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Diagnosis in orthopaedics

Diagnosis in orthopaedics. Z. Rozkydal T. Tomáš. The aim: To establish the diagnosis To consider the differential diagnosis Suggestion for the management of the disease 1. History 2. Examination 3. Diagnostic imaging 4. Laboratory tests. History Family history Previous disorders

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Diagnosis in orthopaedics

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  1. Diagnosis in orthopaedics Z. Rozkydal T. Tomáš

  2. The aim: To establish the diagnosis To consider the differential diagnosis Suggestion for the management of the disease 1. History 2. Examination 3. Diagnostic imaging 4. Laboratory tests

  3. History Family history Previous disorders Pharmacological Social background Working ability Symptoms of the disease Pain analysis

  4. Family history Genetic disorders Disorders of the parents, of brothers and sisters Delivery, abortion Malignancy Important disorders (diabetes mellitus, blood diseases, neurological disorders, TB etc)

  5. Previous disorders Delivery (complications, weight) Psychomotor development Mental problems Admission to the hospital Trauma, surgery Gynaecologic problems Bleeding Focuses of the infection Alergy Transfusion, hepatitis B, C and HIV

  6. Pharmacological history Drugs, dosage, effectiveness Social background Living, marriage, relatives, habits Working ability The way of manual work Transport

  7. History of the disease The onset of the symptoms. How oft, how long, progression, alleviation The relation to the physical activity Dyscomfort The ability to walk Localisation Character of problems The way of trauma event

  8. Pain analysis Intensity, frequency Acute, chronic Localised, referred pain Visceral pain The type- sharp, blunt, burning, stumbling Neuralgia Sciatica Phantom pain Neurogenic claudication

  9. VAS – visual analogue scale Line with 10 degrees 0 - no pain 10 - the worst, intractable pain Pain of 5 degrees or more- a need for change of analgetics

  10. Examination General - head, neck, chest, abdomen, extremities St. orthopedicus generalis St. orthopedicus localis Posture and walking

  11. Aspexis Somatic type - asthenic, normosthenic, pycnic, adiposogenital, gigantisms, dwarfism Nourishment cachexia, normal nourishment, obesity

  12. Body mass index: weight kg BMI ------ heightm2 bellow 20 - cachexia 20-25 - normal 25-30 - overweight 30-35 - obesity over 35 - severe obesity

  13. Aspexis Skin Nails Subcutaneus nodes Lymphatic nodes

  14. Deformity • - genetic (aplasia, hypoplasia, hyperplasia) • acquired (traumatic absence) • Malalignment (varosity, valgosity, • antecurvation, recurvation) • Deformity of the spine (kyphosis, scoliosis, • lordosis)

  15. Swelling Localised – infection, lymfostatic, venostatic tumor, bursa Generalised (cardial, renal, hypoproteinemic) Anasarca Decollement

  16. Effusion in the joint Serous Serofibrinous Gelly Septic Haemarthrosis

  17. Tenderness - superficial - deep Meassurement of the lenght of the extremity Meassurement of the circumference of the extremity

  18. Function Passive and active movements Range of motion – levels of SFTR Sagital Frontal Transversal = horizontální Rotation

  19. Stability - Stable joint - subluxation - dislocation . Laxity Tests- The fifth finger, thumb, elbow, knee

  20. Stiffness - extraarticular - intraarticular Muscle contracture - acute - chronic

  21. Muscles - hypertrofic - eutrophic - hypotrophic - atrophic

  22. Muscle test 0 - no activity 0 % 1 - trace 10 % 2 - motion without gravity 25 % 3 - motion against gravity 50 % 4 - motion against gravity and slight resistance 75 % 5 - normal activity 100 %

  23. Posture Correct posture Postural kyphosis Flat back Lumbar hyperlordosis

  24. Gait analysis Phases 1. heel strike 2. standing phase 3. the heel off 4. swing phase Normal way of walking Limping Hemiparetic gait Spastic gait Drop foot Parkinson´s disease posture and walking

  25. Diagnostic imaging • X-ray examination • Contrast radiography- sinography, arthrography, myelography • Angiography • Diagnostic ultrasound • Radionuclide scanning • Computed tomography - CT • Magnetic resonance imaging - MRI • DEXA – dual energy absorptionmetry • Bone biopsy • Electromyography

  26. Laboratory examination • Infection: ESR, leucocytes, CRP, electrophoresis • Osteopathy: Calcium, phosphorus, alcaline phosphasate, acid phosphatase, U-pyridinolin aand deoxypyridinolin, parathormon • Markers in bone tumors

  27. Joint effusions • Cytology • Microscopic examination • Biochemical examination • Bacteriological examination • Imunological examination • PCR

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