History taking in

Orthopaedics
 Introduction

• Subspecialty service
• Easy diagnosis difficult management
 History taking
• Presenting complaint

- Trauma & fall mechanism / details

• Past medical history

- Previous trauma

- Previous surgery

- Rheumatological conditions

- Congenital deformity
 History taking
• Medications:

- Analgesics

- DMARDS, Steroids, Immunosuppressants

- Anti-coagulation

• Social History:

- Drink and smoke

- Living area and condition / family or social support

- Impact of treatment

- (Loss of function)
 History taking
• Others:

- Fasting status

- Previous anaesthesia

- Recent admission to other hospitals

- Patients understanding of the disease and expectations (athletes,

cosmesis: clavicle, ACJ, deformity)

- Motive (work related, compensation) and motivation

 Presenting Complaint
• Pain

• Swelling

• Stiffness

• Deformity

• Loss of function
(establish timeline/chronicity of symptoms)
 Pain
• Common orthopaedic presentation

• Usual pain questions

• Site / radiation

- Referred pain

- Eg: Hip pain felt in groin / ant. thigh / knee / radiation from lumbar spine

- Eg: Upper limb pain from c-spine pathology

• Timing - OA vs RA

• Severity (type of analgesic required)

• Other association - Gout, Diarrhoea, Recent sepsis

 Loss of function
• Impact on:

- Activities of daily living

- Mobility (walking aids)

- Occupation

- Family / Social

- Hobbies / sporting activities

- Sleep

• Important for determination of treatment

 Swelling
• Unilateral or bilateral

• Monoarthritis or polyarthritis

• Presence of pain / inflammation

• Time of onset

- ACL vs Meniscal injuries (immediate vs delayed effusion)

• Relation to activity levels (OA)

 Stiffness

• RA, Frozen shoulder, knee locking, missed fractures

• Iatrogenic

• Upper limbs: Feeding / washing / grooming

• Lower limbs: Ability to get in / out of bath, care for feet

 Deformity
• Chronicity

- Acute

- Chronic

• Causes:

- Mechanical (fracture, dislocation, torn meniscus)

- Ligament / tendon rupture

- Muscle contracture / paralysis

- Pain

- Growth
 Orthopaedic Examinations
• Exposure

• Look - Skin colour, shininess, creases, deformity, swelling, wasting.

• Feel - Tenderness, signs of inflammation, altered sensation, lumps and bumps,

bones and joints.

• Move - Active / passive movement, unstable movement, provocative

movement.

• Special tests

(Always compare with contralateral)