History Taking in Orthopaedics

July 19, 2017 | Author: Vaibhav Krishna | Category: Orthopedic Surgery, Paresthesia, Pain, Knee, Peripheral Neuropathy
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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


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


Systemic disorder like RA, AS


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 ABC LOC Spine, Joints, limbs Previous history of injury

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