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? 1 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 2 3 Leathery thickening – Chronic 3 Soft fluctuating – Acute 3 Hard – Bone 3 Thick, slow-moving – Pitting oedema Û Crepitus, Abnormal sounds On Examination: Û Vital Signs Û Motor Assessment Range of Motion (ROM) Active - When and where pain starts - Whether movement increases pain - Pattern of movement - Trick movements Passive - When and where pain starts - Whether movement increases pain - Pattern of movement - D/F between range of motion available - End feel End Feel Normal - Bone to Bone - Soft Tissue Approximation - Tissue Stretch Abnormal - Early Muscle Spasm - Late Muscle Spasm - Hard Capsular - Soft Capsular - Bone to Bone - Empty - Springy Block Capsular Patterns Manual Muscle Testing MRC Grading Resisted Isometrics - On contraction causes pain and, if it does, pain’s intensity & quality - Strength of contraction - Type of contraction causing problem (concentric, isometric, eccentric) 3 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 4 - 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: 5 SPECIAL ORTHOPAEDIC TESTS z Shoulder: h Speed Test - Bicipital Tendinitis (Biceps or Straight Arm Test) h Yergason’s Test - Bicipital Tendinitis h Lippman’s Test - Bicipital Tendinitis h Supraspinatus Test - Supraspinatus Tear (Empty Can Test) h Drop Arm Test (Codman’s Test) - Rotator Complex h Neer Impingement Test - Supraspinatus & Biceps Tendon h Roos Test - Thoracic Outlet Syndrome h Wright Test - Thoracic Outlet Syndrome h Adson Test - Thoracic Outlet Syndrome h Allen’s Test - Thoracic Outlet Syndrome h Upper Limb Tension Test (ULTT) ULTT 1 - Median nerve & anterior interosseous nerve ULTT 2 - C5, 6, 7, Median nerve, Musculocutaneous nerve & axillary nerve ULTT 3 - Radial nerve ULTT 4 - C8, T1, Ulnar nerve h Apprehension Test - Anterior Shoulder Dislocation h Rockwood Test - Anterior Shoulder Instability h Dugas Test - Anterior Shoulder Dislocation h Posterior Apprehension Test - Posterior Shoulder Dislocation h Push Pull Test - Posterior Shoulder Dislocation h Sulcus Test - Inferior Shoulder Instability h Clunk Test - Labral Tear 6 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 7 z Hip: h Patrick’s Test - Hip Joint? (FABER or Figure Four Test) 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 8 z Cervical Spine: h Foraminal Compression - Cervical Radiculitis (Sparling’s Test) h ULTT’s D/F Diagnosis h Shoulder Depression Test & - Compression of nerve roots or Abduction Test Brachial Plexus Lesion h Jackson’s Compression Test - Pressure on nerve root h Valsalva Tests - Herniated disc / Tumour / Osteophyte h Vertebral Artery Test - Compression of Vertebral (Cervical Quadrant Test) Artery z Thoracic Spine: h Slump Test - Impingement of Dura & Spinal Cord / Nerve Roots z Lumbar Spine: h Slump Test - For Neuromeningeal Tract h SLR (Basic), 2, 3, 4, Crossed SLR - Sciatic, Tibial, Sural, Common Peroneal, Disc Prolapse h Valsalva Maneuver - Increased Intrathecal Pressure h Schober’s Test - Measure Flexion of Lumbar Spine h Stoop Test - Neurogenic Intermittent Claudication z Tests for Malingering: h Hoover Test - Malingering for Back Pain h Burns Test - Malingering for Back Pain 9.