crepitus – may be audible only by stethoscope & it is not
transmitted through the adjacent bone . fine crepitus may
accompany inflammation of the tendon sheath
 Course crepitus – it may be audible at a distance & is palpable
through the bone . coarse crepitus usually affects cartilage or
bone damage .
Ligamentus snaps – it is usually single, loud & painless
o Cracking by joint distraction : it is common at the finger joints & is
cause by production of an intra-articular gas bubble (such cracking
can not be repeated until the bubble reformed)
Capillary filling : nail filling test
Nodules
Pulses
Scar : heal / non heal / length
EDEMA : edema is an abnormal accumulation of fluid in the
intercellular spaces : pitting /non pitting
Swelling : it is abnormal enlargement of a body part
 It may be as the result of bone thickening , synovial membrane
hickening or fluid accumulation in and around the joint .
 It may be extracellular or intacellular ,intracapsular or
extracapsular
 Characteristic of swelling :
 Comes soon after injury – blood
 Comes on after 8 to 24 hrs – synovial
 Boggy , spongy feeling – synovial
 Harder , tense feeling with warmth – blood
 Tough , dry - callus
ON EXAMINATION:
Vital signs
Heart rate : 60 – 100 b/m
Blood pressure : 120 / 70 mmhg
Temperature : 36.5 -37.5’c
Respiratory rate : 12 -16 c/m
MOTOR EXAMINATION:
RANGE OF MOTION (ROM)
Active : when and where pain starts
: whether movement increases pain
: pattern of movement
: trick movements
limitation of AROM may indicate affection of either contractile or non-
contractile tissue or both,further testing should perform to isolate the
cause .
Passive : when and where pain starts
: difference between range of motion available
: end feel
( END-FEEL : the type of structure which limits a ROM has a
characteristic feel that may be detected by the examiner who is
performing passive ROM , this feeling which is experienced by an
examiner as a barrier to further motion at the end of passive ROM is
called END-FEEL)
MOVEMENT END
FEEL
ROM
Shoulder
flexion
Firm 0 - 180
Shoulder
extension
Firm 180 – 0 -60
Shoulder
abduction
and
adduction
Firm 0 – 180
And
180 - 0
Shoulder
medial
rotation
&
Lateral
rotation
Firm
0 – 70
0 - 90
Wrist flexion
&
extension
0 –
150
Soft
150 - 0
hard
Forearm
supination
&
pronation
Firm
Hard
0 – 80
0 – 80
Wrist flexion
&
extension
0 – 80
0 – 70
Firm
Hard (or
firm)
Wrist radial
deviation
&
Hard 0 – 20
ulnar
deviation
Firm 0 - 30
Hip flexion Soft
(firm)
0 – 120
Hip extension Firm 0 - 20
Hip
abduction
Firm 0 - 45
Hip
adduction
Firm 0 – 30
Hip internal &
external
rotation
Firm
O – 45
Knee flexion
& extension
Firm
Hard
0 – 150
150 – 0
Ankle
dorsiflexion
Firm 0 - 20
Ankle
planterflexion
Firm
(or
hard)
O – 50
Ankle
eversion
Firm O - 15
Ankle
inversion
Firm 0 – 35
MMT OF MUSCLES
GRADE VALUE MOVEMENT GRADE
5+ Normal (100%) Complete ROM
against gravity with
maximal resistance
4 Good (75%) Complete ROM
against gravity with
some (moderate)
resistance
3+ Fair + Complete ROM
against gravity with
minimal resistance
3 Fair(50 %) Complete ROM
against gravity
3- Fair - Some but not
complete ROM
against gravity
2+ Poor + Initiates motions
against gravity
2 Poor (25 %) Complete ROM with
gravity eliminated
2- Poor - Initiates motion if
gravity is eliminated
1 Trace Evidence of slight
contractility but no
joint motion
0 Zero No contraction
palpeted
JOINT PLAY MOVEMENT
Also known as assesory joint motion
CAPSULAR PATERN : pattern of limitation or restriction .
Loose packed position : it is the position in which there is minimal
congruency b/w the articular surface and the joint capsule with the
ligament being in position of greatest laxity and passive separation of
joint surfaces being greatest .
Close packed position : in this position the two joint surfaces fit
together precisely (fully congruent) ligament and capsules of the joint
are maximally tight .
SENSORY ASSESSMENT
Superficial sensations
 Pain
 Temperature
 Light touch
 pressure
Deep sensations
 Propioception
 Kinesthesia
 Vibration
Cortical sensation
 Graphesthesia
 Sterognosis
 Tactile localization
 2 point discrimination
MRC GRADING
S0 : no sensation
S1 : deep proprioception
S2: skin touch , pain , thermal sensation
S3 : s2 with accurate localization but deficient sterognosis , cold
sensitivity , hypersensitivity
often present
S3+ : object and texture recognization but not normal sensation , good
but not normal two
point discrimination
S4 : normal sensation
REFLEXES
Grading of reflexes
0 : absent
1 : diminished
2 : normal
3 : brisk
4 : exaggerated
Superficial reflexes
o Corneal
o Abdominal
o Planter
o cremastetic
Deep tendon reflexes
o Jaw (cranial nerve V)
o Biceps (c5 – c6)
o Brachioradialis (c5 – c6)
o Triceps (C7 – C8)
o Patella (L3 – L4 )
o Medial hamstring (L5,S1)
o Lateral hamstring (S1 – S2)
o Tibialis posterior(L4 – L5)
o Achilles (S1 –S2)
Dermatomes
The sensory distribution of each nerve root is called dermatome . “ a
dermatome is defined as the area of skin supplied by a single nerve root
”
MYOTOMES : group of muscles supplied by a single nerve root
In the testing of myotome each contraction is held for minimum 5
seconds to see weather the weakness becomes evident .
Limb length measurement:
 True limb length measurement : that is from ASIS to medial
malleolus
 Apperent limb length measurement : umbilical to medial malleoli
 Functional leg length discrepancy : usually as a result of muscular
weakness or inflexibility at the pelvis or foot and ankle
GIRTH MEASUREMENTS : circumference of body parts is refferedto
as girth.
GAIT ANALYSIS
o step length : 72 cm
o stride length : 144 cm
o step width : 5 to 10 cm
o cadence : 90 to 120 steps per minute
o other
FUNCTIONAL EVALUATION
FUNCTIONAL EVALUATION OF UPPERLIMB
o dressing
o combing
o washing
o eating
o toilationg
o other
FUNCTIONAL EVALUATION OF LOWERLIMB
o stair climbing
o cycling
I
INVESTIGATIONS
 X-RAY
 CT scan
 MRI scan
 Bone scan
 Angiography
 Myelogram
 Electro - diagnostic study
Pathological findings
Radiological findings
Diagnostic imaging :
 to confirm a diagnosis
 to establish a diagnosis
 to determine severity of a disease
 to determine progression of a disease
 to determine stage of healing
 to enhance pt treatment
 to determine anatomical alignment
SPECIAL TESTS
DIFFERENCIAL DIAGNOSIS
DIAGNOSIS
PHYSIOTHERAPY AIMS
 to relieve pain
 to increase ROM
 to correct the deformity
 to relieve stiffness
 to improve muscle power and strength
 to improve muscle endurance
 to maintain tissue extensibility
 to correct posture
 to correct balance
 to train for walking aids
 gait training
 other
SHORT TERM GOALS
LONG TERM GOALS
PHYSIOTHERAPY PLAN
HOME EXERCISE PROGRAM
ERGONOMICS
Treatment:
By: Dr. Sandhya dhokia

More Related Content

What's hot

Berg balance scale. By Philans Cosmos Ankrah
Berg balance scale. By Philans Cosmos AnkrahBerg balance scale. By Philans Cosmos Ankrah
Berg balance scale. By Philans Cosmos AnkrahPhilans Cosmos Ankrah
 
Proprioceptive neuromuscular facilitation
Proprioceptive neuromuscular facilitationProprioceptive neuromuscular facilitation
Proprioceptive neuromuscular facilitationBhawna Rajput
 
GOLFERS ELBOW AND PHYSIOTHERAPY MANAGEMENT
GOLFERS ELBOW AND PHYSIOTHERAPY MANAGEMENT GOLFERS ELBOW AND PHYSIOTHERAPY MANAGEMENT
GOLFERS ELBOW AND PHYSIOTHERAPY MANAGEMENT Shahid Uz Zafar
 
Cervical spondylosis; Physiotherapy approach
Cervical spondylosis; Physiotherapy approachCervical spondylosis; Physiotherapy approach
Cervical spondylosis; Physiotherapy approachenweluntaobed
 
Hemiplegic Gait Rehabilitation
Hemiplegic Gait RehabilitationHemiplegic Gait Rehabilitation
Hemiplegic Gait RehabilitationDr. Rima Jani (PT)
 
Biomechanics of posture
Biomechanics of postureBiomechanics of posture
Biomechanics of posturekumarkirekha
 
Congenital Dislocation of the Hip - PHYSIOTHERAPY
Congenital Dislocation of the Hip - PHYSIOTHERAPYCongenital Dislocation of the Hip - PHYSIOTHERAPY
Congenital Dislocation of the Hip - PHYSIOTHERAPYUPASANA AGARWAL
 
Faradic Foot Bath, Faradism Under Pressure, Faradism Under Tension, Stimulati...
Faradic Foot Bath, Faradism Under Pressure, Faradism Under Tension, Stimulati...Faradic Foot Bath, Faradism Under Pressure, Faradism Under Tension, Stimulati...
Faradic Foot Bath, Faradism Under Pressure, Faradism Under Tension, Stimulati...Sreeraj S R
 
PT MANAGEMENT OF GBS
PT MANAGEMENT OF GBSPT MANAGEMENT OF GBS
PT MANAGEMENT OF GBSKeerthi Priya
 
Joint mobilization AmiR
Joint mobilization AmiRJoint mobilization AmiR
Joint mobilization AmiRAlam Zeb Amir
 
Functional re education
Functional re educationFunctional re education
Functional re educationDr. Muzahid
 
Proprioceptive neuromuscular facilitation
Proprioceptive neuromuscular facilitationProprioceptive neuromuscular facilitation
Proprioceptive neuromuscular facilitationAarti Sareen
 
PRINCIPLES OF TENDON TRANSFERS
PRINCIPLES OF TENDON TRANSFERSPRINCIPLES OF TENDON TRANSFERS
PRINCIPLES OF TENDON TRANSFERSBenthungo Tungoe
 

What's hot (20)

Berg balance scale. By Philans Cosmos Ankrah
Berg balance scale. By Philans Cosmos AnkrahBerg balance scale. By Philans Cosmos Ankrah
Berg balance scale. By Philans Cosmos Ankrah
 
Proprioceptive neuromuscular facilitation
Proprioceptive neuromuscular facilitationProprioceptive neuromuscular facilitation
Proprioceptive neuromuscular facilitation
 
GOLFERS ELBOW AND PHYSIOTHERAPY MANAGEMENT
GOLFERS ELBOW AND PHYSIOTHERAPY MANAGEMENT GOLFERS ELBOW AND PHYSIOTHERAPY MANAGEMENT
GOLFERS ELBOW AND PHYSIOTHERAPY MANAGEMENT
 
Cervical spondylosis; Physiotherapy approach
Cervical spondylosis; Physiotherapy approachCervical spondylosis; Physiotherapy approach
Cervical spondylosis; Physiotherapy approach
 
Frenkels exercise
Frenkels exerciseFrenkels exercise
Frenkels exercise
 
Hemiplegic Gait Rehabilitation
Hemiplegic Gait RehabilitationHemiplegic Gait Rehabilitation
Hemiplegic Gait Rehabilitation
 
Biomechanics of posture
Biomechanics of postureBiomechanics of posture
Biomechanics of posture
 
Congenital Dislocation of the Hip - PHYSIOTHERAPY
Congenital Dislocation of the Hip - PHYSIOTHERAPYCongenital Dislocation of the Hip - PHYSIOTHERAPY
Congenital Dislocation of the Hip - PHYSIOTHERAPY
 
Roods approach
Roods approach   Roods approach
Roods approach
 
Principles of mulligan
Principles of mulliganPrinciples of mulligan
Principles of mulligan
 
Faradic Foot Bath, Faradism Under Pressure, Faradism Under Tension, Stimulati...
Faradic Foot Bath, Faradism Under Pressure, Faradism Under Tension, Stimulati...Faradic Foot Bath, Faradism Under Pressure, Faradism Under Tension, Stimulati...
Faradic Foot Bath, Faradism Under Pressure, Faradism Under Tension, Stimulati...
 
Fg test
Fg testFg test
Fg test
 
Periarthritis shoulder
Periarthritis shoulderPeriarthritis shoulder
Periarthritis shoulder
 
Patellar tendinopathy
Patellar tendinopathyPatellar tendinopathy
Patellar tendinopathy
 
PT MANAGEMENT OF GBS
PT MANAGEMENT OF GBSPT MANAGEMENT OF GBS
PT MANAGEMENT OF GBS
 
Joint mobilization AmiR
Joint mobilization AmiRJoint mobilization AmiR
Joint mobilization AmiR
 
Functional re education
Functional re educationFunctional re education
Functional re education
 
Proprioceptive neuromuscular facilitation
Proprioceptive neuromuscular facilitationProprioceptive neuromuscular facilitation
Proprioceptive neuromuscular facilitation
 
PRINCIPLES OF TENDON TRANSFERS
PRINCIPLES OF TENDON TRANSFERSPRINCIPLES OF TENDON TRANSFERS
PRINCIPLES OF TENDON TRANSFERS
 
Orthosis of hand ppt
Orthosis of hand pptOrthosis of hand ppt
Orthosis of hand ppt
 

Similar to Ortho assessment for physiotherapist

Part 4 examination of motor and sensory system
Part 4 examination of motor and sensory systemPart 4 examination of motor and sensory system
Part 4 examination of motor and sensory systemAtul Saswat
 
Examination Of Extremities
Examination Of ExtremitiesExamination Of Extremities
Examination Of Extremitiesyeditepe tıp
 
Examination Of Extremities
Examination Of ExtremitiesExamination Of Extremities
Examination Of Extremitiesyeditepe tıp
 
examination of the hip joint
examination of the hip jointexamination of the hip joint
examination of the hip jointPallav Agrawal
 
Goniometer (range of motion )
Goniometer (range of motion )Goniometer (range of motion )
Goniometer (range of motion )Ajay Agarawal
 
Range Of Motion Assessment
Range Of Motion Assessment Range Of Motion Assessment
Range Of Motion Assessment Maleeha Amjed
 
The Examination of the Knee_040716.pptx
The Examination of the Knee_040716.pptxThe Examination of the Knee_040716.pptx
The Examination of the Knee_040716.pptxdeepaksampath5
 
Knee clinical examination for orthopaedic residents.dr mohamed ashraf TD medi...
Knee clinical examination for orthopaedic residents.dr mohamed ashraf TD medi...Knee clinical examination for orthopaedic residents.dr mohamed ashraf TD medi...
Knee clinical examination for orthopaedic residents.dr mohamed ashraf TD medi...drashraf369
 
Non union neck of femur
Non union neck of femurNon union neck of femur
Non union neck of femurJose Austine
 
Assessment and special tests of Hip joint
Assessment and special tests of Hip jointAssessment and special tests of Hip joint
Assessment and special tests of Hip jointShamadeep Kaur (PT)
 
NurseReview.Org - Muscoloskeletal System
NurseReview.Org - Muscoloskeletal SystemNurseReview.Org - Muscoloskeletal System
NurseReview.Org - Muscoloskeletal SystemNurse ReviewDotOrg
 
Musculoskeletal system
Musculoskeletal systemMusculoskeletal system
Musculoskeletal systemPritom Das
 
Clinical Examination of shoulder joint
Clinical Examination of shoulder jointClinical Examination of shoulder joint
Clinical Examination of shoulder jointAbdullahIhsaas
 
Musculoskeletal Injuries
Musculoskeletal Injuries Musculoskeletal Injuries
Musculoskeletal Injuries paramedicbob
 
Orthopaedic history taking ugpg
Orthopaedic history taking ugpgOrthopaedic history taking ugpg
Orthopaedic history taking ugpgKishore Vemula
 

Similar to Ortho assessment for physiotherapist (20)

Part 4 examination of motor and sensory system
Part 4 examination of motor and sensory systemPart 4 examination of motor and sensory system
Part 4 examination of motor and sensory system
 
Examination Of Extremities
Examination Of ExtremitiesExamination Of Extremities
Examination Of Extremities
 
Examination Of Extremities
Examination Of ExtremitiesExamination Of Extremities
Examination Of Extremities
 
examination of the hip joint
examination of the hip jointexamination of the hip joint
examination of the hip joint
 
Knee Examination.pptx
Knee Examination.pptxKnee Examination.pptx
Knee Examination.pptx
 
Goniometer (range of motion )
Goniometer (range of motion )Goniometer (range of motion )
Goniometer (range of motion )
 
Range Of Motion Assessment
Range Of Motion Assessment Range Of Motion Assessment
Range Of Motion Assessment
 
The Examination of the Knee_040716.pptx
The Examination of the Knee_040716.pptxThe Examination of the Knee_040716.pptx
The Examination of the Knee_040716.pptx
 
Knee clinical examination for orthopaedic residents.dr mohamed ashraf TD medi...
Knee clinical examination for orthopaedic residents.dr mohamed ashraf TD medi...Knee clinical examination for orthopaedic residents.dr mohamed ashraf TD medi...
Knee clinical examination for orthopaedic residents.dr mohamed ashraf TD medi...
 
Surgery 6th year, Tutorial (Dr. Ali A. Nabi)
Surgery 6th year, Tutorial (Dr. Ali A. Nabi)Surgery 6th year, Tutorial (Dr. Ali A. Nabi)
Surgery 6th year, Tutorial (Dr. Ali A. Nabi)
 
Non union neck of femur
Non union neck of femurNon union neck of femur
Non union neck of femur
 
Assessment and special tests of Hip joint
Assessment and special tests of Hip jointAssessment and special tests of Hip joint
Assessment and special tests of Hip joint
 
NurseReview.Org - Muscoloskeletal System
NurseReview.Org - Muscoloskeletal SystemNurseReview.Org - Muscoloskeletal System
NurseReview.Org - Muscoloskeletal System
 
Musculoskeletal system
Musculoskeletal systemMusculoskeletal system
Musculoskeletal system
 
Shoulder
ShoulderShoulder
Shoulder
 
Clinical Examination of shoulder joint
Clinical Examination of shoulder jointClinical Examination of shoulder joint
Clinical Examination of shoulder joint
 
ASSESSMENT.pptx
ASSESSMENT.pptxASSESSMENT.pptx
ASSESSMENT.pptx
 
Examination of hip joint
Examination of hip jointExamination of hip joint
Examination of hip joint
 
Musculoskeletal Injuries
Musculoskeletal Injuries Musculoskeletal Injuries
Musculoskeletal Injuries
 
Orthopaedic history taking ugpg
Orthopaedic history taking ugpgOrthopaedic history taking ugpg
Orthopaedic history taking ugpg
 

Recently uploaded

Decoding the Tweet _ Practical Criticism in the Age of Hashtag.pptx
Decoding the Tweet _ Practical Criticism in the Age of Hashtag.pptxDecoding the Tweet _ Practical Criticism in the Age of Hashtag.pptx
Decoding the Tweet _ Practical Criticism in the Age of Hashtag.pptxDhatriParmar
 
Team Lead Succeed – Helping you and your team achieve high-performance teamwo...
Team Lead Succeed – Helping you and your team achieve high-performance teamwo...Team Lead Succeed – Helping you and your team achieve high-performance teamwo...
Team Lead Succeed – Helping you and your team achieve high-performance teamwo...Association for Project Management
 
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnv
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnvESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnv
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnvRicaMaeCastro1
 
4.9.24 School Desegregation in Boston.pptx
4.9.24 School Desegregation in Boston.pptx4.9.24 School Desegregation in Boston.pptx
4.9.24 School Desegregation in Boston.pptxmary850239
 
Grade Three -ELLNA-REVIEWER-ENGLISH.pptx
Grade Three -ELLNA-REVIEWER-ENGLISH.pptxGrade Three -ELLNA-REVIEWER-ENGLISH.pptx
Grade Three -ELLNA-REVIEWER-ENGLISH.pptxkarenfajardo43
 
Objectives n learning outcoms - MD 20240404.pptx
Objectives n learning outcoms - MD 20240404.pptxObjectives n learning outcoms - MD 20240404.pptx
Objectives n learning outcoms - MD 20240404.pptxMadhavi Dharankar
 
6 ways Samsung’s Interactive Display powered by Android changes the classroom
6 ways Samsung’s Interactive Display powered by Android changes the classroom6 ways Samsung’s Interactive Display powered by Android changes the classroom
6 ways Samsung’s Interactive Display powered by Android changes the classroomSamsung Business USA
 
Employablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptxEmployablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptxryandux83rd
 
Indexing Structures in Database Management system.pdf
Indexing Structures in Database Management system.pdfIndexing Structures in Database Management system.pdf
Indexing Structures in Database Management system.pdfChristalin Nelson
 
How to Uninstall a Module in Odoo 17 Using Command Line
How to Uninstall a Module in Odoo 17 Using Command LineHow to Uninstall a Module in Odoo 17 Using Command Line
How to Uninstall a Module in Odoo 17 Using Command LineCeline George
 

Recently uploaded (20)

Decoding the Tweet _ Practical Criticism in the Age of Hashtag.pptx
Decoding the Tweet _ Practical Criticism in the Age of Hashtag.pptxDecoding the Tweet _ Practical Criticism in the Age of Hashtag.pptx
Decoding the Tweet _ Practical Criticism in the Age of Hashtag.pptx
 
INCLUSIVE EDUCATION PRACTICES FOR TEACHERS AND TRAINERS.pptx
INCLUSIVE EDUCATION PRACTICES FOR TEACHERS AND TRAINERS.pptxINCLUSIVE EDUCATION PRACTICES FOR TEACHERS AND TRAINERS.pptx
INCLUSIVE EDUCATION PRACTICES FOR TEACHERS AND TRAINERS.pptx
 
Mattingly "AI & Prompt Design" - Introduction to Machine Learning"
Mattingly "AI & Prompt Design" - Introduction to Machine Learning"Mattingly "AI & Prompt Design" - Introduction to Machine Learning"
Mattingly "AI & Prompt Design" - Introduction to Machine Learning"
 
Team Lead Succeed – Helping you and your team achieve high-performance teamwo...
Team Lead Succeed – Helping you and your team achieve high-performance teamwo...Team Lead Succeed – Helping you and your team achieve high-performance teamwo...
Team Lead Succeed – Helping you and your team achieve high-performance teamwo...
 
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnv
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnvESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnv
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnv
 
4.9.24 School Desegregation in Boston.pptx
4.9.24 School Desegregation in Boston.pptx4.9.24 School Desegregation in Boston.pptx
4.9.24 School Desegregation in Boston.pptx
 
Introduction to Research ,Need for research, Need for design of Experiments, ...
Introduction to Research ,Need for research, Need for design of Experiments, ...Introduction to Research ,Need for research, Need for design of Experiments, ...
Introduction to Research ,Need for research, Need for design of Experiments, ...
 
Paradigm shift in nursing research by RS MEHTA
Paradigm shift in nursing research by RS MEHTAParadigm shift in nursing research by RS MEHTA
Paradigm shift in nursing research by RS MEHTA
 
Grade Three -ELLNA-REVIEWER-ENGLISH.pptx
Grade Three -ELLNA-REVIEWER-ENGLISH.pptxGrade Three -ELLNA-REVIEWER-ENGLISH.pptx
Grade Three -ELLNA-REVIEWER-ENGLISH.pptx
 
Objectives n learning outcoms - MD 20240404.pptx
Objectives n learning outcoms - MD 20240404.pptxObjectives n learning outcoms - MD 20240404.pptx
Objectives n learning outcoms - MD 20240404.pptx
 
6 ways Samsung’s Interactive Display powered by Android changes the classroom
6 ways Samsung’s Interactive Display powered by Android changes the classroom6 ways Samsung’s Interactive Display powered by Android changes the classroom
6 ways Samsung’s Interactive Display powered by Android changes the classroom
 
Employablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptxEmployablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptx
 
Indexing Structures in Database Management system.pdf
Indexing Structures in Database Management system.pdfIndexing Structures in Database Management system.pdf
Indexing Structures in Database Management system.pdf
 
Faculty Profile prashantha K EEE dept Sri Sairam college of Engineering
Faculty Profile prashantha K EEE dept Sri Sairam college of EngineeringFaculty Profile prashantha K EEE dept Sri Sairam college of Engineering
Faculty Profile prashantha K EEE dept Sri Sairam college of Engineering
 
Plagiarism,forms,understand about plagiarism,avoid plagiarism,key significanc...
Plagiarism,forms,understand about plagiarism,avoid plagiarism,key significanc...Plagiarism,forms,understand about plagiarism,avoid plagiarism,key significanc...
Plagiarism,forms,understand about plagiarism,avoid plagiarism,key significanc...
 
Chi-Square Test Non Parametric Test Categorical Variable
Chi-Square Test Non Parametric Test Categorical VariableChi-Square Test Non Parametric Test Categorical Variable
Chi-Square Test Non Parametric Test Categorical Variable
 
Mattingly "AI & Prompt Design: Large Language Models"
Mattingly "AI & Prompt Design: Large Language Models"Mattingly "AI & Prompt Design: Large Language Models"
Mattingly "AI & Prompt Design: Large Language Models"
 
How to Uninstall a Module in Odoo 17 Using Command Line
How to Uninstall a Module in Odoo 17 Using Command LineHow to Uninstall a Module in Odoo 17 Using Command Line
How to Uninstall a Module in Odoo 17 Using Command Line
 
prashanth updated resume 2024 for Teaching Profession
prashanth updated resume 2024 for Teaching Professionprashanth updated resume 2024 for Teaching Profession
prashanth updated resume 2024 for Teaching Profession
 
Spearman's correlation,Formula,Advantages,
Spearman's correlation,Formula,Advantages,Spearman's correlation,Formula,Advantages,
Spearman's correlation,Formula,Advantages,
 

Ortho assessment for physiotherapist

  • 1. ORTHOPAEDIC ASSESSMENT (SOAP notes: subjective ,objective , assessment and plan ) Subjective assessment Name: Age: Sex: Occupation: Address: OPD NO / IPD NO: DOE; Dominant side: Chief complaint: HISTORY Present history Date of onset of injury: Mechanism of injury:  Road side accident  Direct injury  Indirect injury  Bending / twisting injury  Rotational injury Mode of onset:  Sudden  Gradual  Insidious  Periodic
  • 2. Duration : that help to determine the condition  Acute: present since 7 to 10 days  Sub acute : present since 10 days to 7 weeks  Chronic: present for longer than 7 weeks Condition:  Improved  Stationary  Worsen Current treatment: Pain assessment Site: Side; Type: nerve pain, muscle pain etc. Different type of pain and related structure TYPES OF PAIN STRUCTURE Cramping, dull aching Muscle Dull aching Ligament, joint capsule Sharp shooting Nerve root Sharp bright , lightening - like Nerve Burning pressure like , stinging , aching Sympathetic nerve
  • 3. Deep nagging, dull Bone Sharp severe, intolerable Fracture Throbbing, diffuse Vasculature Frequency: Nature: constant / periodic / episodic Pain aggravating factor & pain relieving factor: Intensity: Intensity of pain can be assessed with the help of VAS (visual analogue scale) or numerical rating scale . VAS: Numerical rating scale: Past medical history Relevant previous medical problem to present condition History of other disease & injuries Operation & hospitalization Medication
  • 4. Personal history Personal habits:  Sleeping habits  Tobacco: duration, frequency, amount  Cigarette smoking: duration, frequency, amount  Alcohol: duration, frequency , amount PHYSICAL ACTIVITIES:  Occupational  Recreational  Exercises  Other Family history Similar problem in relatives Hereditary diseases Consanguinity Social history Social status: Educational status: Environmental history Environment of home Environment of work place FUNCTIONAL HISTORY  Previous
  • 5.  Current Objective assessment SENSORIUM:  Alert: awake and attentive to normal stimulation  Lethargic: drowsy, may fall asleep if not stimulated  Stupor: responds only to strong, noxious stimuli , returns to unconscious state  Coma: can not be aroused AMBULATORY STATUS: Note patient’s mode of locomotion such as on wheel chair, ambulatory with or without assistive device, bedridden, etc. General condition of patient: poor / good / medium Body Built:  ectomorphic :: thin prominence of structure from ectoderm  mesomorphic : muscular , prominence of structure from mesoderm  endomorphic : heavy , fat body built , prominence of structures from endoderm Posture (Attitude of limbs) :  Standing, sitting , lateral views  Anterior, posterior and lateral view  The posture should be taken from maximum possible position  Deviations at diff region should be checked
  • 6. Assessment of posture in saggital plane (normal) Frontal plane analysis anterior view
  • 7. Posterior view Deformity  Congenital anomalies – such as CTEV  Acquired deformity – fixed flexion deformity , knock knes , bow leg etc External appliances  functional aids including walking aids , catheters etc .  protective aids such as orthotic and prosthesis Gait analysis OBSERVATION- • Perform a general overview of patients posture • Observe walking at normal speed ,then slow and fast speed • The examiner must watch the lumbar spine ,pelvis ,hips ,knees ,feet and ankle during walking • Patient should walk bare foot. • Also examine the pt. Walking with and without aids.
  • 8. OBSERVATION IN ANTERIOR VIEW The examiner should note-  Any lateral tilt of pelvis  Sideways swinging of trunk  Rotation of pelvis  Movements of hip  Ankle and foot movements-amount of toe out and toe in  Note bowing of femur on tibia  This view is best used to examine the wt. Loading period of gait cycle.  Note any abduction or circumduction of swing leg  Any atrophy of musculature of ant. Thigh and leg  Width of base OBSERVATION IN LATERAL VIEW • Rotation of shoulder and thorax • Reciprocal swing • Spinal posture • Pelvic rotation • Movements at jts .of lower limb • Step length ,stride length, cadence • Check adequate knee extension and flexion at phases of stance and swing phase. • Any hyperextension of knee
  • 9. • Check coordination • Gait parameters. FOOTWEAR • Patient asked to walk in normal footwear as well as in barefoot • Observe patients footwear • Observe wearing down of heels and socks • Condition of shoe uppers and creases • Examine the feet for callus formation , blisters ,corns and bunions • Different shoes can modify a patients gait and amount of energy necessary to perform gait. PATHOLOGICAL GAIT  Antalgic gait  Ataxic gait  Calcaneal gait  Circumductory gait  Hand to knee gait  High stepping gait  Lordotic gait  Scissoring gait  Trendlenburd gait  Valgus gait  Waddling gait TROPHYC CHANGES / SURGICAL SCAR Trophical or skin vhnges like texture , bruising , color and presence of scar , wounds or pressuresores etc .
  • 10. ON PALPATION: Tenderness: A state in which pain is felt on the release of pressure over a part Grading tenderness when palpating Grade 1 – patient complains of pain Grade 2 – patient complains of pain and winces Grade 3 – patient winces and withdraws the joint Grade 4 – patient will not allow palpation of the joint TONE : flabby(hypotonia , wasting) ;hard (hypertonia) Crepitation : crepitus is palpable cruching sensation present throughout the movement of the involved joint or enthesis structure .  Fine crepitus – may be audible only by stethoscope & it is not transmitted through the adjacent bone . fine crepitus may accompany inflammation of the tendon sheath  Course crepitus – it may be audible at a distance & is palpable through the bone . coarse crepitus usually affects cartilage or bone damage . Ligamentus snaps – it is usually single, loud & painless o Cracking by joint distraction : it is common at the finger joints & is cause by production of an intra-articular gas bubble (such cracking can not be repeated until the bubble reformed) Capillary filling : nail filling test
  • 11. Nodules Pulses Scar : heal / non heal / length EDEMA : edema is an abnormal accumulation of fluid in the intercellular spaces : pitting /non pitting Swelling : it is abnormal enlargement of a body part  It may be as the result of bone thickening , synovial membrane hickening or fluid accumulation in and around the joint .  It may be extracellular or intacellular ,intracapsular or extracapsular  Characteristic of swelling :  Comes soon after injury – blood  Comes on after 8 to 24 hrs – synovial  Boggy , spongy feeling – synovial  Harder , tense feeling with warmth – blood  Tough , dry - callus ON EXAMINATION: Vital signs Heart rate : 60 – 100 b/m Blood pressure : 120 / 70 mmhg Temperature : 36.5 -37.5’c Respiratory rate : 12 -16 c/m MOTOR EXAMINATION: RANGE OF MOTION (ROM) Active : when and where pain starts
  • 12. : whether movement increases pain : pattern of movement : trick movements limitation of AROM may indicate affection of either contractile or non- contractile tissue or both,further testing should perform to isolate the cause . Passive : when and where pain starts : difference between range of motion available : end feel ( END-FEEL : the type of structure which limits a ROM has a characteristic feel that may be detected by the examiner who is performing passive ROM , this feeling which is experienced by an examiner as a barrier to further motion at the end of passive ROM is called END-FEEL) MOVEMENT END FEEL ROM Shoulder flexion Firm 0 - 180 Shoulder extension Firm 180 – 0 -60
  • 13. Shoulder abduction and adduction Firm 0 – 180 And 180 - 0 Shoulder medial rotation & Lateral rotation Firm 0 – 70 0 - 90 Wrist flexion & extension 0 – 150 Soft
  • 14. 150 - 0 hard Forearm supination & pronation Firm Hard 0 – 80 0 – 80 Wrist flexion & extension 0 – 80 0 – 70 Firm Hard (or firm) Wrist radial deviation & Hard 0 – 20
  • 15. ulnar deviation Firm 0 - 30 Hip flexion Soft (firm) 0 – 120 Hip extension Firm 0 - 20 Hip abduction Firm 0 - 45 Hip adduction Firm 0 – 30 Hip internal & external rotation Firm O – 45 Knee flexion & extension Firm Hard 0 – 150 150 – 0 Ankle dorsiflexion Firm 0 - 20 Ankle planterflexion Firm (or hard) O – 50 Ankle eversion Firm O - 15 Ankle inversion Firm 0 – 35 MMT OF MUSCLES GRADE VALUE MOVEMENT GRADE 5+ Normal (100%) Complete ROM against gravity with maximal resistance
  • 16. 4 Good (75%) Complete ROM against gravity with some (moderate) resistance 3+ Fair + Complete ROM against gravity with minimal resistance 3 Fair(50 %) Complete ROM against gravity 3- Fair - Some but not complete ROM against gravity 2+ Poor + Initiates motions against gravity 2 Poor (25 %) Complete ROM with gravity eliminated 2- Poor - Initiates motion if gravity is eliminated 1 Trace Evidence of slight contractility but no joint motion 0 Zero No contraction palpeted JOINT PLAY MOVEMENT Also known as assesory joint motion CAPSULAR PATERN : pattern of limitation or restriction . Loose packed position : it is the position in which there is minimal congruency b/w the articular surface and the joint capsule with the
  • 17. ligament being in position of greatest laxity and passive separation of joint surfaces being greatest . Close packed position : in this position the two joint surfaces fit together precisely (fully congruent) ligament and capsules of the joint are maximally tight .
  • 18.
  • 19. SENSORY ASSESSMENT Superficial sensations  Pain  Temperature  Light touch  pressure Deep sensations  Propioception  Kinesthesia  Vibration Cortical sensation  Graphesthesia  Sterognosis  Tactile localization  2 point discrimination MRC GRADING S0 : no sensation S1 : deep proprioception S2: skin touch , pain , thermal sensation S3 : s2 with accurate localization but deficient sterognosis , cold sensitivity , hypersensitivity often present S3+ : object and texture recognization but not normal sensation , good but not normal two point discrimination S4 : normal sensation
  • 20. REFLEXES Grading of reflexes 0 : absent 1 : diminished 2 : normal 3 : brisk 4 : exaggerated Superficial reflexes o Corneal o Abdominal o Planter o cremastetic Deep tendon reflexes o Jaw (cranial nerve V) o Biceps (c5 – c6)
  • 21. o Brachioradialis (c5 – c6) o Triceps (C7 – C8) o Patella (L3 – L4 ) o Medial hamstring (L5,S1) o Lateral hamstring (S1 – S2) o Tibialis posterior(L4 – L5) o Achilles (S1 –S2) Dermatomes The sensory distribution of each nerve root is called dermatome . “ a dermatome is defined as the area of skin supplied by a single nerve root ”
  • 22. MYOTOMES : group of muscles supplied by a single nerve root In the testing of myotome each contraction is held for minimum 5 seconds to see weather the weakness becomes evident .
  • 23. Limb length measurement:  True limb length measurement : that is from ASIS to medial malleolus  Apperent limb length measurement : umbilical to medial malleoli  Functional leg length discrepancy : usually as a result of muscular weakness or inflexibility at the pelvis or foot and ankle GIRTH MEASUREMENTS : circumference of body parts is refferedto as girth. GAIT ANALYSIS o step length : 72 cm o stride length : 144 cm o step width : 5 to 10 cm o cadence : 90 to 120 steps per minute o other
  • 24. FUNCTIONAL EVALUATION FUNCTIONAL EVALUATION OF UPPERLIMB o dressing o combing o washing o eating o toilationg o other FUNCTIONAL EVALUATION OF LOWERLIMB o stair climbing o cycling I
  • 25.
  • 26. INVESTIGATIONS  X-RAY  CT scan  MRI scan  Bone scan  Angiography  Myelogram  Electro - diagnostic study Pathological findings Radiological findings Diagnostic imaging :  to confirm a diagnosis  to establish a diagnosis  to determine severity of a disease  to determine progression of a disease  to determine stage of healing  to enhance pt treatment  to determine anatomical alignment SPECIAL TESTS DIFFERENCIAL DIAGNOSIS DIAGNOSIS PHYSIOTHERAPY AIMS  to relieve pain  to increase ROM  to correct the deformity  to relieve stiffness
  • 27.  to improve muscle power and strength  to improve muscle endurance  to maintain tissue extensibility  to correct posture  to correct balance  to train for walking aids  gait training  other SHORT TERM GOALS LONG TERM GOALS PHYSIOTHERAPY PLAN HOME EXERCISE PROGRAM ERGONOMICS Treatment:
  • 28.
  • 29. By: Dr. Sandhya dhokia