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Orthopaedic Disorders in General Practice von L M Newell, Richard (eBook)

  • Verlag: Elsevier Reference Monographs
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Orthopaedic Disorders in General Practice

Orthopaedic Disorders in General Practice

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    Format: ePUB
    Kopierschutz: AdobeDRM
    Seitenzahl: 135
    Sprache: Englisch
    ISBN: 9781483182650
    Verlag: Elsevier Reference Monographs
    Größe: 1802 kBytes
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Orthopaedic Disorders in General Practice

Chapter 3 The Clinical Examination

Publisher Summary

This chapter reviews the different types of orthopedic clinical examinations that a practitioner must commit to reach an initial diagnosis. The basic requirement of orthopedic clinical examination requires good light and sufficient room to watch the patient walk, stand, undress, and get on and off a couch. It is not mandatory that every patient undresses completely for examination, but the presenting part should always be examined unclothed. The unobtrusive observation of the patient's gait, and body movements while talking, undressing, and moving on, off, and around the examination couch provides valuable information to the doctor. Also, inconsistencies between real and apparent - complained of - degree of disability and between ranges of joint movement elicited in the formal examination and the informal are of great value in assessing the relative importance of organic and functional components to the presenting complaint. For a more formal examination of the interned patient, the examining doctor has to follow the simple paradigm of look, feel, and move; this order of examination is important and must be followed without fail. The doctor needs to develop a baseline economical neurological assessment that will exclude the dangerous patterns and recognize the common patterns of abnormality. Here again informal examination plays a part, for example, noticing the patient's gait, any abnormalities of limb position on movement, the degree of facility with which the patient unbuttons his shirt or laces his shoes.

Orthopaedic clinical examination is neither difficult nor complicated. The requirements are simple: good light and sufficient room to watch the patient walk, stand, undress and get on and off a couch. A tape measure and a reflex hammer are useful, but not essential.

It is not mandatory that every patient undress completely for examination, but the presenting part should always be examined unclothed. Patients complaining of back pain must be examined stripped to the least garments necessary to preserve modesty and dignity. Patients with neck and shoulder pain should strip to the waist with the same consideration, and those presenting with hip and knee pain should remove trousers, skirt and petticoat and tights or stockings.
Formal and informal examination

Unobtrusive observation of the patient's gait, body movements while talking and undressing and moving on, off and around the examination couch can give much valuable information to the doctor. These observations should be correlated with the history and taken in conjunction with the 'non-verbal history' to which reference has already been made. Inconsistencies between real and apparent (complained of) degree of disability, and between ranges of joint movement elicited in the formal examination and the 'informal', are of great value in assessing the relative importance of organic and functional components to the presenting complaint. Common examples are the patient with the rigid back and grossly limited straight leg raise on formal examination who can both sit upright with straight knees and bend fully to remove shoes and socks, or the patient whose neck or shoulder is apparently stiff and painful who removes or dons coat or pullover without difficulty.

Further specific discussion of the elucidation of 'non-organic signs' will be found in Chapter 8 Low Back Pain ( pp. 35 - 49 ). Informal examination is also of paramount importance where the patient is unable either to give a history or to co-operate with formal examination for reasons of age (infancy and the elderly confused) or mental deficiency.
Formal orthopaedic examination

General principles

No better rubric can be adv

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