2. Introductions
• Orthopaedics is a branch which deals with the
musculoskeletal (locomotory) system – tissues
needed to move i.e. Bones, muscles, nerves,
joints, etc
• Ortho – straight
• Pedis –child
4. Amplification
a) Pain – characteristic
- Stabbing
- Cutting
- Burning
- Throbbing
- Colicky
- Gnawing (characteristic of tumors)
- Dull
• Does the pain radiate?
• What was the onset of the pain - Insidious or sudden?
• Is the pain progressive i.e. Does the severity increase with
time?
5. • Is the pain intermittent, periodic or constant?
– What is the duration between episodes of pain?
– Is the duration between periodicity of pain
increasing/decreasing?
• Is the pain mild, moderate, severe, unbearably
severe?
• What are the exacerbating factors?
• What are the relieving factors?
• What position causes discomfort?
• What affects the severity of the pain?
• Does any medication affect the severity of the
pain?
6. • Is the pain associated with fever?
• Is the pain associated with any neurological
disorders e.g. Numbness?
• Is the pain associated with any other changes
e.g. Swelling, ulceration, discharge?
• Does the appearance of the swelling
increase/decrease the pain?
• Does the pain interfere with daily activities?
How much?
• Is there any loss of function?
7. b) Loss of function
- Onset?
- Traumatic/non-traumatic?
- What function has been lost?
- Is the loss of function intermittent or
permanent?
- Are there factors which affect the functioning
of the particular site/limb?
- Are there any exacerbating/relieving factors?
8. c) Swelling
- Relation of the swelling to pain? Was the swelling
preceding by the pain? Or came afterwards? E.g.
In osteosarcoma, the pain is felt by the patient a
month before swelling appears, where is
abscesses the swelling precedes the pain
- Has it caused any loss of function?
- Is the swelling associated with fever or any other
systemic symptoms e.g. loss of appetite, loss of
weight.
- Any history of sinus formation?
9. • Any history of discharge? Purulent/
haemorrhagic?
• Any history of ulceration?
• Are there any other associated symptoms?
• Are there constitutional symptoms?
• History of changes/difficulties in other
systems? E.g. GIT, RS, GUT?
• Any investigation/treatment done?
10. d) Deformity
- Congenital or acquired?
If Acquired:
- How did it happen?
- Onset? Slowly occurring progressive deformity
v/s sudden traumatic deformity?
- Is the deformity progressive?
- How much does the deformity affect daily
activities?
- Does he need any aid? Walking aid/wheelchair?
- Have any correcting measures been attempted?
- Is there a family history of the same problem?
11. Family and social history
• Living conditions
• Number of dependants?
• Depending on someone else?
• Married? Relatives?
• Occupation?
• Personal habits? Alcohol intake? Cigarette
smoking?
12. Past medical history
• Any long-term medication? E.g. Steroids
• Any surgical procedures?
• Any other medical illnesses? E.g. DM
• Any history of chronic illnesses such as TB
13. Physical Examination
• General survey of the patient:
- Gait – limping?
- Assistance? Walking aid/wheelchair/stretcher/
crutches
- Can the patient stand properly? Shortening on
one side?
- Any obvious deformities of the spine, upper
limb, lower limbs, knee joint, feet?
14. Examination of the knee joint
• Any obvious divergence of the axis of the knee
joint from the normal (7-8o vulgus)
• Bow legs – varus deformities
• Knock knees – vulgus deformities
• Swelling on the knee?
• Skin over the swelling? – color, margins, well-
circumscribed or not? Regular or irregular?
Hypervascularization? Any ulceration, discharge,
sinus?
• Temperature changes?
15. • Maximum area of tenderness
• Consistency of the swelling?
• Margins of the swelling?
• Is the swelling mobile or fixed to the
underlying tissues?
• Does the swelling arise from bone/muscles?
• Examine the joints near the swellings and to
what extent they are affected?
16. Other Examinations
• Examination of lymph nodes
• Examination of liver, spleen, chest
• Perform a full neurological examination i.e.
Examination of the CNS and PNS
Editor's Notes
Excessive long term alcohol can cause skeletal problems such as pathological fractures
Cigarette smoking causes Buerger’s disease
Trendelenburg test – test the abductors of the hip joint
Hypervascularization – characteristic of some tumours