history taking in orthopaedics
TRANSCRIPT
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