History Taking in

Orthopaedics

Orthopaedics: Ortho – straight

Paedics – children

Musculoskeletal systems

Bones, joints, muscles, tendons, ligaments, peripheral nerves, blood vessels. special tissue:– meniscus, bursa, cartilage etc.

Divisions of Orthopaedics

Trauma SurgerySpine SurgeryArthroscopy & Sports MedicineHand SurgeryPaediatric Orthopaedics Joint Replacement (Arthroplasty)Oncology

Trauma - 80 % (worldwide)

Our setup - 95%

Group of Diseases

Congenital & Developmental abnormalities Infection & inflammation

Arthritis & rheumatic disorders

Metabolic & Endocrine disorders

Tumors & Lesions that mimic them

Sensory disturbance & muscle weakness

Injury & Mechanical derangement

History Taking

Patient – story

Doctor constructs – history

history – systematic, carefully, patiently compiled & informative

Points in history taking

• General Information

Age Sex

Occupation

• Presenting Complaint

• Pain• Stiffness• Swelling• Instability• Deformity• Limp• Altered Sensation• Loss of function

Symptoms

Pain

Most Common complain

Grading of pain

I No painII Mild, can be ignoredIII Moderate, requires treatmentIV Severe, intrusive despite analgesicsV Very severe, inhibits virtually all activities

• At the site of the pathology:

Location, duration, progression, nature, intensity

Specific Characters of pain

Sharp shooting pain of back - PIVD

Chronic pain, ↑ activities - Degenerative Changes

Constant boring pain - Infective, neoplastic

• Referred pain:

From To Neck Shoulder Shoulder Arm ElbowForearm, hand Lumbar Spine Groin LS Spine Gluteal Region Hip Thigh, knee, legThigh Knee

Autonomic pain:

from autonomic nerves & accompany peripheral blood vessels

e.g. after operation

Poorly understood, often doubted

Stiffness

Symptom of joint involvement

Protective mechanism, spasm around joint

Generalized: Systemic disorder like RA, AS

Localized: to particular joint

Swelling

Soft tissue, joint, bone

After trauma, injury or reactive

Rapidly or slowly

Painful or not

Constant or comes and goes

Same size or ↑

Instability

C/O Joint giving way

Muscle weakness, ligamentous deficiency & disruption

Deformity

Associated with pain & stiffness

c/o knock knees, bowlegs,

Important: Progressive or not

Impaired function or not

Limp

Abnormal pattern of ambulation

Involved joint, dysfunctional muscle,

Due to deformity

Progressive or not

Altered Sensation

C/O tingling, numbness, burning pain

Nerve involvement

Note progressive

Eg. diabetic neuropathy, radiculopathy, laceration

Loss of function

Depends on individual needs

Judged on social, professional, domestic & recreational demands

• Personal history & background work, travel, recreation, home circumstances, support from family & friend

• Family history genetic disease RA. Communicable disease TB

Past Medical History previous trauma, injury, sprain, strain

Systemic Review LBP : Acute UTI PID

Trauma Patient

General History A B C LOC

Spine, Joints, limbs

Previous history of injury