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DIAGNOSIS IN

ORTHOPAEDIC
S
DYNAMIC ACTIVITY OF CELL

GROSS LESSION
-CLINICAL TISSUE REACTION
-RADIOGRAPHIC PATHOLOGICAL PROCESS
-LABORATORY

RATIONALE OR REASON
DIAGNOSTIC FOR TREATMENT

PATIENT
ORTHOPAEDIC IS
CONCERN WITH:
BONES
JOINTS
MUSCLES
TENDONS
NERVES
VASCULARS
CONDITIONS THAT AFFECT THE
MUSCULOSCLETAL SYSTEM :
CONGENITAL AND DEVELOPMENT
ABNORMALITY
INFECTION AND INFLAMMATION
ARTHRITIS AND RHEUMATIC DISORDERS
METABOLIC DYSFUNCTION AND
DEGENERATION
TUMOURS AND LESIONS THAT MIMIC THEM
SENSORY DISTURBANCE AND MUSCLE
WEAKNESS
INJURY AND MECHANICAL DERANGEMENT
DIAGNOSIS IN
ORTHOPAEDICS
1. HISTORY
2. EXAMINATION
3. DIAGNOSTIC IMAGING
4. BLOOD TESTS
5. SYNOVIAL FLUID ANALYSIS
6. BONE BIOPSY
7. ARTHROSCOPY
8. ELECTRODIAGNOSIS
HISTORY
a. SYMPTOMS (PRESENT HYSTORY)
b. PAST HISTORY
c. FAMILY HISTORY
d. SOCIAL BACKGROUND
HISTORY
SYMPTOMS (PRESENT HYSTORY)
ONSET
LOCATION
CHRONOLOGIC
QUALITY
QUANTITY
INFLUENCE FACTORS
CONCOMITANT SYMPTOMS
SYMPTOMS
OF MUSCULOSCLETAL
SYSTEM
LOOK WRONG:
SWELLING
DEFORMITY
FEEL WRONG:
PAIN
CHANGE IN SENSIBILITY
MOVE WRONG:
STIFFNESS
WEAKNESS
INSTABILITY
LOSS OF FUNCTION
PAIN
PAIN FROM DAMMAGED TISSUE
REFFERT PAIN
AUTONOMIC PAIN
PAIN
GRADE I MILD :PAIN THAT CAN EASILIY BE
IGNORE
GRADE II MODERATE : PAIN THAT CANNOT
BE IGNORED, INTERFERS WITH
FUNCTION AND NEEDS TREATMENT
FROM TIME TO TIME
GRADE III SEVERE : PAIN THAT IS PRESENT
MOST OF THE TIME, DEMANDING
CONSTANT ATTENTION
GRADE IV TOTALLY INCAPACITATING PAIN
EXAMINATION

a. GAIT AND LIMP


b. EXAMINATION OF THE EFFECTED
PARTS
c. NEUROLOGICAL EXAMINATION
GAIT AND LIMP

HEEL STRIKE
STANCE PHASE
TOE OFF
SWING PHASE
EXAMINATION OF
THE EFFECTED
LOOK
SKIN
SHAPE
POSISITION
FEEL
SKIN
SOFT TISSUE
BONES AND JOINT
TENDERNESS
MOVE
ACTIVE
PASSIVE
ABNORMAL
LOOK
SKIN
SHAPE
POSISITION
EXAMINATION OF THE
EFFECTED
DEFORMITY
JOINT DEFORMITY
BONE DEFORMITY
DEFORMITY

VARUS AND VALGUS


KHYPOSIS AND LORDOSIS
SCOLIOSIS
FIXED DEFORMITY
POSTURAL DEFORMITY
Pathophysiogy OF
JOINT DEFORMITY
CONTRACTURE OF THE OVERLYING
SOFT TISSUES
MUSCLE IMBALANCE
CHRONIC ARTHRITIS
SIX CAUSES OF JOINT
DEFORMITY
SKIN CONTRACTURE
FASCIAL CONTRACTURE
MUSCLE CONTRACTURE
MUSCLE IMBALANCE
JOINT INSTABILITY
JOINT DESTRUCTION
SIX CAUSES OF BONE
DEFORMITY
CONGENITAL DISORDERS
BONE SOFTENING
DYSPLASIA
GROWTH PLATE INJURY
FRACTURE MALUNION
PAGETS DISEASE
FEEL
THE SKIN
SOFT TISSUE
BONE AND JOINTS
TENDERNESS
IN BONY LUMPS FIND
SITE
SIZE
MARGIN
CONSISTENCY
TENDERNESS
MULTIPLICITY
MOVE
ACTIVE
PASSIVE
ABNORMAL
NORMAL MOVEMENT
FLEXION/EXTENSION
ADDUCTION/ABDUCTION
EXTERNAL ROTATION/INTERNAL
ROTATION
PRONATION/SUPINATION
CIRCUMDUCTION
JOINT STIFFNESS
ALL MOVEMENTS ABSENT
ALL MOVEMENTS LIMITED
SOME MOVEMENTS LIMITED

REMEMBER RANGE
OF MOTION
JOINT LAXITY
IN CHILDREN MORE MOBILE
PERSISTENCT GENERALIZED JOINT
HYPERMOBILITY
DISEASE
SOFT TISSUE DISORDERS
NEUROLOGICAL
EXAMINATION
GENERAL APEARANCE
ASSESING MOTOR FUNCTION
ASSESING SENSORY FUNCTION
NEUROLOGICAL EXAMINATION

APPEARANCE
TONE AND POWER
POWER ( 0 - 5 )
TENDON REFLEXES
SUPERFICIAL REFLEXES
THE PLANTAR REFLEX
SENSIBILITY
CORTICAL AND CELEBELLAR FUNCTION
SENSIBILITY
HYPERAESTHESIA
HYPOAESTHESIA
ANAESTHESIA
TEMPERATUR RECOGNATION
TWO POINT DISCRIMINATION
VIBRATION TEST POSITIONING
SENSESENSE OF JOINT POSTURE
STEREOGNOSIS
THE SENSE OF BALLANCE
DIAGNOSTIC
IMAGING
a. PLAIN FILM RADIOGRAPHY
b. X-RAYS USING CONTRAST MEDIA
c. XERORADIOGRAPHY
d. TOMOGRAPHY
DIAGNOSTIC
IMAGING
e. COMPUTED TOMOGRAPHY (CT)
f. MAGNESTIC RESONANCE IMAGING
(MRI)
g. DIAGNOSTING ULTRASOUND
h. RADIONUCLIDE IMAGING
PLAIN FILM
RADIOGRAPHY
HOW TO READ AN X-
RAY
THE PATIENT/IDENTITY
THE SOFT TISSUES
SHAPE
DENSITY
THE BONES
SHAPE
DENSITY
ARCHITECTURE:PERIOSTEAL,CORTEX,ENDOSTEUM
THE JOINT
DIAGNOSTIC ASSOCIATIONS
X-RAYS USING CONTRAST
MEDIA

SINOGRAPHY
ARTHROGRAPHY
MYELOGRAPHY
XERORADIOGRAPHY
COMPUTED
TOMOGRAPHY (CT)
MAGNESTIC
RESONANCE
IMAGING (MRI)
DIAGNOSTIC
ULTRASOUND
RADIONUCLIDE IMAGING

BONE-SEEKING ISOTOPES
OTHER RADIONUCLIDE COMPOUNDS
BONE-SEEKING ISOTOPES
99M
TcHDP
INCREASED ACTIVITY IN THE
PERFUSION PHASE
DECREASED ACTIVITY IN THE
PERFUSION PHASE
INCREASED ACTIVITY IN THE BONE
PHASE
DIMINISHED ACTIVITY IN THE BONE
PHASE
OTHER RADIONUCLIDE
COMPOUNDS
TECHNETIUM-LABELLED SULPHUR
COLLOID
GALLIUM-67
INDIUM-111-LABELLED LUCOCYTES
BLOOD TESTS
a. NON-SPECIFIC BLOOD TESTS
b. RHEUMATOID FACTOR TESTS
c. TISSUE TYPING
d. BIOCHEMISTRY
NON-SPECIFIC BLOOD
TESTS
NON-SPECIFIC BLOOD ABNORMALITIES
HYPOCHROMIC ANAEMIA
LEUCOCYTOSIS
ERYTHROCYTE SEDIMENTATION RATE
(ESR)
C-REACTIVE PROTEIN
PLASMA GAMMA-GLOBULINS
SYNOVIAL FLUID
ANALYSIS
ACUTE JOINT SWELLING AFTER
INJURY
SUSPECTED INFECTION
ACUTE SYNOVITIS IN ADULTS
CHRONIC SYNOVITIS
SYNOVIAL FLUID
ANALYSIS
a. TECHNIQUE
b. GROSS EXAMINATION
c. MICROSCOPIC EXAMINATION
d. LABORATORY TEST
BONE BIOPSY

a. OPEN OR CLOSED
b. PRECAUTIONS
ARTHROSCOPY

a. TECHNIQUE
b. DIAGNOSIS
c. COMPLICATIONS
ELECTRODIAGNOSIS

a. MOTOR NERVE CONDUCTION


b. SENSORY CONDUCTION
c. ELECTROMYOGRAPHY
d. INTERPRETATION AND DIAGNOSIS
INTERPRETATION

DATA/PROBLEM
HYPOTHESIS/DD
MECHANISM
MORE INFORMATION
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