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History Taking

in
Orthopaedics
Orthopaedics:
Ortho – straight

Paedics – children

Musculoskeletal systems

Bones, joints, muscles,


tendons,
ligaments, peripheral
nerves,
blood vessels.
special tissue:–
meniscus, bursa, cartilage
etc.
Divisions of Orthopaedics

Trauma Surgery
Spine Surgery
Arthroscopy & Sports Medicine
Hand Surgery
Paediatric Orthopaedics
Joint Replacement (Arthroplasty)
Oncology

Trauma - 80 % (worldwide)

Our setup - 95%


Group of Diseases

Congenital & Developmental abnormalities

Infection & inflammation

Arthritis & rheumatic disorders

Metabolic & Endocrine disorders

Tumors & Lesions that mimic them

Sensory disturbance & muscle weakness

Injury & Mechanical derangement


History Taking

Patient – story

Doctor constructs – history

history – systematic, carefully, patiently


compiled & informative
Points in history taking

• General Information

Age

Sex

Occupation

• Presenting Complaint
Symptoms

• Pain
• Stiffness
• Swelling
• Instability
• Deformity
• Limp
• Altered Sensation
• Loss of function
Pain
Most Common complain

Grading of pain

I No pain
II Mild, can be ignored
III Moderate, requires treatment
IV Severe, intrusive despite analgesics
V Very severe, inhibits virtually all activities
• At the site of the pathology:

Location, duration, progression,


nature, intensity
Specific Characters of pain

Sharp shooting pain of back - PIVD

Chronic pain, ↑ activities - Degenerative Changes

Constant boring pain - Infective, neoplastic


• Referred pain:

From To
Neck Shoulder
Shoulder Arm
Elbow Forearm, hand
Lumbar Spine Groin
LS Spine Gluteal Region
Hip Thigh, knee, leg
Thigh Knee
Autonomic pain:

from autonomic nerves


& accompany peripheral blood vessels

e.g. after operation

Poorly understood, often doubted


Stiffness

Symptom of joint involvement

Protective mechanism, spasm around joint

Generalized: Systemic disorder like RA, AS

Localized: to particular joint


Swelling

Soft tissue, joint, bone

After trauma, injury or reactive

Rapidly or slowly

Painful or not

Constant or comes and goes

Same size or ↑
Instability

C/O Joint giving way

Muscle weakness, ligamentous deficiency & disruption


Deformity

Associated with pain & stiffness

c/o knock knees, bowlegs,

Important: Progressive or not

Impaired function or not


Limp

Abnormal pattern of ambulation

Involved joint, dysfunctional muscle,

Due to deformity

Progressive or not
Altered Sensation
C/O tingling, numbness, burning pain

Nerve involvement

Note progressive

Eg. diabetic neuropathy, radiculopathy, laceration


Loss of function

Depends on individual needs

Judged on social, professional,


domestic & recreational demands
• Personal history & background
work, travel, recreation, home
circumstances,
support from family & friend

• Family history
genetic disease RA. Communicable
disease TB
Past Medical History
previous trauma, injury,
sprain, strain

Systemic Review
LBP : Acute UTI
PID
Trauma Patient

General History
ABC
LOC

Spine, Joints, limbs

Previous history of injury