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DIAGNOSIS IN

ORTHOPAEDICS
ORTHOPAEDIC IS
CONCERN WITH:
• BONES
• JOINTS
• MUSCLES
• TENDONS
• NERVES
• VASCULARS
CONDITIONS THAT AFFECT THE
MUSCULOSCLETAL SYSTEM :
• CONGENITAL AND DEVELOPMENT ABNORMALITY
• Trauma/INJURY AND MECHANICAL DERANGEMENT
• TUMOURS AND LESIONS THAT MIMIC THEM
• INFECTION AND INFLAMMATION
• Degenerative./ARTHRITIS AND RHEUMATIC DISORDERS
• METABOLIC DYSFUNCTION AND DEGENERATION
• HEMATHOLOGY
• MISCELANIUOS
– SENSORY DISTURBANCE AND MUSCLE WEAKNESS
DIAGNOSIS IN
ORTHOPAEDICS
1. HISTORY
2. PHYSICAL EXAMINATION

CAN BE DIAGNOSED BY HISTORY AND


PHYSICAL EXAMINATION. WE CALL IT
AS A CLINICAL DX. OR DD
INVESTIGATION

1. DIAGNOSTIC IMAGING
2. BLOOD TESTS
3. SYNOVIAL FLUID ANALYSIS
4. BONE BIOPSY
5. ARTHROSCOPY
6. ELECTRODIAGNOSIS
CORRELATE THE FINDING

• HYSTORY
• PHYSICAL EXAMINATION
• DISEASE
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
• PAGET’S 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
TOMOGRAPHY
COMPUTED
TOMOGRAPHY (CT)
MAGNESTIC RESONANCE
IMAGING (MRI)
DIAGNOSTING 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