Orthopaedic Assessment

Made Easy
The Matrix Approach
Department of Orthopaedics and Traumatology

TP Lam
 Orthopaedic Assessment

Prohibitive task

Different bones and joints

Different lists of items for physical
examination
 The Learning Objectives

From history to physical examination

The Generic Scheme
 General items
 Standard items
 Specific items

Handle Hx, P/E with confidence and
ease – The Matrix Approach
Let’s do a simulated case

A 80 years old lady with right “hip pain”

 History

Chief Complaint
 Where is the problem ? beware of referral pain

Etiology DDx 1 DDx 2 DDx 3 ...... DDx n
 Physical Onset
 Social Site
 mental Severity

Quality

factor

factor

Macro time

Micro time

Radiation

Associated factor
 History

Complications
 Physical
 Pathological eg AVN, epiphyseal closure, osteoarthritis etc
 Functional eg ambulatory status, activity tolerance, ADL
 Complication due to treatment ie iatrogenic
 Social - occupational, financial, marital, familial
 mental – mood, self-esteem

Prognosticating factors and extent of the disease
 History

Patient’s background - Physical

 MSK
 Handedness
 Pre-morbid ambulatory status

 Daily activities requirement – job, hobbies, sport,

living environment
 Response to previous treatment

 Patient’s expectation
 History

Patient’s background - Physical

 Medical
 Past health
 Medication

 Previous operation

 Allergy

 Birth history

 Developmental history

 Immunization
 History

Patient’s background - Physical

 Medical
 Menstrual
 Obstetric history

 Smoking, drinking,

 Illegal drug

 Traveling history

 Familial disease
 History

Patient’s background -
Psychosocial background
 Marital
 Family
 Occupational
 Living / environmental
 Other social
 Prognosticating factors Physical
social
And extent of disease Mental

etiology Main problem Complication

(including iatrogenic)
Physical Physical
social social Physical
Mental Mental social
Mental

Background
(Response to previous treatment
Patient’s expectation)
Physical
social
Mental
 Main dish at dinner –
tarred “Chinese Fried Rice”

Tray :- background

Core problem :- “Chinese Fried Rice”

Ingredient :- etiology

Tarred :- complication

The customer response :- prognosticating
factor
 Prognosis &
Etiology Problem Complication Background Extent of ds

History
 Physical examination

P/E must be done when you have a list of

differential diagnoses in mind

Pre-requisites
 Good history
 Physical examination

Introduction

Mind-set for inspection, palpation, movement,

General Standard Specific

Posture Components Components
Gait
 Introduction

introduce yourself,

ask patient’s name,

Ask for permission to exam and explain what you will do

ask the patient where is the pain, reassure him that if there is any pain or
discomfort, you will stop immediately

+/- chaperone

Determine position of patient (eg supine, sitting, prone )

Make sure patient is comfortable

be polite, gentle and considerate

(treat your patient in a way you would
like your dentist to treat you)

Hygienic measure:- wear a mask, wash
hand
 Mind-set

Before you inspect
 Adequate exposure
 Look from all directions

Before you palpate
 Ask patient where the pain is ….
 Check every anatomical landmark in details

For movement
 check both active and passive ROM

Wash hand afterwards
 Physical examination

General examination
 General appearance eg dysmorphic feature
 Ligamentous laxity
 Other stigmata of underlying medical
problems eg anemia
 Height and weight

Posture

Gait
 Gait

A must for all patients with spine and

lower limb problems

Gait can be observed right at the time
when the patient enters the
consultation room
 Gait

Walking
 Normal, tip-toe walking, heel walking

Standing

Sitting

Squatting

Jumping on one leg or both legs

running
 Walking

Cadence, step length, stride length, velocity,

rhythm, balance, swing and stance phase

Unusual pattern
 Trendelenburg gait, antalgic gait, foot drop gait
etc…..

Trunk, hip, knee, ankle and foot at swing and
stance phases
 Posture

See how they handle their belongings

See how well they undress themselves for
examination eg take off their sleeves
 Only with patient’s permission
 Physical examination

Introduction

Mind-set for inspection, palpation, movement,

General Standard Specific

Posture Components Components
Gait
 Standard components

Look, feel, move, percussion, auscultation

Skin, muscle, bone, joint, any mass

Artery, vein, lymphatics and nerve

The Examination Matrix I and II
Color
Trophic change
Hair status
Skin texture
Ulcer
Hemangioma
Pigmentation
Scar
The examination matrix I
Sinus
Dilated vein
Swelling eg
rheumatoid nodule,
gouty tophi
Skin Muscle Bone Joint Mass
bruising Look Muscle bulk Mass Deformity Look for any
Spasm Length – Effusion mass, swelling
Mass apparent, real Soft tissue swelling site, size and
Deformity shape

Feel Temperature Muscle spasm / Any mass Tenderness Soreness

tone Contour Effusion Structure
Compartment Tenderness Synovial Surface
Mass thickening Skin, tissue
plane
Move – ROM
active Crepitation
passive Jerk, click

Percuss For For percussion

fasciculation tenderness

auscultate Crepitation Bruit

 The examination matrix II
Artery Vein Lymphatics Nerve Nerve
Motor sensory
Look Color Dilated vein Lymphedema Muscle wasting
Trophic change edema fasciculation
Ulcer
Feel Temp Temp LN Muscle tone Test sensation
Pulse
Move – Power
active Clonus,
passive Babinski

Percuss Reflex Tinel

auscultate bruit
 Specific components

Shoulder

Elbow

Wrist

Hand and finger

Hip

Knee

Ankle

Neck

Thoracic and lumbar spine

SIJ
 When finish

Thank the patient

Put back clothing

Make sure patient is comfortable

Mention you will explain to the patient your
findings
 Selective

Examples
 Elderly patient in the surgical ward
 2 years old boy in the paed ITU
 A 20 years old chef with finger tip injury
Specific components

Shoulder

Elbow

Wrist

Hand and finger

Hip

Knee

Ankle

Neck

Thoracic and lumbar spine

SIJ
 Hip - specific components

Thomas’s test
 Flex the normal hip till lumbar lordosis obliterated
 Press down abnormal leg to check flexion deformity of hip joint

Trendelenburg’s test
 Adequate exposure
 Can be done from front or back
 Lift normal leg just by flexing knee to 90 degrees (hip remains
neutral in extension)
 Assess for tilting of pelvis to the normal side
 When at front, feel pressure of patient’s hand on examiner’s hand
 When at back, monitor pelvic movement by checking position of PSIS
 Beware of delayed Trendelenburg’s test (ie wait for 30 seconds)

Trendelenburg’s gait
 Trendelenburg’s test
illustrated with a case with right hip problem

Positive if pelvis dropped

on unsupported left side
with or without
 Left leg stretch out to support
a toppling trunk
 Pressure of patient’s left hand
on your right hand
 Trunk toppled or tilted to left
side with impending fall to
left side
 Trunk lean to right side as in
photo

From “The adult hip” by “John K Callaghan” 1998, Lippincott-Raven

 Trendelenburg’s test
illustrated with a case with right hip problem

Sometimes the patient may

have trunk tilted to right
side with pelvis raised by
left leg just before the left
leg is raised
 This is strictly speaking not a
Trendelenburg sign, but the
posture is suggestive of
abductor insufficiency

From “The adult hip” by “John K Callaghan” 1998, Lippincott-Raven

 Trendelenburg’s test
illustrated with a case with right hip problem

Positive Trendelenburg test

is due to abductor
insufficiency due to
 Weak abductor
 Decreased lever arm at hip
joint
 Painful hip arthropathy
causing functional abductor
weakness

From “The adult hip” by “John K Callaghan” 1998, Lippincott-Raven

 Trendelenburg gait

From “The adult hip” by “John K Callaghan” 1998, Lippincott-Raven

 Hip – points to note

Length measurement

Apparent leg length discrepancy checked by
 Measuring from umbilicus (or xiphisternum) to
medial malleolus
 Due to pelvic obliquity, hip adduction deformity
 Hip – points to note

Real leg length discrepancy checked by

 Square pelvis
 Upper trunk along axis of bed
 Line joining both ASIS perpendicular to spine
 Note any abduction or adduction deformity of hip
 Abduct or adduct normal hip at same degrees
 Measure length on both sides
 From ASIS to medial malleolus (MM)
 From ASIS to medial knee joint line (KJL)
 From KJL to MM
 From greater trochanter to KJL
 Block test
 With 0.5cm, 1cm, 1.5 cm blocks etc
 Hip – points to note

Leg length
 Need to determine which segment is involved
 Above trochanter:- Bryant triangle, Klisic’s line
 Check greater trochanter – KJL difference
 Check KJL to MM difference
 Flex both hips and knees and assess relation of
knee between R and L sides
 Hip – points to note

Look for gluteal muscle wasting

ROM
 Flexion and extension
 Fix the pelvis by flexing normal hip before testing for flexion
 IR and ER – beware of wrong direction
 Abduction and adduction
 Use forearm to stabilize pelvis before checking these movement
 Knee - specific components

MCL
 Valgus stress test:- with knee at 30 degrees
flexion
 Compare both sides

LCL
 Varus stress test:- with knee at 30 degrees
flexion
 Compare both sides
 Knee - specific components

ACL
 Anterior drawer
 Make sure tibial stepoff normal, and same for both
sides
 Lachman’s test

PCL
 Posterior sag test
 Posterior drawer test
 Knee - specific components

Meniscal sign
 Flex knee
 U swing the leg
 Posterior lesion

 30 degrees flexion of knee first

 Then press on medial and lateral knee joint line
 Extend knee

 Anterior lesion if pain or click

 Knee - specific components

Meniscal sign
 Mcmurray
 For medial meniscus
 90 degrees knee flexion, external rotate, valgus stress
 Then gradually extend knee
 Look at patient face for apprehension, locate the site of pain if
present, feel knee for click an tenderness, feel for locking
 For lateral meniscus
 Same except internal rotate, varus stress
 Knee - specific components

Meniscal sign
 Apley
 Patient prone
 Knee flexed at 90 degrees

 Compression while rotating tibia :- meniscal problem

 Distraction while rotating tibia :- ligamentous problem

 Knee - specific components

Patellar and extensor mechanism

 Palpate patellar facet
 Feel for crepitus at PFJ as knee is flexed and extended
 Extension power at knee
 Q angle
 Formed between the midaxis of the femur and the line extending from
the mdipoint of the patella to the tibial tubercle. ( abnormal if > 15
degrees)
 Check patellar mobility
 Patellar mobility (medial and lateral) usually less than ½ of its width
 Apprehension test
 Laterally shift patella as one is flexing the knee
Knee - specific components

J sign:- As the knee is
extended from a 90-degree
flexed position (A) to a fully
extended position (C), the
patella describes an
exaggerated inverted J-shaped
course, indicating
predominance of laterally
directed forces.

From DeLee: DeLee and Drez's Orthopaedic Sports Medicine, 2nd ed

 Knee – points to note

Look
 Quadriceps wasting
 Genu valgus, varus but make sure both patellae are
facing forward and no knee flexion deformity
 Intercondylar distance
 Inter-malleolar distance
 Tibio-femoral angle

Effusion
 Patellar tap (displace fluid from suprapatellar pouch first)
 Fluid displacement (keep hand on suprapatellar pouch
 Fluid thrill
 Knee – points to note

Landmarks for palpation

 Femoral condyle, collateral attachment,
 Knee joint line
 Tibial condyle, tibial tuberosity, fibular head
 Patellar tendon, patella
 Shoulder - specific components

Shoulder instability
 Apprehension test
 Load + shift test
 Relocation test
 Sulcus sign
 Shoulder - specific components

Impingement
 Neer’s impingement sign
 Hawkin’s sign

Biceps tendon problem
 Palpation for tenderness
 Speed’s test
 Yergason’s test
 Shoulder - specific components

Rotator cuff
 External rotation against resistance – infraspinatus, teres
minor
 Empty beer can test, Painful arc– supraspinatus
 Lift off test – subscapularis

ACJ
 Direct palpation for tenderness
 Cross flexion test
 Shear test

Scapular winging
 Shoulder - points to note

Look :- deltoid wasting

Bony landmarks for palpation :- clavicle, ACJ,
acromion, subacromial area, coracoid, scapula,
humeral head, (biceps tendon)

ROM:-
 flexion, extension, (with shoulder internally rotated and
externally rotated)
 abduction, adduction, (glenohumeral and scapulothoracic)
(with externally rotated shoulder)
 ER, IR
 Elbow - specific components

Elbow laxity
 Varus stress test
 Valgus stress test

Tests for tennis elbow
 Pain over lateral epicondyle with resisted wrist extension
with elbow extended and pronated
 Similar procedure but for resisted finger extension

Tests for golfer’s elbow
 Pain over medial epicondyle with resisted wrist flexion
with elbow extended and supinated
Elbow – points to note

Carrier angle
 Cubitus valgus, varus

Bony landmarks for palpation
 Lateral condyle
 Medial epicondyle
 Olecranon process, ulna
 Radial head, neck, then shaft
 Radio-capitellar joint
 Front of elbwo
 Ulnar nerve at cubital tunnel

ROM
 Flexion, extension
 Supination, pronation
wrist - specific components

DRUJ stability

De Quervain’s disease
 Finkelstein test

Allen’s test
 Wrist – Points to note

Bony landmarks for palpation

 Distal radius, Lister’s tubercle, styloid process
 Distal ulna, styloid process
 DRUJ
 Anatomic snuffbox
 Carpal tunnel boundary
 Scaphoid tubercle, trapezium, pisiform, hook of hamate

ROM
 Dorsiflexion, palmarflexion
 Radial and ulnar deviation
 Supination and pronation
 Hand and finger - specific
components

Allen’s test

Pinch grip, thumb to side of index grip

Abduction and adduction stress on IPJ

FDS/FDP action

Cross finger test

Froment’s test

O sign (FPL, FDP)
 Hand and finger – points to note

Trigger finger

Mallet finger

Swan neck deformity

Boutonniere deformity

Z-deformity of thumb
 Ankle – specific components

Ligaments: Inferior tibio-fibular syndesmosis

 Dorsiflex ankle or
 Laterally shift hindfoot
 Squeeze test
 Locally stress lateral malleolus
 External rotational stress test
 Ankle – specific components

Ligaments:
 Anterior drawer test for ankle joint
 Compare both sides
 Test the anterior talofibular ligament

 Talar tilt test (varus)

 With ankle neutral:- test calcaneofibular ligament
 With ankle plantarflexed:- test anterior talofibular
ligament
 Talar tilt test (valgus)
 Test integrity of deltoid ligament
Ankle – specific components

Tendon:
 Tibialis posterior tendon tenderness
 Peroneal tendon tenderness
 Tendoachilles
 Look for gap
 Palpate for gap

 Test plantarflexion power

 Single leg heel raise

 Simmonds, / Thompson’s test

Ankle – specific components

Examine the sole for callosity and

Shoe !

For physiologic flat foot:-
 Medial arch apparent when
 Passive dorsiflexion of big toe
 Tip toe
 Ankle – points to note

Deformity
 Hindfoot
 Varus , valgus (tibial calcaneal angle)
 Calcaneus, equinus
 Forefoot
 Adduction, abduction

ROM
 Differentiate between ankle and subtalar joint movement
 Ankle :- dorsiflexion, plantarflexion
 Subtalar :- inversion, eversion
 Ankle – points to note

Landmarks
 Os calcis, talar head
 Lateral malleolus, medial malleolus
 Navicular tuberosity,
 MT bones, cuboid
 Ankle joint line
 Medial longitudinal arch
 Neck - specific components

Radiculopathy sign
 Spurling’s test

Myelopathic sign
 Hoffmann’s sign
 Lhermitte’s test
 10 seconds test
 Finger escape test
 Inverted supinator reflex

Neurological examination of upper / lower limbs
 Motor, myotome
 Sensory, dermatome
 Neck – points to note

Torticollis

ROM
 Flexion, extension
 Lateral rotation
 Lateral flexion
 Thoracic spine - specific
components

Forward bending test
 A test for apical rotation of spine
 Ask patient to put both feet together and facing forward,
keep knees straight, then slowly bend forward with both
hands kept in midline in dependent position

Plumb line for trunk shift

Neurology of lower limbs
 Motor, myotome
 Sensory, dermatome
 Abdominal reflex
 Lumbar spine - specific
components

SLR
 Make sure hip is normal
 Make sure no hamstring tightness

Lasegue’s test
 Completed by lower the leg slightly followed by
dorsiflexing the ankle to reproduce pain shooting down
the lower limb

Bowstring test

Cross SLR
 Lumbar spine

Reversed Lasegue test / femoral stretch test

 Test for femoral nerve tension sign

Neurology of lower limbs
 Motor and sensory
 Lumbar and Thoracic spine –
points to note

Deformity
 Hypo, hyper – kyphosis of lordosis

Shober’s test
 Differentiating from hip stiffness

Palpation
 Every single vertebra with its spinous process
 Check for stepping
 SIJ

Pelvic compression

Pelvic stretch

Fabere test / Patrick test
 Thoracic Outlet Syndrome

Adson’s test

Halstead’s test

Roo’s test
 Radial nerve

Posture:- a paper while dorsiflexing at wrist

Numbness at dorsum of anatomic snuffbox

Wasting
 Triceps, brachioradialis, ECRL, ECRB, forearm
extensor muscle,
 Radial nerve

Motor loss
 Extension at MCPJ and IPJ of thumb (EPL inserted to DP, EPB inserted to
PP)
 Weakness at abduction of thumb
 APL, supplied by PIN, is affected and APL is inserted to APB or into radial side
of the base of the first metacarpal bone (APB, supplied by median nerve, may be
normal, APB is inserted to proximal phalanx of thumb)
 Extension at MCPJ of all fingers (note that extension at IPs of fingers can be
preserved due to action of lumbricals)
 Wrist drop with weakness at ECRL (to 2nd MC base, supplied by radial
nerve per se) and ECRB (to 3rd MC base, supplied by PIN)
 Radial nerve

Motor loss
 ECU
 Supinator:-
 Supination with elbow extended (ie avoid action of biceps which
can supinate forearm with elbow flexed at 90 degrees)
 brachioradialis
 Elbow extension

Special test
 Tinel sign
 Ulnar Nerve

Posture:-
 claw hand deformity
 Less clawing in high ulnar nerve lesion because weak FDP to
little finger give less clawing and vice versa
 Scissoring:- can not adduct finger

Sensation loss
 Volar and dorsum of ulnar 1.5 fingers
 Volar (hypothenar area by way of palmar cutaneous
branch) and dorsum of hand (by way of dorsal cutaneous
branch)
 Ulnar Nerve

Muscle wasting
 Dorsum of first webspace

Motor loss
 Froment’s test
 Finger abduction and adduction
 Little finger abduction
 Little and ring finger FDP
 FCU

Special test
 Tinel sign
 Ulnar nerve subluxation
 Median Nerve

Posture
 Benediction posture

Sensation loss
 Volar and dorsal surface of radial 3.5 fingers
 Volar surface of palm (if palmar cutaneous
branch affected)
 Dorsal surface of hand not affected because
supplied by radial nerve, <compare with ulnar
nerve>
 Median Nerve

Motor loss
 Pronation
 Palmaris longus
 FCR
 FPL (inserted to DP, ie flex IPJ of thumb)
and FPB (inserted to PP, ie flex at MCPJ
of thumb
 FDS to all fingers
 FDP to index and middle fingers
 Median Nerve

Motor loss
 Lumbrical to index and middle
fingers
 APB (feel for its contraction)
 Thumb opposition

Special test
 Tinel sign
 AIN

Posture
 “O” sign

Sensation loss
 None

Motor loss
 FPL, FDP to index and middle
fingers, pronatus quadratus
 Carpal Tunnel Syndrome

Posture
 Normal

Sensation loss
 Volar side and dorsal surface of radial
3.5 digits
 Volar surface of hand not affected unless
palmar cutaneous branch course
underneath flexor retinaculum
 Carpal Tunnel Syndrome

Motor loss
 APB weak, proved by feeling its
contraction
 Thumb opposition weak

Special tests
 Phalen’s test
 Reversed Phalen’s test
 Tinel sign
Analysis of MSK problem (per se)

Skin Ulcer

Power
Muscle
Contracture / Spastic

Length
Deformity :- frontal, sagittal,
Bone rotational
Texture eg osteoporosis
Stability / fracture
Stiffness
Joint Instability / dislocation
degeneration
Analysis of MSK problem (per se)

Vascular insufficiency
Artery
Compartmental syndrome

Vein Venous insufficiency

Sensation loss (including

proprioception)
Nerve Neurogenic pain
In-coordination

Compression, mechanical effect

Mass
eg spinal stenosis, nerve
effect entrapment
 Matrix Approach
Prognosis /
Etiology Problem Complication Background extent of ds

History
 Matrix Approach
Prognosis
Prognosis//
Etiology Problem Complication Background extent
extentof
ofds
ds

History

P/E
 Mental
3D-Matrix
Social
Physical
Prognosis /
Etiology Problem Complication Background extent of ds

History

P/E
 Mental
3D-Matrix
Social
Physical
Prognosis /
Etiology Problem Complication Background extent of ds

History

P/E

Investigation
 Mental
Domain
3D-Matrix
Social
Physical
Prognosis /
Etiology Problem Complication Background extent of ds

History
Theme
P/E Tools

Investigation

Things To Do
 Physical social mental

MSK Occupational
Medical Financial
Iatrogenic complication Marital
Response to past Px family
Patient’s expectation hobbies

Next slide for MSK

problem listing
 After history taking and P/E

Physical
 Right hip pain ? Fracture neck of femur
 Cataract
 DM on medication
 Family history of geriatric fracture, osteoporosis
 Fever, cough with yellowish sputum? Chest infection
 PH:- allergic to penicillin
 MSK:-
 pre-morbid barely independent ADL
 Requirement:- for self care, to regain independence ADL
 After history taking and P/E

Social
 Living with son, daughter-in-law
 both need to work for a living
 3 years old granddaughter

 Finance:- on public Assistance

 Living at NT cottage with poor lighting
 ? Neglected by other family members
 Entered into a difficult situation for the family
 After history taking and P/E

Mentally
 Mild dementia
 Feeling worried and depressed
 WHO classification of health

Physical social mental

MSK Occupational
Medical Financial
Iatrogenic complication Marital
Response to past Px family
Patient’s expectation hobbies

Next slide for MSK

problem listing
 Mental
3D-Matrix
Social
Physical
Prognosis /
Etiology Problem Complication Background extent of ds

History

P/E

Investigation

For Med 5 Σ MSK

Conclusion Σ Σ MSK analysis analysis
Σ Σ

Management Etiology Problem Complication Background prognosis

 Conclusion – History taking

History DDx 1 DDx2 DDx3 ............... DDxn

Onset

 CC Quality

Severity
 HPI Location

 PH ....... Aggravating factor

Relieving factor

Time relationship:-
Micro
Time relationship:-
Macro

Radiation

Associated Factor
 Conclusion – History taking

History DDx 1 DDx2 DDx3 ............... DDxn

Onset

 CC
Tools
Quality

Severity
 HPI Location

 PH ....... Aggravating factor

Relieving factor

Time relationship:-
Micro
Time relationship:-
Macro

Radiation

Associated Factor
 Theme
Prognosticating factors Physical
social
Extent of disease Mental

Complication
etiology Main problem Physical
Physical Physical Treatment
social social
Mental Mental
Psycho-social
Physical
social
Mental
Background
Physical
social
Mental
 Conclusion - Physical examination

Introduction

Mind-set for inspection, palpation, movement,

General Standard Specific

Posture Components Components
Gait
Color
Trophic change
Hair status
Skin texture
Ulcer
Hemangioma
The examination matrix I
Pigmentation
Scar
Sinus
Dilated vein Skin Muscle Bone Joint Mass
bruise etc
Look Muscle bulk Length – Effusion Look for any
Fasciculation apparent, real Deformity mass,
Spasm Deformity swelling
spasticity
Feel Temperature Muscle tone Tenderness Tenderness
Spasm Any mass effusion
Move – ROM
active Crepitation
passive Jerk, click
Percuss For For
fasciculation percussion
tenderness
auscultate bruit
 The examination matrix II
Artery Vein Lymphatics Nerve Nerve
Motor sensory
Look Color Dilated vein Lymphedema Muscle wasting
Trophic change edema fasciculation
Ulcer
Feel Temp Temp LN Muscle tone Test sensation
Pulse
Move – Power
active Clonus,
passive Babinski

Percuss Reflex Tinel

auscultate bruit
 The examination matrix II
Artery Vein Lymphatics Nerve Nerve
Motor sensory
Look Color Dilated vein Lymphedema Muscle wasting
Trophic change edema fasciculation

Feel
Ulcer
Temp Tools
Temp LN Muscle tone Test sensation
Pulse
Move – Power
active Clonus,
passive Babinski

Percuss Reflex Tinel

auscultate bruit
 Theme
Prognosticating factors Physical
social
Extent of disease Mental

Complication
etiology Main problem Physical
Physical Physical Treatment
social social
Mental Mental
Psycho-social
Physical
social
Mental
Background
Physical
social
Mental
 Mental
Domain
3D-Matrix
Social
Physical
Prognosis /
Etiology Problem Complication Background extent of ds

History

P/E

Investigation

Tools Theme Domain

 Physical social mental

MSK Occupational
Medical Financial
Iatrogenic complication Marital
Response to past Px family
Patient’s expectation hobbies

Next slide for MSK

problem listing
 WHO classification of health

Physical social mental

MSK Occupational
Medical Financial
Iatrogenic complication Marital
Response to past Px family
Patient’s expectation hobbies

Next slide for MSK

problem listing
Thank You
 Workshop on
“Meeting with the Elite Athletes-- Injury
Management in Sports”

as part of the SMART Convention

time:- 11:30am, 9-June-07

venue:- Shaw Auditorium, 1/F, School of Public
Health Building School of Public Health building

Opening Ceremony of SMART Convention which
will be held at 10:15am.

enroll with your class representatives and

try to attend the Opening Ceremony
 PMUS3

Problems with printing of teaching files?