This document provides an overview of orthopaedics and the key components of taking a patient history. It describes the musculoskeletal system and main divisions of orthopaedics, including common diseases and injuries. The importance of systematically and carefully compiling a patient's history is emphasized. Key elements to cover include presenting complaints, symptoms of pain, stiffness, swelling, instability, and deformity. Details on grading and characterizing pain and assessing loss of function are also outlined.

1. History Taking
in
Orthopaedics

2. Orthopaedics:
Ortho – straight
Paedics – children
Musculoskeletal systems
Bones, joints, muscles,
tendons,
ligaments, peripheral
nerves,
blood vessels.
special tissue:–
meniscus, bursa, cartilage
etc.

3. Divisions of Orthopaedics
Trauma Surgery
Spine Surgery
Arthroscopy & Sports Medicine
Hand Surgery
Paediatric Orthopaedics
Joint Replacement (Arthroplasty)
Oncology
Trauma - 80 % (worldwide)
Our setup - 95%

4. Group of Diseases
Congenital & Developmental abnormalities
Infection & inflammation
Arthritis & rheumatic disorders
Metabolic & Endocrine disorders
Tumors & Lesions that mimic them
Sensory disturbance & muscle weakness
Injury & Mechanical derangement

5. History Taking
Patient – story
Doctor constructs – history
history – systematic, carefully, patiently
compiled & informative

6. Points in history taking
• General Information
Age
Sex
Occupation
• Presenting Complaint

7. • Pain
• Stiffness
• Swelling
• Instability
• Deformity
• Limp
• Altered Sensation
• Loss of function
Symptoms

8. Pain
Most Common complain
Grading of pain
I No pain
II Mild, can be ignored
III Moderate, requires treatment
IV Severe, intrusive despite analgesics
V Very severe, inhibits virtually all activities

9. • At the site of the pathology:
Location, duration, progression,
nature, intensity

10. Specific Characters of pain
Sharp shooting pain of back - PIVD
Chronic pain, ↑ activities - Degenerative Changes
Constant boring pain - Infective, neoplastic

11. • Referred pain:
From To
Neck Shoulder
Shoulder Arm
Elbow Forearm, hand
Lumbar Spine Groin
LS Spine Gluteal Region
Hip Thigh, knee, leg
Thigh Knee

12. Autonomic pain:
from autonomic nerves
& accompany peripheral blood vessels
e.g. after operation
Poorly understood, often doubted

13. Stiffness
Symptom of joint involvement
Protective mechanism, spasm around joint
Generalized: Systemic disorder like RA, AS
Localized: to particular joint

14. Swelling
Soft tissue, joint, bone
After trauma, injury or reactive
Rapidly or slowly
Painful or not
Constant or comes and goes
Same size or ↑

15. Instability
C/O Joint giving way
Muscle weakness, ligamentous deficiency & disruption

16. Deformity
Associated with pain & stiffness
c/o knock knees, bowlegs,
Important: Progressive or not
Impaired function or not

17. Limp
Abnormal pattern of ambulation
Involved joint, dysfunctional muscle,
Due to deformity
Progressive or not

18. Altered Sensation
C/O tingling, numbness, burning pain
Nerve involvement
Note progressive
Eg. diabetic neuropathy, radiculopathy, laceration

19. Loss of function
Depends on individual needs
Judged on social, professional,
domestic & recreational demands

20. • Personal history & background
work, travel, recreation, home
circumstances,
support from family & friend
• Family history
genetic disease RA. Communicable
disease TB

21. Past Medical History
previous trauma, injury,
sprain, strain
Systemic Review
LBP : Acute UTI
PID

22. Trauma Patient
General History
A B C
LOC
Spine, Joints, limbs
Previous history of injury