Orthopaedic Assessment

-Designed ByDr. Krishna N. Sharma

-PublicationOnline Physio Community, India

Web: http://www.opcindia.info.ms E-Mail: dr.krisharma@gmail.com
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Orthopaedic Assessment
Name :

Age : Address: Chief Complaints:

Gender:

Occupation:

Present History: Mode of Onset: Duration: Associated Problem: Past Medical History: Birth History: History of other diseases & injuries: Operations & Hospitalizations: Medications: Physiotherapy Treatment: Personal History: Personal Habits: Marital Status: Family History: Similar Problem in relatives: Hereditary Diseases: Consanguinity: Infections: Economical History: Income: Source: Social History: Social Status: Educational Status: Environmental History: Environment of Home: Environment of Workplace:

Expenditure:

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Vital Signs: Heart Rate: Blood Pressure: General Observation: Built: Posture: Gait: o Antalgic Gait: o Ataxic Gait: o Calcaneal Gait: o Circumductory Gait: o Hand to Knee Gait: o High Stepping Gait: o Jack Knifing Gait: Local Observation: Inflammation: Swelling: Scar:

Temperature: Respiratory Rate:

o Lordotic Gait: o Scissoring Gait: o Talus Gait: o Trendlenburg Gait: o Valgus Gait: o Varus Gait: o Waddling Gait: o Other: Deformities:

Skin Condition: Muscle Wasting: Shape Alteration:

Palpation: Swelling: Pitting, Non-Pitting Tenderness: Grade/ Grade / Grade / Grade Warmth: Crepitus: Scar: Heal / Non-Heal / Length Sensory Examination: Superficial Sensations: o Pain: Nature: Mode of Onset: Course (If Radiates): Aggravating Factors: Relieving Factors: Visual Analogue Scale: 0 1 2 3 4 5 6 7 8 9 10

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o Touch: Normal, Anesthesia, Hyperesthesia, Hypoesthesia o Temperature: Hot Test Tube (40-45C): Cold Test Tube (5-10C): Deep Sensations: o Propioception: o Kinesthesia: Cortical Sensations: o Graphesthesia: o Stereognosis: Superficial Reflexes: o Corneal Reflexes: o Abdominal Reflexes: Epigastric Region (T7-T9): Upper Abdominals (T9-T11): Lower Abdominals (T11-T12): o Cremastric Reflex (L1-L2): o Anal Reflex (S4-S5): o Planter Reflex: Deep Tendon Reflexes: o Biceps (C5-C6): o Brachioradialis (C5-C6): o Triceps (C7-C8): o Pectoral (C5-T1): o Finger Flexion (C6-T1):

o Vibrations:

o Tactile Localization: o 2 Point Discrimination:

o o o o o

Knee (L3-L4): Post. Tibial (L4-L5): Med Hamstring (L5-S1): Lat. Hamstring (S1S2): Ankle (S1S2):

Range of Motion: Joint Rt.(Active) Lt.(Active) Rt.(Passive) Lt.(Passive) End Feel

Pain

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Muscle Power: Muscle

Rt.

Lt.

Limb Length: Rt. True Apparent Pelvic Square: Segmental Limb Length: Rt. Humeral Ulnar Femoral Tibial Muscle Girth: Rt. Arm Forearm Quadriceps Calf Balance: Static: o Sitting (With eyes open & closed) o Standing (With eyes open & closed) o Tendem Standing (With eyes open & closed) Dynamic: 0 Unable to do 1 With Human Support 2 Using Aid 3 Needs Supervision 4 - Independent Lt. Lt. Lt.

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o Reaching out activities: Able/Unable o Perturbation: Able/Unable Gait Analysis: Stance Phage: Swing Phage: Step Length: Stride Length: Functional Evaluation of Upper Limb: Dressing: Combing: Washing: Eating: Toileting: Other: Functional Evaluation of Lower Limb: Stair Climbing: Cycling: Other: Investigations: Pathological Findings: Radiological Findings:

Base Width: Cadence: Other:

1 - Total Assistance Patient- <25%, Assistant- >75% 2 - Max. Assistance Patient- 25%, Assistant- 75% 3 - Moderate Assistance Patient- 50%, Assistant- 50% 4 - Minimal Assistance Patient- 75%, Assistant- 25% 5 - Supervision Cues without physical contact 6 - Modified Independence Assistive devices, takes more time 7 - Completely Independent

Special Tests:

Differential Diagnosis: Diagnosis: Physiotherapy Aims: To relieve pain To increase ROM To correct the deformity To relieve stiffness To improve muscle power & strength

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To improve muscle endurance To maintain tissue extensibility To correct posture To improve balance To train for walking aids Gait training Other

Short Term Goals:

Long Term Goals:

Physiotherapy Plan:

HEP (Home Exercise Program):

Ergonomics:

Instructions by the Therapist:

Date of Evaluation:

Therapist

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