History Taking in Orthopaedics

History Taking in Orthopaedics

Orthopaedics: Ortho – straight Paedics – children Musculoskeletal systems Bones, joints, muscles, tendons, ligaments, peripheral nerves, blood vessels. special tissue:– meniscus, bursa,

Divisions of Orthopaedics Trauma Surgery Spine Surgery Arthroscopy & Sports Medicine Hand Surgery Paediatric 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

History Taking Patient – story Doctor constructs – history history – systematic, carefully, patiently compiled & informative

Points in history taking • General Information Age Sex Occupation • Presenting Complaint

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

Pain Most Common complain Grading of pain I II III IV V

No pain Mild, can be ignored Moderate, requires treatment Severe, intrusive despite analgesics 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, Changes

↑

activities

Constant boring pain

- Degenerative

- Infective, neoplastic

• Referred pain: From Neck Shoulder Shoulder Elbow Forearm, hand Lumbar Spine LS Spine Region Hip leg Thigh

To Arm Groin Gluteal Thigh, knee, 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

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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 ABC LOC Spine, Joints, limbs Previous history of injury