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Move

Move. Active Vs. Passive Active Always to start with / not to cause pain More used in upper limb Must for assessment of muscle power Passive If need to see difference from active More used in lower limbs. Range of movement. R ecorded in degrees Range of motion:

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Move

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  1. Move Active Vs. Passive • Active • Always to start with / not to cause pain • More used in upper limb • Must for assessment of muscle power • Passive • If need to see difference from active • More used in lower limbs

  2. Range of movement • Recorded in degrees • Range of motion: • Starting from resting xx degrees to xx degrees where motion stops • Zero is the neutral or anatomical position of the joint • e.g, ‘knee flexion 0–140o means • range of flexion from zero (the knee absolutely straight) through an arc of 140o • e.g, ‘knee flexion 20–90o means • flexion begins at 20o(i.e. the joint cannot extend fully) and continues only to 90o • Do NOT use the words: ‘full’, ‘good’, ‘limited’, ‘poor’

  3. Special tests • Different for different joints • e.g. Anterior Drawer Test for ACL tear in Knee • e.g. Patellar tap for knee effusion • e.g. Thomas Test for fixed flexion deformity of Hip • Weight-bearing / gait • Examination of all weight-bearing joints is not complete until weight-bearing is assessed!

  4. Motor power grading • 0 = No power • I = fasciculation of muscle fibers – no movement • II = move with gravity eliminated • III = move against gravity • VI = less than full power • V = full power - normal www.orthopaedicsone.com/

  5. Structures affected • Bones • Joints • Muscles • Tendons • Nerves

  6. Diseases

  7. Diseases • Congenital

  8. Diseases • Congenital

  9. Diseases • Congenital • Developmental

  10. Diseases • Congenital • Developmental • Infections / Inflammations

  11. Diseases • Congenital • Developmental • Infections / Inflammations

  12. Diseases • Congenital • Developmental • Infections / Inflammations • Metabolic

  13. Diseases • Congenital • Developmental • Infections / Inflammations • Metabolic • Tumors / tumor-like

  14. Diseases • Congenital • Developmental • Infections / Inflammations • Metabolic • Tumors / tumor-like • Neuromuscular

  15. Diseases • Congenital • Developmental • Infections / Inflammations • Metabolic • Tumors / tumor-like • Neuromuscular • Traumatic

  16. Investigations • Blood • Imaging • Special

  17. Investigations – Blood Tests • CBC, differential WBC, ESR • C reactive protein • Biochemistry • Hormones • Vitamin D • Special

  18. Investigations - Imaging • X-rays: • Low of 2s • Two views: AP and Lateral • Two joints: Above and Below • Two sides: Right and Left • Two occasions • Two Doctors ! • Special views: • Obliques, Tunnel view, skyline, functional flexion / extension • Arthrography: • Shows intra-articular structures • Functional in hip

  19. Investigations - Imaging • Other imaging techniques • CT scan • Bone components and fragment relations • MRI (with / without contrast) • Soft tissue • Tumors • Bone scan • Functional: blood supply, infection

  20. Investigations - Special • Culture / sensitivity • Manteaux test • Serology • Factors • Sickling • Genetic • Biopsy • Arthrocentesis (aspiration) • Arthroscopy

  21. Summary • Orthopedic course is interesting, logic, makes sense, mechanics • History • Relate to function • Detailed mechanism of injury in trauma • Examination: • Look, Feel, Move, Special • Diseases • All types of disease and injury

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