DIAGNOSIS IN

ORTHOPAEDIC
S
 DYNAMIC ACTIVITY OF CELL

GROSS LESSION
-CLINICAL TISSUE REACTION
-RADIOGRAPHIC PATHOLOGICAL PROCESS
-LABORATORY

RATIONALE OR REASON
DIAGNOSTIC FOR TREATMENT

PATIENT
 ORTHOPAEDIC IS
CONCERN WITH:
BONES
JOINTS
MUSCLES
TENDONS
NERVES
VASCULARS
CONDITIONS THAT AFFECT THE
MUSCULOSCLETAL SYSTEM :
CONGENITAL AND DEVELOPMENT
ABNORMALITY
INFECTION AND INFLAMMATION
ARTHRITIS AND RHEUMATIC DISORDERS
METABOLIC DYSFUNCTION AND
DEGENERATION
TUMOURS AND LESIONS THAT MIMIC THEM
SENSORY DISTURBANCE AND MUSCLE
WEAKNESS
INJURY AND MECHANICAL DERANGEMENT
 DIAGNOSIS IN
ORTHOPAEDICS
1. HISTORY
2. EXAMINATION
3. DIAGNOSTIC IMAGING
4. BLOOD TESTS
5. SYNOVIAL FLUID ANALYSIS
6. BONE BIOPSY
7. ARTHROSCOPY
8. ELECTRODIAGNOSIS
 HISTORY
a. SYMPTOMS (PRESENT HYSTORY)
b. PAST HISTORY
c. FAMILY HISTORY
d. SOCIAL BACKGROUND
 HISTORY
SYMPTOMS (PRESENT HYSTORY)
ONSET
LOCATION
CHRONOLOGIC
QUALITY
QUANTITY
INFLUENCE FACTORS
CONCOMITANT SYMPTOMS
 SYMPTOMS
OF MUSCULOSCLETAL
SYSTEM
LOOK WRONG:
SWELLING
DEFORMITY
FEEL WRONG:
PAIN
CHANGE IN SENSIBILITY
MOVE WRONG:
STIFFNESS
WEAKNESS
INSTABILITY
LOSS OF FUNCTION
 PAIN
PAIN FROM DAMMAGED TISSUE
REFFERT PAIN
AUTONOMIC PAIN
 PAIN
GRADE I MILD :PAIN THAT CAN EASILIY BE
IGNORE
GRADE II MODERATE : PAIN THAT CANNOT
BE IGNORED, INTERFERS WITH
FUNCTION AND NEEDS TREATMENT
FROM TIME TO TIME
GRADE III SEVERE : PAIN THAT IS PRESENT
MOST OF THE TIME, DEMANDING
CONSTANT ATTENTION
GRADE IV TOTALLY INCAPACITATING PAIN
 EXAMINATION

a. GAIT AND LIMP

b. EXAMINATION OF THE EFFECTED
PARTS
c. NEUROLOGICAL EXAMINATION
 GAIT AND LIMP

HEEL STRIKE
STANCE PHASE
TOE OFF
SWING PHASE
 EXAMINATION OF
THE EFFECTED
LOOK
SKIN
SHAPE
POSISITION
FEEL
SKIN
SOFT TISSUE
BONES AND JOINT
TENDERNESS
MOVE
ACTIVE
PASSIVE
ABNORMAL
 LOOK
SKIN
SHAPE
POSISITION
 EXAMINATION OF THE
EFFECTED
DEFORMITY
JOINT DEFORMITY
BONE DEFORMITY
 DEFORMITY

VARUS AND VALGUS

KHYPOSIS AND LORDOSIS
SCOLIOSIS
FIXED DEFORMITY
POSTURAL DEFORMITY
 Pathophysiogy OF
JOINT DEFORMITY
CONTRACTURE OF THE OVERLYING
SOFT TISSUES
MUSCLE IMBALANCE
CHRONIC ARTHRITIS
 SIX CAUSES OF JOINT
DEFORMITY
SKIN CONTRACTURE
FASCIAL CONTRACTURE
MUSCLE CONTRACTURE
MUSCLE IMBALANCE
JOINT INSTABILITY
JOINT DESTRUCTION
 SIX CAUSES OF BONE
DEFORMITY
CONGENITAL DISORDERS
BONE SOFTENING
DYSPLASIA
GROWTH PLATE INJURY
FRACTURE MALUNION
PAGETS DISEASE
 FEEL
THE SKIN
SOFT TISSUE
BONE AND JOINTS
TENDERNESS
 IN BONY LUMPS FIND
SITE
SIZE
MARGIN
CONSISTENCY
TENDERNESS
MULTIPLICITY
 MOVE
ACTIVE
PASSIVE
ABNORMAL
 NORMAL MOVEMENT
FLEXION/EXTENSION
ADDUCTION/ABDUCTION
EXTERNAL ROTATION/INTERNAL
ROTATION
PRONATION/SUPINATION
CIRCUMDUCTION
 JOINT STIFFNESS
ALL MOVEMENTS ABSENT
ALL MOVEMENTS LIMITED
SOME MOVEMENTS LIMITED

REMEMBER RANGE
OF MOTION
 JOINT LAXITY
IN CHILDREN MORE MOBILE
PERSISTENCT GENERALIZED JOINT
HYPERMOBILITY
DISEASE
SOFT TISSUE DISORDERS
NEUROLOGICAL
EXAMINATION
GENERAL APEARANCE
ASSESING MOTOR FUNCTION
ASSESING SENSORY FUNCTION
NEUROLOGICAL EXAMINATION

APPEARANCE
TONE AND POWER
POWER ( 0 - 5 )
TENDON REFLEXES
SUPERFICIAL REFLEXES
THE PLANTAR REFLEX
SENSIBILITY
CORTICAL AND CELEBELLAR FUNCTION
 SENSIBILITY
HYPERAESTHESIA
HYPOAESTHESIA
ANAESTHESIA
TEMPERATUR RECOGNATION
TWO POINT DISCRIMINATION
VIBRATION TEST POSITIONING
SENSESENSE OF JOINT POSTURE
STEREOGNOSIS
THE SENSE OF BALLANCE
 DIAGNOSTIC
IMAGING
a. PLAIN FILM RADIOGRAPHY
b. X-RAYS USING CONTRAST MEDIA
c. XERORADIOGRAPHY
d. TOMOGRAPHY
 DIAGNOSTIC
IMAGING
e. COMPUTED TOMOGRAPHY (CT)
f. MAGNESTIC RESONANCE IMAGING
(MRI)
g. DIAGNOSTING ULTRASOUND
h. RADIONUCLIDE IMAGING
 PLAIN FILM
RADIOGRAPHY
HOW TO READ AN X-
RAY
THE PATIENT/IDENTITY
THE SOFT TISSUES
SHAPE
DENSITY
THE BONES
SHAPE
DENSITY
ARCHITECTURE:PERIOSTEAL,CORTEX,ENDOSTEUM
THE JOINT
DIAGNOSTIC ASSOCIATIONS
 X-RAYS USING CONTRAST
MEDIA

SINOGRAPHY
ARTHROGRAPHY
MYELOGRAPHY
XERORADIOGRAPHY
 COMPUTED
TOMOGRAPHY (CT)
MAGNESTIC
RESONANCE
IMAGING (MRI)
DIAGNOSTIC
ULTRASOUND
 RADIONUCLIDE IMAGING

BONE-SEEKING ISOTOPES
OTHER RADIONUCLIDE COMPOUNDS
BONE-SEEKING ISOTOPES
99M
TcHDP
INCREASED ACTIVITY IN THE
PERFUSION PHASE
DECREASED ACTIVITY IN THE
PERFUSION PHASE
INCREASED ACTIVITY IN THE BONE
PHASE
DIMINISHED ACTIVITY IN THE BONE
PHASE
 OTHER RADIONUCLIDE
COMPOUNDS
TECHNETIUM-LABELLED SULPHUR
COLLOID
GALLIUM-67
INDIUM-111-LABELLED LUCOCYTES
 BLOOD TESTS
a. NON-SPECIFIC BLOOD TESTS
b. RHEUMATOID FACTOR TESTS
c. TISSUE TYPING
d. BIOCHEMISTRY
 NON-SPECIFIC BLOOD
TESTS
NON-SPECIFIC BLOOD ABNORMALITIES
HYPOCHROMIC ANAEMIA
LEUCOCYTOSIS
ERYTHROCYTE SEDIMENTATION RATE
(ESR)
C-REACTIVE PROTEIN
PLASMA GAMMA-GLOBULINS
 SYNOVIAL FLUID
ANALYSIS
ACUTE JOINT SWELLING AFTER
INJURY
SUSPECTED INFECTION
ACUTE SYNOVITIS IN ADULTS
CHRONIC SYNOVITIS
 SYNOVIAL FLUID
ANALYSIS
a. TECHNIQUE
b. GROSS EXAMINATION
c. MICROSCOPIC EXAMINATION
d. LABORATORY TEST
 BONE BIOPSY

a. OPEN OR CLOSED
b. PRECAUTIONS
 ARTHROSCOPY

a. TECHNIQUE
b. DIAGNOSIS
c. COMPLICATIONS
ELECTRODIAGNOSIS

a. MOTOR NERVE CONDUCTION

b. SENSORY CONDUCTION
c. ELECTROMYOGRAPHY
d. INTERPRETATION AND DIAGNOSIS
INTERPRETATION

DATA/PROBLEM
HYPOTHESIS/DD
MECHANISM
MORE INFORMATION
LEARNING ISSUE
MEET THE EXPERT
DX/TX/RECOMENDATION
TERIMA KASIH