[11.02] History Taking and PE of Common Orthopedic Conditions V2.pdf

Outpatient Department

Where is an orthopedic assessment typically more detailed because there is more time compared to the ER?

Subjective and Objective

What are the two main parts or scope of an orthopedic assessment?

History taking

What represents the subjective part of an orthopedic assessment?

Physical Examination

What represents the objective part of an orthopedic assessment?

Pain or instability

What are the two most common chief complaints in the outpatient department?

Recurrently dislocating because it is loose without pain

How is instability defined in the context of a shoulder complaint?

Nangangalay

What is the Tagalog term often used by patients to describe pain?

Parang kumakalas, nanghihina, or namamanhid

What are three Tagalog terms often used by patients to describe instability?

PQRST or OLDCARTS

What are the two mnemonics used to probe a chief complaint?

Onset, Palliating/Provoking factors, Quality, Radiation, Severity, and Timing

What does the mnemonic OPQRST stand for?

Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation, Timing, and Severity

What does the mnemonic OLDCARTS stand for?

Comorbidities

What should be asked for because some conditions may be explained or are aggravated by them?

Numbness and tingling of fingers and feet in a glove and stocking pattern

What musculoskeletal symptom can diabetes cause?

Adhesive capsulitis or frozen shoulder

What specific shoulder condition is predisposed by uncontrolled blood sugar in diabetes?

Osteoarthritis of the joints, particularly the hips and knees

What condition can obesity cause?

Carpal tunnel syndrome or De Quervains tenosynovitis

What two conditions are postpartum patients more prone to?

Determine if information is pertinent

What is the goal of sifting through a patient's history of trauma or manipulation?

Treatment through massage or hilot where the bone never fully healed

What type of previous treatment history for a broken bone is likely pertinent to current pain?

Surgical history

Which part of the history assesses for implants, malunions, or previous unsatisfactory outcomes?

Chronic steroid use

What specific drug intake is critical to ask about in an orthopedic past medical history?

Movement wherein the person has a goal

What is the definition of exercise in a personal and social history?

Movement that happens as a product of something, such as walking to work

What is the definition of physical activity?

Frequency and intensity

What two aspects of sports engagement should a physician ask about?

Ergonomics

What concept should be assessed regarding the workplace or daily activities like studying positions?

Footwear

Which part of the personal and social history is very important for predisposing a patient to plantar fasciitis?

Shoes without an arch support or those incompatible with one's foot type

What type of footwear predisposes a patient to plantar fasciitis?

Pain at the soles of the feet especially in the first steps in the morning

What is the characteristic clinical presentation of plantar fasciitis?

Hyperuricemia

To which metabolic condition is diet most pertinent in a musculoskeletal history?

High fructose corn syrup

What is proven as the main implicated intake with hyperuricemia?

Soft drinks, processed food, and sugars

Where is high fructose corn syrup commonly found?

Alcohol

Besides high fructose corn syrup, what other intake is implicated by rheumatologists in hyperuricemia?

Beans and munggo

According to rheumatologists, what foods do not cause hyperuricemia?

Respect and authority balanced with jokes

How should a physician present themselves to a patient regarding decorum?

Adequate exposure and coverage

What are the two requirements for proper draping and attire during an orthopedic physical exam?

When the patient walks in

When does the physical inspection of an orthopedic patient generally begin?

Antalgic gait

What is the medical term for a painful gait?

Gait, gross deformity, scars, swelling, and redness

What five things should a physician generally inspect for?

Determine if limitation is due to pain or a mechanical block

What is the purpose of testing active unassisted range of motion?

Self-limiting or guarding

What characterizes a limitation in ROM where the full range is available when assisted?

Contralateral side

To what should the affected side always be compared during a physical exam?

Demonstration or mirroring

What is the easiest way to explain range of motion maneuvers to a patient?

Touch their ears

What is a quick way to gauge the range of motion of the shoulders?

Touch shoulders

What is a quick way to gauge the range of motion of the elbows?

Internal rotation

Which specific shoulder movement limitation can suggest adhesive capsulitis or frozen shoulder?

Asking how they put on their bra

How can a physician test for shoulder internal rotation limitations in an older lady?

Palpate the painful part last

What is the general rule for palpation regarding tenderness?

Bony prominences and symmetry

Besides tenderness, what two things should be checked during palpation?

Elicit pain

What must an orthopedic test be able to do to be considered positive?

Draped

How might a patient be prepared if they are required to remove their shirt for a shoulder exam?

Deltoid wasting

What specific muscle wasting should be checked for from both the front and back of the shoulder?

Winged scapula

What should be checked for by asking the patient to push against a wall with both hands?

Ipsilateral serratus anterior muscle weakness secondary to long thoracic nerve injury

What does protrusion of the scapula during a wall-push test indicate?

Long thoracic nerve

Injury to which nerve causes a winged scapula?

Back of the hands

What part of the hand is used to assess and compare joint temperature?

Sternoclavicular, acromioclavicular, acromion, and coracoid process

What are four parts of the shoulder girdle that should be palpated?

Shoulder abduction and external rotation with elbow flexion

What does asking a patient to put hands on the back of their head and push elbows back test?

Reach the back as far as possible

How is active shoulder internal rotation tested?

150 to 180 degrees

What is the normal range for active shoulder flexion?

Approximately 40 degrees

What is the normal range for active shoulder extension?

Up to 180 degrees

What is the normal range for active shoulder abduction?

30 to 40 degrees

What is the normal range for active shoulder adduction?

80 to 90 degrees

What is the normal range for active shoulder external rotation?

Keep elbows by the sides flexed at 90 degrees while moving forearms outwards in an arc

How is active shoulder external rotation performed?

80 to 90 degrees

What is the normal range for active shoulder internal rotation?

Feel for crepitus

What should the examiner do during passive movement that is different from active movement?

Empty Can or Jobes Test

Which test assesses for weakness and impingement of the supraspinatus?

First 30 degrees

For how much of the shoulder motion is the supraspinatus responsible?

Abduct to 90 degrees, angle forward 30 to 45 degrees, and internally rotate with thumb down

How is the arm positioned for the Empty Can test?

Supraspinatus

Which muscle is the Jobes test primarily assessing?

Painful Arc or Drop Arm Test

Which test assesses for impingement or a tear of the supraspinatus by having the patient lower their arm?

Between 60 and 120 degrees

Where does impingement or tendonitis of the supraspinatus typically cause pain during abduction?

Drop arm, jagged movement, or pain at 40, 30, or 0 degrees

What three signs suggest supraspinatus injury during the Drop Arm test?

Abduct at the first 15 degrees

What is the specific initial function of the supraspinatus muscle?

Resisted External Rotation

Which test assesses for tendonitis or a tear of the infraspinatus?

Infraspinatus

Which muscle does resisted external rotation primarily assess?

Resisted Internal Rotation

Which test assesses for tendonitis or a tear of the subscapularis?

Subscapularis

Which muscle does resisted internal rotation assess?

Place dorsum of hand on lower back and move it off against resistance

How is resisted internal rotation of the shoulder tested?

Adhesive capsulitis, frozen shoulder, or old age

What are three common reasons a patient might have a severe block for reaching their back?

Subscapularis pathology or a subscapular nerve lesion

What does the inability to move the hand off the back during resisted internal rotation indicate?

Ask how it affects daily activities

What should be asked if a patient presents with a hypermobile elbow?

5 to 15 degrees

What is the normal range for the carrying angle of the elbow?

Fixed flexion deformities

What should be looked for during a lateral inspection of the elbow?

Rheumatoid nodules and psoriatic plaques

What two things should be looked for on the posterior aspect of the elbow?

Lateral epicondyle, olecranon, and medial epicondyle

What three bony landmarks are palpated in an elbow exam?

Biceps tendon

Which tendon is palpated with the elbow flexed to 90 degrees?

0 to 145 degrees

What is the normal range of motion for elbow flexion?

0 degrees

What is the normal degree for elbow extension?

0 to 85 degrees

What is the normal range of motion for elbow pronation?

0 to 90 degrees

What is the normal range of motion for elbow supination?

Origin of the wrist flexors and extensors

Why is resistance applied to the wrist during elbow special tests?

Medial epicondylitis or Golfers Elbow

Which condition involves inflammation of the wrist flexor tendons?

Active wrist flexion against resistance

How is a patient screened for Medial Epicondylitis?

Flexor carpi radialis and flexor carpi ulnaris

Which two forearm muscles are activated during wrist flexion?

Wrist and not the biceps

Where should a patient feel the resistance during a Golfers Elbow test?

Lateral epicondylitis or Tennis Elbow

Which condition involves inflammation of the wrist extensor tendons?

Active wrist extension against resistance

How is a patient screened for Lateral Epicondylitis?

Repetitive motion or cumulative trauma

What is the typical cause of Tennis Elbow?

Cooks, sweepers, and badminton players

What are three examples of people who might develop Lateral Epicondylitis due to flicking their wrist?

Supinate or pronate against resistance while shaking hands

What is another technique to check for epicondylitis besides simple wrist flexion/extension?