Musculoskeletal examination vivek pandey pdf download

This book is a complete guide to musculoskeletal examination for trainees in orthopaedics. Divided into fifteen sections, the text begins with an overview of history taking and the basics of physical examination. The following chapters provide in depth detail on the clinical evaluation of different sections of the musculoskeletal system and common
diseases and disorders that may be encountered. Chapters follows a step by step format and each test is accompanied by explanatory photographs and diagrams to assist understanding. The final sections of the book cover gait assessment and patterns, and the clinical evaluation of swellings, scar tissue, sinuses and ulcers. Key points Complete guide
to orthopaedic examination for trainees Covers all sections of the musculoskeletal system and common conditions Explanatory photographs and diagrams accompany each test Includes discussion on gait assessment, and evaluation of swellings and scar tissue Case format and tips for a short Orthopaedics case presentation Orthopaedic cases are
presented as short case in examination. The candidate is given a brief time of 10-20 minutes to evaluate each case. Hence, it is important that he/she must know art of quick evaluation and crisp presentation. General format for presentation Name Age Sex Occupation Address Initial
demographic data can be said as “Mr. AB, 28 year old male from Bangalore health worker by occupation is a right handed person presents with chief complaints…” Handedness (especially in upper limb case) Chief complaint (in chronological order) History of present illness (HOPI): -Description of each chief complaint separately -Important positive
history -Important negative history Past History: Personal history: Treatment history: Family history: Menstrual history: At the end of the complete history taking, the candidate must be able to arrive at some conclusion about broad category of the diagnosis. The disease could be Congenital: present from birth/late presentationTraumatic: H/O
traumaInflammatory: e.g., Many joints involved, malaise, multi-system affectionInfective: H/O feverNeoplastic: H/O rapidly growing swelling, loss of weight, appetite,Metabolic: Osteoporosis, gout with relevant historyDegenerative: Mostly age related Osteoarthritis, tendinitisOthers. So, while taking history, student must take relevant positive and
negative history from each category to rule out other category A very common mistake during case presentation is mixing treatment history with HOPI. It should always be avoided. It takes away the focus from HOPI. Only case where one can mix present history with treatment history is a case of trauma whereas in all other cases, treatment history
should be mentioned separately. Examination General examination & Systemic examinnationLocal examination Gait (in case of lower limb)AttitudeInspectionPalpationMovementsMeasurementNeurovascular examinationSpecial tests for individual pathologyJoint above and below Final diagnosis should have following components. DurationAnatomical
SiteSidePathologyEtiologyComplication, if any Example of a complete diagnosis: One year old, right side tibial shaft non-union due to road traffic accident with shortening. Description: One year old (duration) Right side (side) tibial shaft (anatomical site) non-union (pathology) due to road traffic accident (etiology) with shortening (complication)
Diagnosis should be based upon points favoring the diagnosis from history and examination.Student must not give the diagnosis based upon negative pointsIt is not ALWAYS essential to give a differential diagnosis. Eg. There will not be any differential diagnosis for tibial non-union. However, there can be differential diagnosis in patients with
rheumatoid arthritis of knee. Certain tips while performing examination: General and systemic examination should ALWAYS be done. However, A) If general examination is normal, it can be said as “general examination normal”. If there is a significant abnormality, it should be informed. e.g., “pallor present”. B) If Systemic examination is normal, it
can be said as “systemic examination normal”. In case of a disorder which has a systemic effect or it is a part of systemic illness like Rheumatoid arthritis/ tuberculosis, it is important to do quick systemic examination. During regular case presentation/exam viva, it is wrong to say that “I have not done the general or systemic examination”. It should
always be done even in short cases. If both are normal, it can be summarized as “general and systemic examination normal” and candidate should focus upon the local examination as orthopaedic cases are given as short case. In the category of movement, candidate should mention like this example. Knee movement: 0- 1000. 0-900 is painless whereas
rest 100 is painful. Further is not possible. Both active and passive are same. Avoid adjective like “knee movement is full/ very good”! Examination is an objective assessment and no adjective should be added during examination. In the category of measurement, one can straight away tell the discrepancy/normalcy of limb length rather than narrating
the individual measurements of limb and not calculating the final discrepancy. Example; during examination, a student measures the individual length of bone. The objective of limb length measurement is to analyze the discrepancy in the limb length, if any and to assess the area of discrepancy (femur/tibia/both.. etc) Usual, but wrong way of answer:
“The right femur is 52 cm long and right tibia is 35 cm long. The left femur is 52 cm long and left tibia is 33 cm long”. After this statement, many students think that the job is over. After the individual measurements of bones, goal is to measure the “limb length discrepancy” which is 2 cm short tibia in this case. So, simple way is calculate the
discrepancy, if any and answer accordingly. Simple and right way of answer: “The right lower limb is two cm short as compared to the left, and the shortening is in tibia”. If the limbs are equal in length, then saying that “There is no limb length discrepancy” is enough. During the presentation of short case, examiner is not interested in the individual
measurement of bone length. In the category of neurovascular (NV) examination: If the NV examination is normal, it can be said as “neurovascular examination is normal”If the NV examination is abnormal, then individual finding should be told. E.g., if pulse is absent but neurological examination is normal, then it is appropriate to say that
“neurological examination is normal. However, Dorsalis pedis artery is not felt on right side” Joint above and below should be examined. So, in case of a knee pathology, if they are normal, it can be again summarized as Joint above (hip) and ankle (below) is normal. However, if there is an abnormal finding, it should be informed. While presenting the
finding of the case, two things to be avoided unless asked for Methodology of examinationEtiology of finding. Classic example is limb length. How the student examines and what is the cause of short limb is not to be presented while presenting the finding that the tibia is short in measurement section. If examiner asks that, how did you measure the
limb length; only then examinee should inform the methodology.Also, why the tibia is short should be kept reserved for discussion and not to be told during finding presentation. Example; tibia is short because of bone loss during accident. Here is why Meddco should be in our hand If a member falls ill in our house, treatment for him requires not only
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