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    Diagnosis in Orthopaedics

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    Bakta Giri
    Orthopaedics is concerned with bones, joints, muscles, tendons, nerves and blood vessels. Conditions that affect the musculoskeletal system include congenital abnormalities, trauma, tumors, infections, arthritis, metabolic disorders, and more. Diagnosis involves obtaining a history, physical examination, imaging tests, blood tests, synovial fluid analysis, biopsies, arthroscopy, and electrodiagnosis to determine the condition. The findings are then correlated to make a diagnosis. History and physical exam alone can diagnose many orthopaedic conditions clinically.

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    Diagnosis in Orthopaedics

    Uploaded by

    Bakta Giri
    705 views48 pages
    Orthopaedics is concerned with bones, joints, muscles, tendons, nerves and blood vessels. Conditions that affect the musculoskeletal system include congenital abnormalities, trauma, tumors, infections, arthritis, metabolic disorders, and more. Diagnosis involves obtaining a history, physical examination, imaging tests, blood tests, synovial fluid analysis, biopsies, arthroscopy, and electrodiagnosis to determine the condition. The findings are then correlated to make a diagnosis. History and physical exam alone can diagnose many orthopaedic conditions clinically.

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    Orthopaedics is concerned with bones, joints, muscles, tendons, nerves and blood vessels. Conditions that affect the musculoskeletal system include congenital abnormalities, trauma, tumors, infections, arthritis, metabolic disorders, and more. Diagnosis involves obtaining a history, physical examination, imaging tests, blood tests, synovial fluid analysis, biopsies, arthroscopy, and electrodiagnosis to determine the condition. The findings are then correlated to make a diagnosis. History and physical exam alone can diagnose many orthopaedic conditions clinically.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    705 views48 pages

    Diagnosis in Orthopaedics

    Uploaded by

    Bakta Giri
    Orthopaedics is concerned with bones, joints, muscles, tendons, nerves and blood vessels. Conditions that affect the musculoskeletal system include congenital abnormalities, trauma, tumors, infections, arthritis, metabolic disorders, and more. Diagnosis involves obtaining a history, physical examination, imaging tests, blood tests, synovial fluid analysis, biopsies, arthroscopy, and electrodiagnosis to determine the condition. The findings are then correlated to make a diagnosis. History and physical exam alone can diagnose many orthopaedic conditions clinically.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 48

    DIAGNOSIS IN

    ORTHOPAEDICS
    ORTHOPAEDIC IS
    CONCERN WITH:
    • BONES
    • JOINTS
    • MUSCLES
    • TENDONS
    • NERVES
    • VASCULARS
    CONDITIONS THAT AFFECT THE
    MUSCULOSCLETAL SYSTEM :
    • CONGENITAL AND DEVELOPMENT ABNORMALITY
    • Trauma/INJURY AND MECHANICAL DERANGEMENT
    • TUMOURS AND LESIONS THAT MIMIC THEM
    • INFECTION AND INFLAMMATION
    • Degenerative./ARTHRITIS AND RHEUMATIC DISORDERS
    • METABOLIC DYSFUNCTION AND DEGENERATION
    • HEMATHOLOGY
    • MISCELANIUOS
    – SENSORY DISTURBANCE AND MUSCLE WEAKNESS
    DIAGNOSIS IN
    ORTHOPAEDICS
    1. HISTORY
    2. PHYSICAL EXAMINATION

    CAN BE DIAGNOSED BY HISTORY AND


    PHYSICAL EXAMINATION. WE CALL IT
    AS A CLINICAL DX. OR DD
    INVESTIGATION

    1. DIAGNOSTIC IMAGING
    2. BLOOD TESTS
    3. SYNOVIAL FLUID ANALYSIS
    4. BONE BIOPSY
    5. ARTHROSCOPY
    6. ELECTRODIAGNOSIS
    CORRELATE THE FINDING

    • HYSTORY
    • PHYSICAL EXAMINATION
    • DISEASE
    HISTORY
    a. SYMPTOMS (PRESENT HYSTORY)
    b. PAST HISTORY
    c. FAMILY HISTORY
    d. SOCIAL BACKGROUND
    HISTORY
    SYMPTOMS (PRESENT HYSTORY)
    • ONSET
    • LOCATION
    • CHRONOLOGIC
    • QUALITY
    • QUANTITY
    • INFLUENCE FACTORS
    • CONCOMITANT SYMPTOMS
    SYMPTOMS
    OF MUSCULOSCLETAL SYSTEM
    • LOOK WRONG:
    – SWELLING
    – DEFORMITY
    • FEEL WRONG:
    – PAIN
    – CHANGE IN SENSIBILITY
    • MOVE WRONG:
    – STIFFNESS
    – WEAKNESS
    – INSTABILITY
    • LOSS OF FUNCTION
    PAIN
    • PAIN FROM DAMMAGED TISSUE
    • REFFERT PAIN
    • AUTONOMIC PAIN
    PAIN
    • GRADE I MILD :PAIN THAT CAN EASILIY BE
    IGNORE
    • GRADE II MODERATE : PAIN THAT CANNOT BE
    IGNORED, INTERFERS WITH FUNCTION
    AND NEEDS TREATMENT FROM TIME TO
    TIME
    • GRADE III SEVERE : PAIN THAT IS PRESENT
    MOST OF THE TIME, DEMANDING
    CONSTANT ATTENTION
    • GRADE IV TOTALLY INCAPACITATING PAIN
    EXAMINATION

    a. GAIT AND LIMP


    b. EXAMINATION OF THE EFFECTED PARTS
    c. NEUROLOGICAL EXAMINATION
    GAIT AND LIMP

    • HEEL STRIKE
    • STANCE PHASE
    • TOE OFF
    • SWING PHASE
    EXAMINATION OF THE
    EFFECTED
    • LOOK
    – SKIN
    – SHAPE
    – POSISITION
    • FEEL
    – SKIN
    – SOFT TISSUE
    – BONES AND JOINT
    – TENDERNESS
    • MOVE
    – ACTIVE
    – PASSIVE
    – ABNORMAL
    LOOK
    • SKIN
    • SHAPE
    • POSISITION
    EXAMINATION OF THE
    EFFECTED
    • DEFORMITY
    – JOINT DEFORMITY
    – BONE DEFORMITY
    DEFORMITY

    • VARUS AND VALGUS


    • KHYPOSIS AND LORDOSIS
    • SCOLIOSIS
    • FIXED DEFORMITY
    • POSTURAL DEFORMITY
    Pathophysiogy OF JOINT
    DEFORMITY
    • CONTRACTURE OF THE OVERLYING SOFT
    TISSUES
    • MUSCLE IMBALANCE
    • CHRONIC ARTHRITIS
    SIX CAUSES OF JOINT
    DEFORMITY
    • SKIN CONTRACTURE
    • FASCIAL CONTRACTURE
    • MUSCLE CONTRACTURE
    • MUSCLE IMBALANCE
    • JOINT INSTABILITY
    • JOINT DESTRUCTION
    SIX CAUSES OF BONE
    DEFORMITY
    • CONGENITAL DISORDERS
    • BONE SOFTENING
    • DYSPLASIA
    • GROWTH PLATE INJURY
    • FRACTURE MALUNION
    • PAGET’S DISEASE
    FEEL
    • THE SKIN
    • SOFT TISSUE
    • BONE AND JOINTS
    • TENDERNESS
    IN BONY LUMPS FIND
    • SITE
    • SIZE
    • MARGIN
    • CONSISTENCY
    • TENDERNESS
    • MULTIPLICITY
    MOVE
    • ACTIVE
    • PASSIVE
    • ABNORMAL
    NORMAL MOVEMENT
    • FLEXION/EXTENSION
    • ADDUCTION/ABDUCTION
    • EXTERNAL ROTATION/INTERNAL
    ROTATION
    • PRONATION/SUPINATION
    • CIRCUMDUCTION
    JOINT STIFFNESS
    • ALL MOVEMENTS ABSENT
    • ALL MOVEMENTS LIMITED
    • SOME MOVEMENTS LIMITED

    •REMEMBER RANGE OF
    MOTION
    JOINT LAXITY
    • IN CHILDREN MORE MOBILE
    • PERSISTENCT GENERALIZED JOINT
    HYPERMOBILITY
    – DISEASE
    – SOFT TISSUE DISORDERS
    NEUROLOGICAL EXAMINATION

    • GENERAL APEARANCE
    • ASSESING MOTOR FUNCTION
    • ASSESING SENSORY FUNCTION
    NEUROLOGICAL EXAMINATION

    • APPEARANCE
    • TONE AND POWER
    – POWER ( 0 - 5 )
    • TENDON REFLEXES
    • SUPERFICIAL REFLEXES
    • THE PLANTAR REFLEX
    • SENSIBILITY
    • CORTICAL AND CELEBELLAR FUNCTION
    SENSIBILITY
    • HYPERAESTHESIA
    • HYPOAESTHESIA
    • ANAESTHESIA
    • TEMPERATUR RECOGNATION
    • TWO POINT DISCRIMINATION
    • VIBRATION TEST POSITIONING
    SENSESENSE OF JOINT POSTURE
    • STEREOGNOSIS
    • THE SENSE OF BALLANCE
    DIAGNOSTIC
    IMAGING
    a. PLAIN FILM RADIOGRAPHY
    b. X-RAYS USING CONTRAST MEDIA
    c. XERORADIOGRAPHY
    d. TOMOGRAPHY
    DIAGNOSTIC
    IMAGING
    e. COMPUTED TOMOGRAPHY (CT)
    f. MAGNESTIC RESONANCE IMAGING
    (MRI)
    g. DIAGNOSTING ULTRASOUND
    h. RADIONUCLIDE IMAGING
    PLAIN FILM RADIOGRAPHY
    HOW TO READ AN X-RAY
    • THE PATIENT/IDENTITY
    • THE SOFT TISSUES
    – SHAPE
    – DENSITY
    • THE BONES
    – SHAPE
    – DENSITY
    – ARCHITECTURE:PERIOSTEAL,CORTEX,ENDOSTEUM

    • THE JOINT
    • DIAGNOSTIC ASSOCIATIONS
    X-RAYS USING CONTRAST
    MEDIA

    • SINOGRAPHY
    • ARTHROGRAPHY
    • MYELOGRAPHY
    XERORADIOGRAPHY
    TOMOGRAPHY
    COMPUTED
    TOMOGRAPHY (CT)
    MAGNESTIC RESONANCE
    IMAGING (MRI)
    DIAGNOSTING ULTRASOUND
    RADIONUCLIDE IMAGING

    • BONE-SEEKING ISOTOPES
    • OTHER RADIONUCLIDE COMPOUNDS
    BONE-SEEKING ISOTOPES
    99M
    TcHDP
    • INCREASED ACTIVITY IN THE PERFUSION
    PHASE
    • DECREASED ACTIVITY IN THE
    PERFUSION PHASE
    • INCREASED ACTIVITY IN THE BONE
    PHASE
    • DIMINISHED ACTIVITY IN THE BONE
    PHASE
    OTHER RADIONUCLIDE
    COMPOUNDS
    • TECHNETIUM-LABELLED SULPHUR
    COLLOID
    • GALLIUM-67
    • INDIUM-111-LABELLED LUCOCYTES
    BLOOD TESTS
    a. NON-SPECIFIC BLOOD TESTS
    b. RHEUMATOID FACTOR TESTS
    c. TISSUE TYPING
    d. BIOCHEMISTRY
    NON-SPECIFIC BLOOD TESTS
    • NON-SPECIFIC BLOOD ABNORMALITIES
    – HYPOCHROMIC ANAEMIA
    – LEUCOCYTOSIS
    – ERYTHROCYTE SEDIMENTATION RATE (ESR)
    – C-REACTIVE PROTEIN
    – PLASMA GAMMA-GLOBULINS
    SYNOVIAL FLUID
    ANALYSIS
    • ACUTE JOINT SWELLING AFTER INJURY
    • SUSPECTED INFECTION
    • ACUTE SYNOVITIS IN ADULTS
    • CHRONIC SYNOVITIS
    SYNOVIAL FLUID
    ANALYSIS
    a. TECHNIQUE
    b. GROSS EXAMINATION
    c. MICROSCOPIC EXAMINATION
    d. LABORATORY TEST
    BONE BIOPSY

    a. OPEN OR CLOSED
    b. PRECAUTIONS
    ARTHROSCOPY

    a. TECHNIQUE
    b. DIAGNOSIS
    c. COMPLICATIONS
    ELECTRODIAGNOSIS

    a. MOTOR NERVE CONDUCTION


    b. SENSORY CONDUCTION
    c. ELECTROMYOGRAPHY
    d. INTERPRETATION AND DIAGNOSIS

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