WEEK 1
THE MUSCULOSKELETAL EXAMINATION
- Most of orthopedic history involves pain
- Ask about:
- Location of pain,
- Hx of trauma,
- Localized vs diffuse,
- Acute vs chronic,
- Inflammatory vs noninflammatory,
- Limited ROM, systemic features,
- Always ask about previous orthopedic surgeries/internal hardware
- Monoarticular joint pain: one area of joint pain
- Polyarticular joint pain: multi-joint pain
- Timing of onset:
- Acute: developed over the course of hours
- Chronic: insidious, weeks-months
- Limited ROM: important to know if the ROM is stiffness or actually being stopped
- Tightness= perceived tightness or resistance to movement
- Systemic features: is there any fever, chills, rash, anorexia, weight loss, weakness
Joint & Systemic Disorders:
- Systemic Lupus Erythematosus: butterfly (malor) rash on cheeks
- Psoriatic arthritis: scaly rash, pitted, nails
- Lyme Disease
- Reiter’s Syndrome
- Gonococcal arthritis
Low back pain
- Always evaluate for bowel or bladder dysfunction
- DRE, test rectal sphincter
Neck pain
- Cervical spine important to evaluate
- Ask about radiation to arm or shoulder
- Numbness/tingling weakness?
Red flags for back pain/neck pain:
- Age >50yrs
- Hx of cancer
- Unexplained weight loss
- Pain lasting >1 month & not responding to Tx
- Night or rest pain
- History of IV drug use
- Presence of infxn
- As a general rule ALWAYS inspect the joint above and below an injury
