Orthopedics Flashcards
H&P Overview: History (3 points of interest)
- joint
- muscular
- skeletal
H&P Overview: Physical Exam (steps in examination)
- inspection
- palpation
- range of motion
- manual muscle testing
- neuro and vascular testing
- special tests
HPI: Joint Symptoms
- change in size/contour
- swelling/redness
- pain (constant / intermittent / with specific movement)
- laterality
- location of joint (anterior, posterior, medial, lateral)
- effet on ADLs
- locking/giving way
- associated events
- timing (temporal factors)
- self-treatment
- medications
HPI: Muscular Symptoms
- location
- character
- limitation of movement
- weakness/fatigue
- paralysis, tremor, tic, spasm, clumsiness, wasting, pain
- precipitating factors
- injury, strenuous activity, sudden movement, stress
- self treatment
- heat, ice, splints, rest, massage
- medications
HPI: Skeletal Symptoms
- character
- limping or difficulty w/ gait
- numbness, tingling, pressure sensation
- pain w/ movement
- crepitus
- deformity: change in contour
- associated event
- injury, recent fx, strenuous activity, sudden movement, stress, postmenopause
- self treatment
- rest, splints, chiropractic, acupuncture
- medications
HPI: Injury (5 questions)
- MOI:
- direct trauma, overuse, sudden change in direction, forceful contraction, overstretch
- sensation:
- click, pop, tearing, numbness, tingling, catching, locking, grating, snapping, warmth/coldness, wt. bearing status
- pain:
- location, type, onset (sudden/gradual), aggravating/alleviating factors, position of comfort
- swelling:
- location, timing (activity vs. injury)
- self treatment
- rest, ice, heat, splints, meds
Past medical history (4 questions)
- trauma
- nerves, soft tissue, bones, joints, residual problems, bone infections, loss of limb
- surgery
- chronic illness
- CA, arthritis (osteo vs. autoimmune), osteoporosis, renal or neuro disorder, DM, HTN, CAD, PVD, sickle cell, hemophilia
- skeletal deformities or congenital anomalies
Family History
- congenital abnormalities
- scoliosis or back problems
- OA / autoimmune disorders
- genetic disorders
- cancer
Social History
- employment
- exercise
- functional abilities
- weight changes
- height changes
- nutrition
- tobacco or alcohol use
OA risk factors
- obesity
- FH of OA
- hypermobility syndromes
- aging (>40 y/o)
- injury / high level of sports activities
- occupation w/ overuse of joints
Osteoporosis risk factors
- race
- light body frame, thin
- FH of osteoporosis
- nulliparous
- amonrrhea or menopause before 45
- sedentary lifestyle
- inadequate Ca+ or Vit D intake
- excessive carbonated drinks
- scoliosis, RA, CA, MS, chronic illness, previous fractures
- metabolic disorders, DM, hypercortisolism, hypogonadism, hyperthyroidism
- drugs decreasing bone density
- cigarette smoking or heavy EtOH use
body planes
limb range of motion
Physical exam - key points
- inspection
- general appearance
- skin and subcutaneous tissues
- symmetry
- palpation
- joints (above and below)
- muscle tone
- range of motion (active and passive)
- special testing
- neuro and vascular exam
PE - gait analysis
PE - manual muscle testing (MMT)
- evaluates function and strength
- break test- isometric hold
- make test- resistance through ROM
PE - palpation steps
- localize point of maximum tenderness
(“point to where it hurts most”)
- start at unaffected side/away from painful area
Cervical Exam MMT/Nerves
UE Sensory Exam
Cervical Spine Special Test
Spurling’s test
Impingement Tests
Neer sign & Hawkins sign
Rotator Cuff Tear Tests
Empty Can test & Drop Arm test
Bicipital Tendinitis tests
Speeds test & Yergason’s test
Shoulder Instability / Labral Pathology tests
Apprehension test & Sulcus sign
SLAP Tear test
(superior labrum anterior and posterior)
O’Brien test
AC joint sprain / OA test
Cross Body test
Epicondylitis test
Long Finger test
Cubital Tunnel Syndrome test
Tinel’s sign
Elbow Instability tests
Varus Stress test / Valgus Stress test / Milking Maneuver
Carpal Tunnel tests
Phalen’s test & Tinel’s sign
DeQuervain Tenosynovitis test
Finkelstein test
Collateral Ligament testing
(MCP/PIP/DIP instability)
Valgus and Varus stress test
Measuring Q-Angle
Measuring Leg Length
Leg Innervation
Lumbar Spine Special Tests
- straight leg raise
- seated SLR
- FABER (flexion-abduction-external rotation) test
Lumbar Spine Waddle Signs
- non-organic tenderness
- pt. standing- light touch should not cause pain
- axial subluxation
- pt. standing- light downward pressure on head should not cause lumbar pain
- seated SLR
- distracted pt. will not lean back
- sensory exam
- monofilament should not cause pain
Hip ROM
Hip Special Tests 1
- Trendelenburg test
- Thomas test
- Log roll
Hip Special Tests 2
- hamstring flexability
- Piriformis test
Knee Joint Effusion Special Tests
Ballottement and Bulge
Knee Medial and Lateral Meniscus Speical Test
McMurray Test
Knee ACL Special Tests
- Lachman test
- Anterior Drawer test
Knee PCL Special Test
Posterior Drawer
Knee MCL & LCL Special Tests
Valgus and Varus Stress Tests
Knee Patellar Dislocation Special Test
Patellar Apprehension Sign
Ankle Laxity Special Test
Anterior Drawer Test
Achilles Tendon Special Test
Thompson Test
Foot Neuropathy Special Test
Foot Squeeze Test - Morton’s Neuroma
