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