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Orthopaedic Assessment

  • ID: age, sex, hand dominance + occupation (if relevant)
  • CC: (chief complaint)
  • HPI: (ChLORIDE FPP)
    • (C) Character: sharp or dull pain
    • (L) Location: region (joint) of origin
    • (O) Onset: sudden vs. gradual
    • (R) Radiation:
    • (I) Intensity: how severe (scale 1-10), impact on ADLs (activities of daily living), is it getting better, worse or staying the same?
    • (D) Duration: acute vs. chronic
    • (E) Events associated: falls, morning stiffness, swelling, redness, joint clicking or locking, muscle cramps, muscle wasting, movement limitation, weakness, numbness or tingling, fever, chills, trauma (mechanism of injury), occupation activities, sports, repetitive movements
    • (F) Frequency: intermittent vs. constant, have you ever had this pain before?
    • (P) Palliative factors: is there anything that makes it better? (rest, activity, meds, heat, cold)
    • (P) Provocative factors: is there anything that makes it worse? (rest, activity, etc.)

  • PMHx: arthritis, gout, osteoporosis, connective tissue disease, past injuries, previous intervention in area of concern (surgery, injections, physiotherapy, etc.), other medical problems
  • Meds: NSAIDs, acetaminophen, narcotics, steroids, immunosuppressants, ASA, anticoagulants, etc.
  • Allergies: antibiotics, anti-inflammatories, anesthetics, etc.
  • FHx: arthritis, osteoporosis, connective tissue disease, malignant hypothermia, etc.
  • SHx: smoking, EtOH, occupation, activity level/exercise, use of mobility aids (cane, walker, wheelchair, etc.)
  • O/E: VITALS, general appearance, ROS (cardiac, resp., neuro, etc.)

1.) Inspection: SEADS, gait, posture

  • Swelling
  • Erythema, Ecchymosis
  • Atrophy
  • Deformity
  • Symmetry

2.) Palpation: TEST CA

  • Tenderness
  • Effusion
  • Swelling
  • Temperature
  • Crepitus
  • Atrophy

3.) Range of Motion (ROM):

  • Active ROM: joint proximal to the joint being examined is immobilized while the pt. moves the joint in question
  • Passive ROM: examiner performs the maneuvers

4.) Neurovascular Assessment: distal pulses & capillary refill, skin colour/temp., sensation & muscle power

5.) Special Tests: joint specific

PEARL

: always examine the joint above & below the area of concern (referred pain) and compare each step of the exam with the contralateral joint/side