Examination in
Orthpaedy and
Traumatology
Examination in
Orthpaedy and
Traumatology
Clinical examination of
patients
SUBJECTIVE
OBJECTIVE
subjective examination
I/ The first look
Indicatory qualify of general patient`s state, his bearing, gait
II/ Evidence
age, proffesion, job, home
III/ Taking a history
1. Caus of enter
2. The main compleints
3. Początek i przebieg choroby Beginning and course of disease
4. Examination in course of:
a) etiology
b) pathogenesis
c) pathology
(cause of disease – posttraumatic, inflammatory, degeneration,
neoplasmatical, congenital and groving causes, systemic diseases and endocrine
organs, neural, static [overload] and another)
d) previous treatment
e) pass diseases ( for ex. infections)
f) complete exam. : heredity, advencement, case of living and
working, intellectual set, education, job, environment
subjective examination
IV/ General state
1) Biological and calendar age
* increase
* weight
* body proportions: tables f.ex. Stratz, Geyor, Kollmen
* physical and psychical dexternity – coordination
* sceletal age
2) Nutrition
3) Functional state of internal systems and
their
influence for moving system
4) State of internal organs
5) Neurological state
Status neurologici
head – neck – trunk – limbs: upper i lower
1)
moving: passive/active
2)
muscular tention
3)
contractions
4)
paresis
5)
paralysis
6)
reflexes
7)
moving
head
incranial syndroms
subiective
headache,
pain of neck,
nausea,
vomiting,
photofobia,
sensitiveness,
pain.
obiective
neck stiffness,
Kernig symptom upper and down
Brodzinsky symptom: cervical and
pubic,
Flaetau symptom
spine
trunk
top symptom
dermal symptoms
feeling and senses
limbs upper and down
paresis
Lovet scale of muscular`s strenght
symmetry
moving
paralysis
Erb – high C5-6 – hand OK
Klumpke – low C8-Th11
upper limbs
C5-Th2 – brachial plexus
radial – C7-8
ulnar – C5-6
biceps C5-6
triceps C6-7
lower limbs
knee L2-4
Achilles tendon S1-2
flexors L5-S1
Lovett scale of muscular
strenght
0 no motion
1 spasm mm without motion effect
2 motion without subdue gravity
3 motion with subdue gravity
4 motion against withstand
5 full range of moving
subiective clinical exam.
V/ STATUS ORTHOPAEDICUS
seeing / measurement / touching with percussion
We examine patient in standing and lying
position
Status orthopaedicus
1) General
1. static:
standing patient:
construction (type); pose,
posture
lying patient:
proportions; symmetry; arrangement
( passive, active, free, compulsory)
2. dynamic:
moving, walk
Status orthopaedicus
2) Ordinal
1. static:
account each segments on the one side and
another side,
set-up, measurement lenght and
circumference of the limbs
2. dynamic:
moving
measurement
circumference of the limbs
upper
shoulder
½ arm
elbow
forearm
wrist
hand
lower
½ pelvis equal trochanter maior (m. gluteus max)
thigh – 20 cm under kneeicap (mm, tumors, inflammation)
thigh – 5 cm under patella ( m. vestus medialis)
knee
shank
under ankle
step joint
measurement lenght
upper limbs - P : L
relational
From apex of processus acromialis to the end of III
finger
inexorable
From tuberculus maioris humeri to the end of III
finger
measurement lenght
lower limbs
relational
From spina iliaca anterior superior(sias) to ankle medial or
lateral
inexorable
From trochanter maior to ankle medial or lateral
Status orthopaedicus
3)
Local
1. static
contour, shape, skin,subcutaneous tissue, muscles, mięśnie,
tendons,
joints and another, setting, malformatiobns, strenght of
muscles,
anatomical
proportions,
color,
nutrition,
temperature, pain, pulse
2. dynamic
moving, specific diagnostic of joints diseases
Examination of joints : contours, anatomical proportions, callusses,
exudation, pain, moving circumscription, another ( leaping, trustles,
pathological moving, tenuousness
, ballot, and another)
additional studys
routine
technical
diagnostic intervention
recognition
plane of treatment