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ORTHOPAEDICS ASSESSMENT
Date: Name: Age: Gender: Occupation: Address: Chief Complaint: History:
Û Present History
3 Allowed to narrate history 3 Date of onset of symptoms 3 Mechanism of injury 3 Mode of onset 3 Condition – Improved, Stationary, Deteriorated 3 Muscular weakness
Û Pain History
3 Duration of symptoms 3 Type of pain 3 Aggravating and Relieving factors
Û Past History
3 Any history of Tuberculosis 3 Bronchial Asthma 3 Blood Pressure 3 Diabetes 3 Cardiac Problems 3 Enquiry made for any accidental injury
Û Family History
3 Hereditary? 3 Consanguinity?
Û Personal History
3 Cigarettes – Number/day How long? 3 Alcoholic – Amount/day Duration
Û Socio-economic History
Û Medical History
3 Present medication patient is on
On Observation:
Û General Condition of patient – Poor, Good, Fair built
Û Wasting
Û Oedema
Û Any bandages, Scars – Area
Extent
Û Attitude of the Limbs – Supine, Sitting, Standing
Type of gait Bony contours Deformities
On Palpation:
Û Tenderness
Grading 1 : Patient complains of pain 2 : Patient complains of pain & winces 3 : Patient winces & withdraws 4 : Patient will not allow palpation of the joint
Û D/F tissue tension and texture
Û Temperature variation of skin
Û Spasm
Û Type of skin – Dry or Excessive moisture
Û Scar – Adherent / Non Adherent
Û Swelling
3 Comes on soon after injury – Blood 3 Comes on after 8 to 24 hours – Synovial 3 Boggy, spongy feeling – Synovial 3 Harder, tense feeling with warmth – Blood 3 Tough, dry – Callus
Joint movements
- Loose packed position
- Close packed position
Û Sensory Assessment
Superficial Sensations
- Pain, Temperature, Light touch, Pressure Deep Sensations
- Movement sense, Position sense Combined Sensations
- Stereognosis, Tactile Localization, Two Point Discrimination, Grapesthesia MRC Grading S0 : No sensation S1 : Deep Proprioception S2 : Skin touch, pain thermal sensation S3 : S2 with accurate localization but deficient stereognosis, cold sensitivity, hypersensitivity often present S3+ : Object and texture recognition but not normal sensation, good but not normal two point discrimination S4 : Normal sensations
Û Reflexes
Superficial Reflexes
- Corneal, Abdominal, Plantar, Cremasteric Deep Reflexes
- Biceps, Triceps, Babinski Reflex, Knee Jerk, Ankle Jerk Clonus Grading 0 : Absent 1 : Diminished 2 : Normal 3 : Brisk 4 : Exaggerated
Û Dermatomes & Myotomes
Û Limb Length Discrepancies
3 Apparent Length 3 True Length
Û Special Tests
Û Functional Assessment
Ambulation - Gait or Wheel Chair
- Independent or Dependent
- Transfers
Û Gait Assessment
3 Type of gait 3 Stride length 3 Step length
Û VAS / NRS Scale
Û ADL
Investigations: Clinical Impression: Differential Diagnosis: Findings to make Final Impression: Final Diagnosis: Goals: 3 Short Term 3 Long Term Treatment Plan: 3 Electric Modalities 3 Manipulation 3 Exercises 3 Splints & Assistive Devices Home Programme:
z Elbow:
h Ligamentous Instability Tests - Lateral & Medial Collateral Ligaments h Cozen’s Test - Lateral Epicondylitis h Mill’s Test - Lateral Epicondylitis h Golfer’s Elbow Test - Medial Epicondylitis h Wartenberg’s Sign - Ulnar Neuropathy h Elbow Flexion Test - Cubital Syndrome h Pronator Teres Test - Pronator Teres Syndrome
z Forearm, Wrist & Hand:
h Finketsein’s Test - Abductor Pollicis Longus & Extensor Pollicis Longus Tenosynovitis h Sweater Finger Test - Ruptured Flexor Digitorum Profundus h Bunnel-Litter Test - Tight Intrinsics h Phalen’s Test - Carpal Tunnel Syndrome h Reverse Phalen’s Test - Carpal Tunnel Syndrome h Froment’s Sign - Paralysis of Adductor Pollicis Longus
z Pelvis:
h Approximation Test - Possible SI Lesion or Sprain Posterior SI Ligaments h Gapping Test - Sprain Anterior SI Ligaments h Sacroiliac Rocking Test (SI Strain) - Sacrotuberous Ligaments h SLR (Lascgucs Test) - SI Problems h Gaenslen’s Test - I/P SI Lesion or Hip Pathology or Lumbar Pathology h Prone Knee Bend Test - For D/F Diagnosis h Yeoman’s Test
z Hip:
h Patrick’s Test (FABER or Figure Four Test)
- Hip Joint? Iliopsoas Spasm h Stinchfield Test - Hip Joint Pathology h Thomas Test - Hip Flexion Contracture h Rectus Femoris Contracture Test - For Rectus Femoris h Ober’s Test - TFL Contracture h Piriformis Test - Piriformis Syndrome
z Knee:
h Valgus Stress Test - Medial Collateral Ligament h Varus Stress Test - Lateral Collateral Ligament h Lachman Test - Anterior Cruciate Ligament h Anterior Drawer Sign - Anterior Cruciate Ligament h Posterior Drawer Sign - Posterior Cruciate Ligament h McMurray Test - Meniscal Tear h Apley’s Test - Meniscal or Ligamentous? h Bounce Home Test - Meniscal Injury h Mediopatellar Plica Test - Mediopatellar Plica h Fluctuation Test - Swelling h Patellar Tap Test - Swelling h Clarke’s Sign - Patellofemoral Dysfunction h McConnell Test - Chondromalacia Patella h Q-Angle or Patellofemoral Angle - Patellofemoral Dysfunction h Fairbank’s Apprehension Test - Dislocation of Patella
z Ankle:
h Anterior Drawer Test - Anterior Talofibular Ligament Injury h Talar Tilt - Calcaneofibular Ligament h Thompson’s Test - Achilles Tendon Rupture
