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CLINICAL ORTHOPEDIC EXAMINATION

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					CLINICAL ORTHOPEDIC
EXAMINATION

       ACCURATE EXAMINATION IS BASED ON:

    –    PROPER HISTORY TAKING




    –    CLINICAL EXAMINATION
CLINICAL ORTHOPEDIC
EXAMINATION

       MANAGEMENT PLAN IS BASED ON:

    –    ACURRATE DIAGNOSIS (ANALYSIS OF
         HISTORY & EXAM.)

    –    NEEDED INVESTIGATIONS
Illness History Taking

   Personal data
   Complaint
    –   Pain
    –   Swelling
    –   Deformity
    –   Loss of function
Present hisory

   ONSET
    –   INSTANTANEOUS
    –    INSIDIOUS
   COURSE
    –   PROGRESSIVE
    –   STATIONARY
    –   REGRESSIVE
    –   INTERMITTENT
    –   REMITTANT
ctd

   Duration of illness
   General effects
   Local effects
Local examination

   Inspection
    –   Skin( redness,scar,sinus&dilated veins)

    –   Muscles( wasting,or hypertrophy)

    –   Swelling( 5S)

    –   Deformity(description)
Examination of swelling

   Inspection
    –   Approximate site
    –   Shape
    –   size
    –   Surface
    –   overlying skin
Examination of swelling

   Palpation
    –   Accurate site
    –   accurate shape
    –   Size
    –   Surface
    –   Mobility( Direction and degree)
    –   Edge( well or ill)
    –   Consistency( Soft, Cystic either soft or tense,
        firm or Hard)
Examination of swelling

   Palpation CTD
    –   Overlying pulsation and thrill

    –   Relations to superficial and deep structures

    –   Local effects on the nearby joint
Local examination

   Palpation
    –   Warmness

    –   Tenderness

    –   Confirmation of signs obtained by inspection

    –   Bony landmarks
Local examination

   Movements (Passive & active)

    –   Range

    –   Associated Pain and / or Crepitations

    –   Abnormal movements
Local Examination

   Special examination:

    –   Measurements( length & girth)

    –   Special tests peculiar to the region examined

    –   Nearby regions

    –   Gait
Physical Examination of the Hip and
Pelvis

   BONY PALPATION
    –   Anterior Aspect
            Anterior Superior Iliac Spines
            Iliac Crest
            Iliac Tubercle
            Greater Trochanter
            Pubic Tubercles
Physical Examination of the Hip
and Pelvis
   Posterior Aspect

           Posterior Superior Iliac Spines

           Greater Trochanter

           Ischial Tuberosity

           Sacroiliac Joint (S2)
Physical Examination of the Hip
and Pelvis

   SOFT TISSUE PALPATION

    –   Femoral Triangle

    –   Sciatic Nerve

    –   Hip and Pelvic Muscles
Physical Examination of the Hip
and Pelvis

   RANGE OF MOTION
    –   Active Range of Motion Tests
    –   Passive Range of Motion Tests
    –   Flexion (Thomas Test) -120°
    –   Extension 30°
    –   Abduction 45°-50°
    –   Adduction 20°-30°
    –   Internal Rotation -35°
    –   External Rotation -45°
Physical Examination of the Hip
and Pelvis

 NEUROLOGIC      EXAMINATION

  – Muscle   Testing

  – Sensation   Tests
Physical Examination of the Hip
and Pelvis
   SPECIAL TESTS
    –   Trendelenburg Test

    –   Tests for Leg Length Discrepancy
           True Leg Length Discrepancy
           Apparent Leg Length Discrepancy

    –   Ober Test for Contraction of the Iliotibial Band

    –   Thomas Test for Flexion Contracture
Physical Examination of the Hip
and Pelvis

   Tests for Congenital Dislocation of the Hip
    –   Ortolani Click
    –   Telescoping
    –   Adduction Contracture


   EXAMINATION OF RELATED AREAS
    –    Rectal Examination
    –    PV Examination
PHYSICAL EXAMINATION OF THE
KNEE

   INSPECTION
            Gait
            Shoe and stocking removal
   Bony palpation
    –   Medial aspect
            Tibial plateau(TP)
            Femoral condyle (F.con.)
            Adductor tubercle
PHYSICAL EXAMINATION OF THE
KNEE

   Lateral aspect
    –   T.p
    –   Lateral tubercle
    –   F.con.
    –   F. epicon.
    –   Head of the fibula
    –   Trochlear groove and patella
PHYSICAL EXAMINATION OF THE
KNEE

   Soft tissue palpation
    –   Anterior aspect

    –   Medial aspect

    –   Lateral aspect

    –   Posterior aspect
PHYSICAL EXAMINATION OF THE
KNEE

   Joint stability

    –   Collateral ligaments

    –   Cruciate ligaments
PHYSICAL EXAMINATION OF THE
KNEE

   Range of motion
    –   Active

    –   Passive
            Flexion ----------1350

            Extension -------00

            Int. rotation -----100

            Ext. rotation 100
PHYSICAL EXAMINATION OF THE
KNEE

   Neurological examination
    –   Muscle testing

            Extension

            Flexion

            Internal and external rotation
PHYSICAL EXAMINATION OF THE
KNEE

   Neurological examination

    –   Sensation testing



    –   Reflex
            Patellar reflex: L2,3,4
PHYSICAL EXAMINATION OF THE
KNEE

   Special tests
          McMurray test

          Apply,s test

          Patella femoral grinding test

          Apprehension test

          Knee joint effusion test
PHYSICAL EXAMINATION OF THE
KNEE

   Examination of the related areas

          Hip and lumbar spine



          Ankle joint ( less often)
Physical examination of the foot
and Ankle

   Inspection
    –   Palpation (bony and soft tissue)
           Medial aspect
             –   First metatarsocuniform
             –   Navicular tubercle
             –   Head of the talus
             –   Medial malleolus
             –   Sustantaculum tali & medial tubercle of the talus
Physical examination of the foot
and Ankle

   Palpation (bony and soft tissue)
    –   Lateral aspect
            5 th metatarsal bone
            5 Th metarsophalangeal joint
            Calcaneus
            Peroneous tubercle
            Lateral malleolus
Physical examination of the foot
and Ankle

   Palpation (bony and soft tissue)
    –   Sinus tarsi area
            Dome of the talus
            Inferior tibiofibular joint
    –   Hind foot
            Dome of the calcaneous
            Medial tubercle
    –   Plantar surface
            Sesamoid bones
            Metatarsal heads
Physical examination of the foot
and Ankle

   Range of motion
    –   Active range of motion
    –   Passive range of motion
            Ankle dorsiflexion -------- 20o
            Ankle plantar flexion------50o
            Subtalar eversion----------5o
            Subtalar inversion---------5o
            Forefoot adduction -------20o
            Forefoot abduction--------10o
Physical examination of the foot
and Ankle

   First metatarsophalangeal joint
    –   Flexion------45o

    –   Extension-------70o-90o


   Mototion of the Lesser toes
Physical examination of the foot
and Ankle

   Neurological examination
    –   Muscle testing
            Dorsiflexors
            Plantar flexors
    –   Sensation tests
    –   Reflex tests
            Achilis tendon reflex (S1)
Physical examination of the foot
and Ankle

   Special Tests
    –   Rigid or supple flat foot
    –   Tibial torsion test
    –   Forefoot adduction correction test
    –   Ankle dorsiflexion test
    –   Homans sign
   Examination of the related areas

				
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