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