Ortho history taking final med

1. Orthopaedic History and Examination
General Tips and Guidelines

2. • General Tips
– Wash hands
– Introduction / seek permission
– Focused History
– Examination (Patient positioning & exposure)
– Differentials
– Imaging
– Investigations
– Final Diagnosis and Management

3. • Orthopaedic History Taking
– Pain
– Loss of function
– Swelling
– Stiffness
– Deformity
– (Establish the chronicity of symptoms)

4. • Orthopaedic History Taking
– Age
– Location of symptoms
– Unilateral (OA) vs. Bilateral (RA)
– Polyarthropathy
– PMH
– Previous history of trauma (predisposes to OA)
– Arthritides
– Previous joint surgery
– Childhood: Developmental Dysplasia of the Hip

5. • Orthopaedic Examinations
– LOOK
– FEEL
– MOVE
– GAIT
– MEASURE
– SPECIAL TESTS

6. • Orthopaedic Examinations
• Always Compare with contra lateral joint
• Upper Limb:
– Functional Assessment
– Cervical Spine
• Lower Limb:
– Gait
– Walking aids
– Thoracolumbar Spine

7. • Finally:
– Assess the neurovascular status of the limb
– Examine the joint above and joint below
– Imaging
– Other investigations (ESR, Rh factor)

8. • Pain
– Most common hip / knee symptom
– Site / Radiation
– Remember referred pain
– Hip pain felt in groin / anterior thigh / knee
– Hip pain may originate from lumbar spine pathology
– Severity (Night pain!) / type of analgesic required
– Frequency & association
– Early morning pain (commonly inflammatory origin)

9. • Loss of function
– Impact on activities of daily living (especially Hands)
– Use of stairs
– Mobility (walking aids)
– Occupation
– Social / sporting activities
– Sleep
– Psychological well being

10. • Swelling
– Unilateral vs. Bilateral
– Time of onset
– ACL vs. Meniscal injuries ( immediate vs. delayed
effusion)
– Relation to activity level (worse with OA)

11. • Stiffness
– More marked in RA
– Early morning
– Takes longer to diminish
– Hip: Ability to get in/out of bath, care for feet
– Upper limb: Feeding / washing / grooming
– Knees: ?Locking (meniscal injury)

12. • Deformity
– Chronicity
– Acute: Tendon ruptures e.g. rheumatoid hands
– Chronic: Often degenerative
– Causes:
• Ligament / tendon rupture
• Muscle contracture / paralysis
• Mechanical (Torn meniscus in locked knee)
– Pain

13. • Orthopaedic History Taking
– Medication:
• Analgesics
• NSAIDS, steroids or disease modifying drugs
– Social Hx: Occupation / hobbies / sports
– Other:
– Walking aids
– Effect of symptoms on ADL, sleep and work

14. Exam preparation
• Practice
• Practice
• Practice ….