Top 8 Examination Of Orthopedic & Athletic Injuries 4Th Edition Top 36 Best Answers

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How do you examine an orthopedic patient?

Localize the area of pain (one finger test—point of maximal tenderness). Inspect skin, soft tissue—note swelling, ecchymosis, color and texture of skin, condition of skin, areas of breakdown or skin laceration. Palpation—bony prominences, ligaments. Evaluate active and passive range of motion of joints.

What is an orthopedic examination?

An orthopedic evaluation is an exam that gives your surgeon the information they need to recommend the best pain-relieving procedures for you. Orthopedic surgeons perform thorough orthopedic evaluations when determining the most appropriate form of treatment for your musculoskeletal condition or injury.

What are the components of an orthopedic exam?

The 5 main parts of any joint exam involve inspection, range of motion (ROM) testing, palpation for tenderness, strength assessment, and special maneuvers or exam tests. Comparison with the normal side is often useful to make decisions about more subtle findings during any or all aspects of the exam.

What are the most common orthopedic injuries?

The 10 Most Common Orthopedic Injuries

Torn Meniscus. The meniscus is a small section of protective cartilage in the knee that allows the knee to move freely. …
Carpal Tunnel Syndrome. …
Torn Rotator Cuff. …
Plantar Fasciitis. …
Torn ACL. …
Tennis Elbow. …
Ankle and Foot Sprains. …
Stress Fractures.

What is the most important observation in an orthopedic evaluation?

Patient History

This is the most important part of the diagnostic procedure. The key elements are: Where is the pain or problem?

What are the components of clinical examination?

A clinical examination comprises three components: the history, the examination, and the explanation, where the doctor discusses the nature and implications of the clinical findings. A patient seeks medical help for three main reasons: diagnostic purposes, treatment or reassurance, or a combination of these factors.

What do orthopedic doctors do?

Orthopedic surgeons are doctors who specialize in the musculoskeletal system – the bones, joints, ligaments, tendons, and muscles that are so essential to movement and everyday life. With more than 200 bones in the human body, it’s an in-demand specialty. Dislocated joints. Hip or back pain.

What happens at Orthopaedics?

Your physician will ask you to perform a number of physical activities during the physical examination, including analyzing your standing posture, gait (your walking style), how you sit and lie down, which will help confirm the diagnosis and eliminate any possible wrong initial evaluations.

What clinical skills are required in an orthopedic practice?

Interpretation of diagnostic imaging (x-ray, MRI, CT, Ultrasound, EMG)
Competent evaluation and diagnostic skills.
Special testing for orthopaedic injuries and disorders.
Wide knowledge of differential diagnosis seen outside of athletic populations.
Cast/splint/brace application.
Apply wound closures.

What is a musculoskeletal exam?

The musculoskeletal examination focuses on assessment of range of motion and evaluation of painful joints or soft tissue structures.

What is palpation in medicine?

(pal-PAY-shun) Examination by pressing on the surface of the body to feel the organs or tissues underneath.

How do you take an orthopedic history?

When and how did the incident occur?
…

Site – where exactly is the pain?
Radiation – does it go anywhere else?
Nature – can you describe the pain?
Severity – how bad is the pain?
Duration – how long have you had the pain?
Frequency – how often do you get the pain?
Aggravating factors – what makes the pain worse?

What are orthopedic diseases?

Orthopedic conditions are injuries and diseases that affect the musculoskeletal system. This body system includes the muscles, bones, nerves, joints, ligaments, tendons, and other connective tissues. Damage to any of these tissues or structures can come from chronic orthopedic diseases or from an injury.

What are examples of orthopedics?

7 Orthopedic Issues

Lower Back Pain. Lower back pain is one of the most common orthopedic issues. …
Knee pain. Knee pain is often experienced by athletes, but it can affect anyone. …
Hamstring injuries. Again, a hamstring-related injury is most often experienced by athletes. …
Plantar fasciitis. …
Scoliosis. …
Hip Fracture. …
Arthritis.

What are 5 typical joint injuries?

Common joint conditions and injuries include:

Bursitis.
Degenerative joint and bone diseases, such as osteoarthritis.
Dislocations.
Fractures and breaks.
Gout, a kind of arthritis.
Osteoporosis.
Rheumatic disorders, including rheumatoid arthritis and ankylosing spondylitis.
Sprains and strains.

How do you take history of a patient in orthopedics?

Has the joint ever given way?
…

Site – where exactly is the pain?
Radiation – does it go anywhere else?
Nature – can you describe the pain?
Severity – how bad is the pain?
Duration – how long have you had the pain?
Frequency – how often do you get the pain?
Aggravating factors – what makes the pain worse?

How do you perform a knee exam?

Method 1: Gently press just medial of the patella, then move the hand in an ascending motion. Then press firmly on the lateral aspect of the knee. …
Method 2: Assess for fluid by placing one hand superior to the patella and with slight downward pressure milk the suprapatellar pouch which emptys into the knee joint.

What is a musculoskeletal exam?

The musculoskeletal examination focuses on assessment of range of motion and evaluation of painful joints or soft tissue structures.

What does an orthopedic doctor do?

Orthopaedic surgeons specialise in surgical treatments for problems caused by disease and injury (trauma) in the bones, joints and other structures involved in making the body move. Most orthopaedic surgeons specialise in particular procedures or areas of the body.

Knee Examination – Orthopaedics

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Introduction to Orthopaedic Surgery

Introduction to Orthopaedic Surgery

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Orthopaedic Surgery is a discipline of surgery that is concerned with the axial and appendicular skeleton and its related structures. There are various subspecialties or subdivisions including fractures, arthritides, soft tissue processes, tumors, metabolic conditions, congenital and acquired conditions. A medical student rotation exposes one to various aspects of Orthopaedic Surgery. This rotation should provide a variety of experiences ranging from operative, office and clinical practice and emergency room experience. There are various texts available for medical students interested in reading about Orthopaedic Surgery while on the rotation. These are included at the end of this handout. Many can be found in the WU library.

History, Physical Examination/Imaging:

History: Onset, duration, and location of complaint. Character of pain. History of injury (if any), mechanism of injury—where, when and how. What makes it better or worse? Any related symptoms or complaints. Past medical history—medical conditions (i.e. Diabetes, CAD, etc.) previous injuries. Hand dominance. Occupation. Social history (tobacco, ETOH, drugs). Medications. Any previous treatment for current (including chiropractor).

Physical Exam: Full body exam and then focus on area of complaints. Localize the area of pain (one finger test—point of maximal tenderness). Inspect skin, soft tissue—note swelling, ecchymosis, color and texture of skin, condition of skin, areas of breakdown or skin laceration. Palpation—bony prominences, ligaments. Evaluate active and passive range of motion of joints. Evaluate vascular status—capillary refill, pulses, skin color. Evaluate neurologic status—motor function, sensation, deep tendon reflexes. Specialized physical exam when necessary (ant. drawer, Lachman, etc.). In an ER situation or with multiple injury patients, ABC comes first (airway, breathing, and circulation) followed by secondary survey to evaluate chest, abdomen, skull, spine and extremities. Always be on the lookout for multiple injuries, especially in unresponsive or intoxicated individuals. Always evaluate joint above and below injured area to rule out associated conditions/injuries. Think about mechanism of injury to get ideas of related injuries—certain injuries occur in a specified pattern or are associated (jump from height with calcaneus fracture—look for lumbar spine fractures).

Radiology: X-ray most commonly used for obvious reasons. Inspect bone—evaluate joints. Need at least 2 views of injured area for adequate evaluation. Other specialized tests include bone scan (for tumors or infection), CT (for bone and marrow), MRI (for soft tissues and muscles, including spinal cord), arthrogram (for intra-articular pathology). Always remember X-rays are a two-dimensional representation of a three-dimensional object.

X-ray Evaluation: Describe views given (i.e. “AP and lateral of left tibia”). Note if patient is skeletally mature or not (are physes open or closed). Then look for pathology. Fractures are described by location (epiphyseal, metaphyseal, diaphyseal, mid shaft, distal and proximal).

Fractures are also described by the fracture pattern (oblique, spinal, transverse, segmental); fractures resulting in more than two bony fragments are referred to as comminuted. A description of the amount of displacement (or separation of fragments from one another is also important)—these are often self-explanatory (non-displaced, minimally displaced); translation refers to a particular plane (i.e. “the distal fragment is anteriorly translated 50%”); fragments should be referred to as proximal or distal and anterior or posterior; medial and lateral translation should be also identified. Percentage refers to the amount of overriding of one fragment on the other. If a fracture is angulated the apex of the angulation should also be noted. Apex anterior and apex posterior are self-explanatory. Varus and valgus are terms used to refer to angulatory deformities in the medial/lateral plane. “Knock knees” are an example of a valgus deformity. Evaluation of the joint is important as well—dislocations occur at joint interfaces. Fractures can extend into joint surfaces—these are known as intra-articular fractures. All of these descriptive terms help identify important features of the fracture(s) as well as provide groundwork for possible treatment options.

Immobilization of the involved extremity, followed by elevation and icing to reduce swelling is standard initial care. Resting (or decreasing use of the extremity) is also important. This is the case with bony and many soft tissue injuries.

The following Objectives List should be utilized by the student as a study tool to allow for as complete coverage of relevant materials as possible. Appropriate text and literature references can be gotten from the individual faculty mentors. The student would be wise to pay special close attention to Objectives numbered 3, 4 and 16: Emergencies, the Effects of Aging and the Management and Diagnosis of Chronic Pain. A week will not go by in your medical life that will not include knowledge of relevant information from one or more of these three specific objectives.

OBJECTIVES LIST

Demonstrate the ability to perform an appropriate musculoskeletal history and physical examination Relevant considerations Chief complaint: acute/chronic, traumatic/atraumatic, mechanism of injury Pain history: OPQRST (onset, pain, quality, radiation, severity-including visual analog scale and timing) Chronology of illness, injury Past medical history, allergies, medications, tobacco history & alcohol consumption, social and family history Pediatric considerations Birth history, milestones, immunization history Physical examination Basic concepts: Look, (inspection) feel, (palpation) move (active, passive, provocative-ROM) Understand relevant topographical anatomy of each site. Spine Standing, sitting, lying supine Neurological exam Motor (myotomes), sensory (dermatomes), reflexes, upper and lower motor neuron findings, pathologic reflexes Hip Adult and pediatric examinations Knee Ligament testing Hip examination in pediatric population (referred pain) Shoulder Rotator cuff examination Cardiac, visceral origin; cervical spine Elbow Hand Foot Gait Develop an organizational framework for the diagnosis and treatment of patients presenting with low back pain Clinical presentation History, physical examination of the spine and extremities (differentiation between mechanical LBP, inflammatory LBP, neurogenic LBP, extremity pain, malignant pain) Gait assessment Imaging Studies Plain radiographs, CT scan, MRI, myelogram Laboratory blood tests Electrodiagnostic studies (EMG, NCV) Pathophysiologic processes Inflammation (spondyloarthropathies ie ankylosing sponoylitis) Infection Metastatic disease Osteoporosis Intervertebral disc degeneration, facet and uncovertebral arthritis Medical Treatment Pharmacological Physiotherapy and occupational therapy Non-medical treatment Alternative therapies Physiotherapy and occupational therapy Other spinal conditions that a student should be able to discuss Neck pain, spinal stenosis, spondylotic myelopathy, vertebral compression fractures Discuss the impact of aging on musculoskeletal health Clinical topics Epidemiology and morbidity/mortality of most common MSK problems of the elderly History and physical examination of specific for elderly patient with musculoskeletal disorder(s) Giant cell arteritis and polymyalgia rheumatica Surgical treatment of lower extremity fractures (femoral-neck, intertrochanteric) in the elderly; complications (AVN, nonunion) Altered gait mechanics in the elderly Metastatic disease of the axial and appendicular skeleton The effects of co-existent medical conditions on musculoskeletal health (including medical complications of hip fractures & their treatment) The effects of polypharmacy on the elderly, as pertains to increased risk of falls, and axial or appendicular fractures Resisted weight lifting (both upper & lower extremities) Pathophysiologic processes Altered fracture healing in the elderly Common fractures in the elderly: spine, pelvis, hip, proximal humerus, distal radius Altered biomechanical and physiological properties of musculoskeletal tissues in the elderly Normal and abnormal muscle, tendon and ligament biology and biomechanics Local and systemic effects of metastatic disease Osteoporosis: Prevention, diagnosis, imaging (bone densitometry), treatment (pharmacological and mechanical) Medical Treatment Pharmacological Medical treatment of osteopenia/osteoporosis Anti-osteoclast agents, calcium supplementation Disease prevention Medical conditions with musculoskeletal manifestations Social impact of musculoskeletal disease in the elderly Utilization of resources Loss of independence, social considerations Integrated team approach to management, prevention Recognize and initiate appropriate treatment for the following musculoskeletal emergencies: septic arthritis, necrotizing fasciitis, compartment syndrome, open fracture, cauda equina syndrome and joint dislocations Prompt identification, diagnosis and treatment of patients with the aforementioned musculoskeletal emergencies Understanding the adverse sequelae from a functional and pathophysiological standpoint that result from delayed or missed diagnosis Develop an organizational framework for the diagnosis, initial management and definitive management of patients with fractures of the axial and appendicular skeleton Appropriate immobilization, history and physical examination with a fracture of the axial or appendicular skeleton Demonstrate the ability to describe a fracture pattern using appropriate plain radiographs Principles of fracture care Reduction, immobilization, rehabilitation, functional restoration Pain control Casting techniques, indications for surgical treatment Stages of fracture healing Intrinsic, extrinsic factors affecting fracture healing Nutrition, smoking, obesity Biomechanics of healing fractures, and of fracture alignment Pathologic fractures Response of cartilage, ligament tendon and skeletal muscle to trauma Develop an organizational framework for the diagnosis and treatment of patients presenting with osteoarthritis Clinical presentation History, physical examination (appendicular skeleton and axial) Imaging studies Plain radiographs Pathophysiologic processes Inflammation (rubor, tumor, calor, dolor) Cartilage degeneration, bony response to altered load Periarticular changes: ligament, tendon, joint capsule Medical treatment of joint pain and inflammation Pharmacological Acetaminophen, non-steroidal anti-inflammatory drugs, COX-2 inhibitors, corticosteroids (oral and intra-articular), analgesics Surgical Osteotomy, arthrodesis, replacement, excision Non-medical treatment of pain and inflammation Alternative medicine Lifestyle and activity modification, disease prevention Other arthridites that a student should be able to discuss Seronegative spondyloarthropathies, gout, pseudogout, septic arthritis (infant, child, adult, elderly, immunocompromised), autoimmune vasculitis Develop an organizational framework for the diagnosis and treatment of patients presenting with rheumatoid arthritis Clinical presentation History, physical examination (appendicular skeleton and axial, joint specific examination, differentiation from sepsis) Adult and Juvenile Rheumatoid arthritis Imaging studies Plain radiographs Joint fluid analysis Basic aspiration and injection techniques Knee Cell count, gram stain, crystals, culture if appropriate clinically Laboratory blood tests Basic bloodwork Erythrocyte sedimentation rate: usefulness, pitfalls C.R.P. Extra-articular Pathophysiologic processes Inflammation (articular and extra-articular) Synovial pathology Cartilage, bone, ligament and tendon responses to stress and inflammation Medical management Pharmacological Acetaminophen, non-steroidal anti-inflammatory drugs, COX-2 inhibitors, corticosteroids Sulfasalazine, hydroxychloroquine, other DMARDs Biologic agents (Enbrel, Remicade) Complications Surgical Non-medical treatment of pain and inflammation Alternative medicine Lifestyle modification Physiotherapy and occupational therapy Develop an organizational framework for the diagnosis and treatment of patients presenting with crystalline arthritis: gout & pseudogout (calcium pyrophosphate) Clinical presentation History, physical examination: joint specific examination (“general” musculoskeletal examination) Joint fluid analysis Basic aspiration and injection techniques Cell count, crystal analysis (MSU & CPPD); gram stain and culture (if clinically appropriate) Imaging studies Plain radiographs Management Anti-inflammatory drugs Hypouricemic therapy (gout) Develop an organizational framework for the diagnosis and treatment of patients presenting with sports injuries (both chronic overuse phenomena and acute injury) Clinical presentation Biomechanics and injury mechanism of acute and chronic sports injuries History and directed physical examination of the acutely injured Athlete History and directed physical examination of chronic injury Appropriate diagnostic imaging of the injured athlete Plain radiographs, MRI (when to obtain each) Pathophysiology Inflammation of musculoskeletal tissues following acute or chronic injury Histopathology of chronic injury Therapeutics Medical treatment Pharmacological treatment Physiotherapy and conditioning Immobilization after injury R.I.C.E. Disease and injury prevention Sports injuries that a student should be able to discuss Ankle sprains, anterior cruciate ligament & meniscal tears, stress fractures, special consideration of the female athlete Develop an organizational framework for the diagnosis and treatment of patients presenting with occupational injury (both acute & chronic overuse phenomena, and injury) Clinical presentation Work related history and physical examination of patient with chronic overuse conditions of the workplace Physical examination of the injured worker Imaging Plain radiographs, nuclear studies Nerve conduction studies and electromyography Indications, interpretation Therapeutics Medical Ergonomics Physiotherapy and occupational therapy Rehabilitation Disease prevention Conditions of overuse that a student should be able to discuss risk factors, presentation and evaluation of Carpal tunnel syndrome, tennis elbow, tendonitis of the upper extremity including trigger finger and de Quervaine’s Develop an organizational framework for the diagnosis and treatment of patients presenting with musculoskeletal infection Clinical evaluation History and physical examination Laboratory investigation Imaging studies Plain radiographs, ultrasound, nuclear studies Collection of microbial specimens Gram stain analysis Differential diagnosis Pathophysiogic processes Inflammation: Acute and chronic Ischaemia and infarction of tissues Microbe-specific infectious processes Immune and humoral response Therapeutics Medical Surgical Systemic disease with potential for the development of musculoskeletal sepsis Develop an organizational framework for the diagnosis and treatment of patients presenting with musculoskeletal neoplasia (both primary and metastatic disease) Clinical evaluation History and physical examination Pediatric vs. adult Primary malignancy Presentation as metastatic disease Common benign MSK neoplasms Laboratory investigation CBC, diff, ESR, serum immuno EP, Calcium, Phos Imaging studies Plain radiographs, CT scan, MRI, chest x-ray, chest CT, abdominal CT, nuclear studies Multiple myeloma: plain radiographs Biopsy Common pathological lesions/diagnosis Pathophysiology Local Effects on bone, soft tissue Bone loss mechanism Systemic Metabolic changes Bone loss mechanism Therapeutics Medical Chemotherapy, radiation therapy Pain control (acute and chronic) Metabolic dysfunction Surgical Principles of surgical treatment Decompression Reconstruction Role of prophylactic surgery Social implications of musculoskeletal malignancy Understand the relevant physiologic, pathologic and sociologic issues involved in the treatment of patients with spinal cord injury or stroke Clinical evaluation History Injury Change in neurological status Bowel, bladder, social independence Physical examination Neurological level (localize the lesion) Motor tone and strength, sensation, reflexes Special considerations Pressure sores, personal hygiene Transportation Imaging Pathophysiology Neurological findings Bladder spasticity Neural degeneration, regeneration Disuse atrophy: muscle, bone, tendon, ligament Parallel: manned space flight Therapeutics Medical treatment of sequelae of SCI, stroke Surgical treatment of sequelae Non-medical treatment Wheelchair, hospital bed Physiotherapy, occupational therapy, prosthetics, orthotics Understand the relevant physiologic, pathologic and sociologic issues involved in the treatment of children with myopathic or neurologic conditions; and complicating neuromuscular problems in adults with diabetes mellitus Clinical topics Differentiate between cerebral palsy, spina bifida, muscular dystrophy Understand the relevant details of the physical examination for each of the conditions Understand the role of gait analysis & footware assessment in the surgical treatment of these conditions Pathophysiology Differentiate between myopathy and neuropathic conditions Understand the natural history of aforementioned conditions Therapeutics Medical Surgical Understand the relevant physiologic, pathologic and sociologic issues involved in the treatment of children with orthopaedic disorders Clinical topics History and physical examination of the limping child History of at-risk factors for DDH Physical examination of an infant for presence of a dislocated or a dislocatable hip Screening physical examination of the spine, lower extremities, neck, upper extremities and internal organs in a child at risk for congenital malformations. Evaluation of the traumatized child Imaging Plain radiographs, ultrasound, nuclear studies, MRI Whole body x-ray series for child abuse Laboratory investigations Pathophysiology Differential diagnosis and pathological processes at work in common paediatric hip conditions. Pathophysiology of epiphyseal osteonecrosis Basic embryology of the musculoskeletal system, as related to developmental abnormalities Pathology and molecular genetics of the skeletal dysplasias Therapeutics Medical Surgical Critical Evaluation Parameters Communication skills Early childhood developmental milestones Child abuse Multi-disciplinary approach to care for an injured or sick child Other pediatric conditions with which the student should be familiar In-toeing and out-toeing differential diagnosis, scoliosis, classification of physeal fractures, osteochondroses, birth injuries, congenital malformations Display understanding of the diagnosis and treatment of patients suffering from chronic pain, and the interdisciplinary approach required for the treatment of this condition Understand the basic pathophysiology of acute and chronic pain syndromes Fibromyalgia Complex regional pain syndrome Chronic neck and low back pain Appreciate the multi-disciplinary approach to the diagnosis and treatment of this condition Understand normal and abnormal bone physiology, and the clinical presentation and treatment of patients with altered bone physiology Clinical topics Paediatric osteochondrodysplasias and metabolic bone disease Osteoporosis Post menopausal Steroid and other drug induced Paediatric diseases Laboratory investigation Imaging Plan xrays Densitometry Biopsy Tetracycline labeling Pathophysiology Demonstrate understanding of the paradigm of bone formation and remodeling, and its disruption in osteoporosis Differential diagnosis of an osteoporotic compression fracture of the spine Therapeutics Medical Surgical Other Disease burden on society Prevention Other conditions affecting bone metabolism with which the student should be familiar Sickle cell disease, osteomalacia, avascular necrosis, steroid-induced osteopenia and Addison’s disease, Paget’s disease, rickets Demonstrate understanding of the principles and practice of injury and disease prevention Understand and promote the use of appropriate protective equipment during athletic activity Car seats Effects of smoking and obesity on the musculoskeletal system Motor vehicle and pedestrian trauma Role and effect of societal violence i.e. alcohol abuse, war trauma

Open Fractures: These involve an injury that breaches the skin and soft tissue and exposes the bone to the outside environment. There are “inside out” injuries (a bone spike pierces the skin and then goes back below the skin surface) and “outside in” injuries (a gunshot wound). Open fractures are graded I, II and III. Grade I open fractures have wounds less than 1 cm. in length. Grade II open fractures are wounds more than 1 cm. in length, but the wound is clean and there is no devitalized tissue. Grade III open fractures have contaminated wounds with devitalized tissue or have comminuted fractures with neurovascular injury. Grade III fractures are subdivided: IIIA have contaminated wounds with minimal periosteal stripping and no neurovascular compromise; IIIB are associated with significant periosteal soft tissue injury; IIIC have significant periosteal stripping/soft tissue injury with associated vascular compromise or nerve injury. Open fractures have a high incidence of complications including infection, nonunion and frank osteomyelitis.

Septic Arthritis: Acute onset of pain, inflammation of a single joint that rapidly increases in severity should alert the physician of a septic arthritis. If septic arthritis is present, early diagnosis and treatment is a necessity. Swelling of the involved joint, erythema, induration, pain with range of motion or weight bearing can be seen. History may include fever, chills, sweats. A history of an injury involving a breach of skin around the joint may be elicited (fight bite). Recent bacterial infection may be in the history. Recent sexual contact should alert one to the possibility of gonococcal arthritis. Patients with immunosuppressive disorders are at increased risk, as are patients on steroids. Arthrocentesis of the involved joint is done—the cell count gives the physician an idea of the white cell content and character of the fluid. If there is a truly septic joint it must be irrigated and debrided immediately to prevent damage to the articular surface from the pus. Treatment includes joint arthrocentesis, CBC, ESR, cultures of joint fluid; if fluid is suspicious for septic arthritis the patient undergoes I & D in the OR immediately and is placed on intravenous antibiotics.

Compartment Syndrome: This is caused by elevated hydrostatic pressure in a closed fascial compartment. The elevated pressure may be muscle injury and swelling, bleeding into a compartment, vascular injury. It is a complication that can be seen with fractures, soft tissue injuries, post-operatively, with crush injuries or venomous bites. As the pressure increases capillary beds collapse shunting blood through the compartment via larger arteries. Venous beds collapse as pressure increases and venous outflow is compromised. This results in increased swelling, higher pressure and resultant ischemia. Clinically one should always be suspicious of compartment syndrome in a patient who complains of intense increase in severity of extremity pain.

The primary physical sign is increased pain. One can also see pain with passive stretching—gentle motion of muscles in the compartment elicits great pain. Paresthesia is a fairly late sign—this indicates that the nerves in the compartment are being adversely affected by the ischemia. If the compartment syndrome is unrecognized or untreated this can eventually progress to a Volkmann’s ischemia where the nerves are irrevocably damaged and the muscles become ischemic and necrose. Firm, tense compartments are another physical sign. Compartment pressures are measured with a manometer and provide objective evidence of increased pressure. Pallor and pulselessness of the extremity are often late signs. The treatment of compartment syndrome involves emergent surgical release of the compartment in the OR. Delayed primary closure of the skin may be done or the skin defect may be approximated with skin grafts with the swelling has resolved. Elevation of the involved extremity is used to reduce swelling.

Orders/Notes:

Routine admission or post-operative orders follow a standard format. Some attending physicians have pre-printed post-op orders for procedures that are done routinely.

Admit to 7300—Dr. Ricci Diagnosis: Left tibia fracture Condition: Stable Vitals: Routine with Q 2 hour neurovascular check to left lower extremity (LE) Activity: Bedrest; strict nonweight bearing (NWB) left LE Nursing: Ice to left leg Diet: NPO after MN (for operating room in AM) IVF: Heplock Allergy: NKDA Meds: Demerol 75 mg IM Q 3-4 prn (for pain)

Vistaril 25-50 mg IM Q 3-4 prn (for pain)

Tylenol #3 i-ii po Q 4-6 prn (for pain)

Tylenol 650 mg po Q 4-6 prn (for headache or fever)

Benadryl 25-50 mg po Q HS prn (to help with sleep)

Mylanta 30 cc po Q 6-8 prn (for indigestion)

Any routine meds the patient is on at home Labs: CBC, SMA 7, PT/PTT, UA with micro, CXR. EKG, type and cross or type and screen (depending on procedure and age of patient) Call HO (house officer—resident on call) for T>38.4, P>120<50, SBP>180<100, RR>20<10 : Explanations or abbreviations in italics and parentheses Example of Brief Operative Note: This is a note that goes in the chart after an operative procedure—it briefly documents what was done and by whom. BON (Brief op note) Preop diagnosis: Left tibia fracture Postop diagnosis: same Procedure: ORIF left tibia Anesthesia: Spinal Surgeons: Ricci, McBeath, WUMS 3 (attending always goes first) EBL (est. blood loss): 150 cc IVF: 1500 cc TT (tourniquet time): one hour and 15 minutes Drains: none Specimens: none Complications: none Dispensation: to PAR (post anesthesia recovery room) in stable condition Signature Example Post-Op Orders: Admit 7300—Dr. Ricci Dx: s/p ORIF L tibia Condition: stable Vitals: per post-op routine (can check with particular resident) with Q 2 hour neurovascular checks to L LE Activity: Bedrest today: OOB to chair in AM with PT for NWB L LE with crutches Nursing: Elevate L LE Ice to L LE Diet: Regular (if renal or diabetic patient change diet accordingly) IVF: D5LR @ 80 cc/hr (fluid replacement rate varies with patient status and procedure) May heplock IVF when pt. has good po intake Allergy: NKDA Meds: Demerol 75-100 mg IM Q 3-4 prn Vistaril 25-50 mg IM Q 3-4 prn Tylenol #3 i-ii po Q 4-6 prn Tylenol 650 mg po Q 4-6 prn Benadryl 25-50 mg po Q HS prn Compazine 10 mg IM Q 6 prn (for nausea/vomiting) Mylanta 30 cc po Q 6-8 prn Labs: (depends on procedure performed) Call HO (parameters same as for above orders) Example Post-op Check Note: Patients are checked a few hours after surgery to make sure they are not having problems or complications. Post-op check Pt. without complaints AFVSS Chest CTA CV RRR Abd S/NT/ND Extrem without c/c/e good capillary refill sensation and motor intact pulses intact A/P: Pt. stable s/p ORIF L tibia PT in am Ice, elevate Signature Example of Routing Daily Note: – Dr. POD 2 (post operative day) Pt. without complaints AFVSS Wound clean, dry, intact DNVI (this is an abbreviation of distal neurovascular intact—this is shorthand for full sensory motor exam— this all must be normal to write DNVI—if there is any question or inconsistency, it must be noted in full—check with individual residents for this) A/P: Pt. doing well with PT Plan discharge to home today F/U one week Ricci’s clinic Signature Example of Discharge Orders: D/C to home (or rehab facility, on occasion) s/p ORIF L tibia Stable condition Instruction: keep wound clean and dry NWB with crutches L LE Prescription: Tylenol #3 i-ii po Q 4-6 prn F/U in Dr. Ricci’s clinic in one week—call 747-2500 for appointment Signature (Ricci’s) Prescriptions are written on appropriate form by resident Of note: these orders are examples of orders specific to the orthopaedic surgery service . Although the format may be the same, the content will be different on the other services you will be on, especially as far as diet, fluids and medications. Before writing for any of this standard order protocol, check with the appropriate resident on your other services. Suggested Reading Resources: Bernstein: Musculoskeletal Medicine - For overviews of basic anatomy, pathoanatomy and physiology. Hoppenfeld: Physical Examination of the Musculo-Skeletal System - A thin green book. It has terrific pictures and explanations. Rang: Children’s Fractures - The best text of pediatric Orthopaedics, for the surgeon, pediatrician and primary care doctor alike. Hoppenfeld: Surgical Approaches in Orthopaedics - Terrific for OR preparation; most of the residents have this. Rispoli: Tarascon Pocket Orthopaedica. - Indispensable pocket reference. ***If you have any suggestions, e-mail Dr. Boyer ([email protected])*** Internet Sites: The following sites may be good starting points for links and for other information: www.aaos.org -The American Academy of Orthopaedic Surgeons -The American Academy of Orthopaedic Surgeons www.assh.org -The American Society for Surgery of the Hand -The American Society for Surgery of the Hand www.wheeless.org -Duke University orthopaedics site -Duke University orthopaedics site www.ejbjs.org -Journal of Bone & Joint Surgery site You can also use Google, search on ORTHOPAEDICS or, ORTHOPAEDIC SURGERY or, for the specific condition which you’re interested. ORTHOPAEDIC TERMS:

What to Expect During an Orthopedic Evaluation

An orthopedic evaluation is an exam that gives your surgeon the information they need to recommend the best pain-relieving procedures for you.

Orthopedic surgeons perform thorough orthopedic evaluations when determining the most appropriate form of treatment for your musculoskeletal condition or injury. These evaluations provide your surgeon with the information they need to create a comprehensive treatment plan. Preparing for your orthopedic evaluation ahead of time can save you from the time and expense of extra follow-up visits.

Medical History Exam

Be as specific as possible when describing your pain. Use details such as where you feel pain, what type of pain you have, how often it hurts, how severe your pain is, and whether or not pain is preventing you from enjoying daily activities. You should also describe any past injuries that could be contributing to your pain. Let your surgeon know about any other chronic pain you deal with, even if it seems unrelated.

Your orthopedic evaluation will cover your complete medical history, including any underlying medical conditions such as arthritis or diabetes. Keeping this information up-to-date and accurate helps lower your risk of complications from conflicting conditions or medications. Be sure to notify your orthopedic surgeon of all the medications you take and any allergies you may have to medications or substances like latex.

Physical Tests

To fully evaluate your condition, your orthopedic surgeon will most likely conduct a few physical tests. These tests are meant to check your flexibility, range of motion, and reflexes. Your surgeon will also check the affected area for swelling and visible symptoms of a condition. Visible lumps, asymmetrical swelling, bulges in your spine, and mottled or bruised skin can all be indications of an orthopedic condition.

Your orthopedic surgeon may have you bend, walk, move up and down stairs, and sit down to test your range of motion. Watching your body’s ability to perform movements helps your doctor evaluate your flexibility, as well as narrow down the list of potential conditions, for a more accurate diagnosis.

Imaging Tests

If your orthopedic surgeon needs more in-depth information on the affected area, they might order imaging tests, such as X-rays or magnetic resonance imaging (MRI). These tests provide your surgeon with detailed images and information on your condition and help them spot any signs of swelling, infection, or displacement.

Keep in mind that your surgeon might need to test more than the area that is causing you pain. For example, shoulder pain can be caused by musculoskeletal problems in your upper spine or neck, while hip pain is sometimes caused by problems with your lower part of the spine.

After your orthopedic evaluation is complete, your surgeon will discuss your treatment options with you based on your medical history exam and the results of physical and imaging tests. If your pain is keeping you from performing the daily activities that make life worth living, schedule an orthopedic evaluation to ensure that any undiagnosed conditions don’t worsen.

To set up an orthopedic evaluation, contact Arkansas Surgical Hospital at(877)-918-7020. Our orthopedic surgeons can help you determine the best course of treatment to relieve your pain and restore your range of motion.

So you have finished reading the examination of orthopedic & athletic injuries 4th edition topic article, if you find this article useful, please share it. Thank you very much. See more: orthopedic examination pdf, orthopedic examination ppt, orthopedic examination book, orthopedic exam questions for medical students, physical examination in orthopaedics apley pdf, orthopedic examination slideshare, nursing assessment of orthopedic patient, orthopedic examination app

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