You are on page 1of 22

Orthopaedic Clinical

Examinations

GENERAL FORMAT
LOOK
FEEL
MOVE
SPECIAL TESTS
FOR COMPLETION

HIP - LOOK
LOOK

Interpretation

Scars

Traumatic / Iatrogenic

Swelling

Lymphadenopathy, effusion (rare), tumor

Symmetry

ASIS & greater trochanter should lie on the same


plane

Erythema

Inflammation / Infection

Sinus

Post operative infection

Muscle wasting

Gluteus, quads

FEEL
FEEL

Interpretation

Pain

Greater trochanter GT bursitis


Femoral head
Adductor longus adductor strain

Crepitus

Rotate the hip - suggests OA

Lymphadenopathy

Inguinal lymph nodes

Apparent leg
length

Xiphisternum to medial malleolus


Pelvic tilt
Abduction / Adduction deformity

True leg length

ASIS to medial malleolus

MOVE
MOVE

ROM

Extension

0-10

Flexion

150

Abduction

45

Adduction

45

External / Internal
rotation

30-40

SPECIAL TEST
SPECIAL TEST

Interpretation

Trendelenburg

OA, abductor weakness, hip pain

Thomas test

Fixed flexion deformity

TRENDELENBURG

THOMAS TEST

FOR COMPLETION
COMPLETION

Interpretation

Joint above & below

Spine & Knee

Distal neurovascular
status

Pulse, dermatomes, myotomes

QoL impingement &


Sleep
Help patient dress
Radiographs

KNEE - LOOK
LOOK

Interpretation

Scars

TKR, Arthroscopy

Swelling

Anterior: Effusion, Synovitis


Posterior: Bakers cyst, popliteal aneurysm
Lateral: Meniscal cyst

Symmetry

Checking alignment of knees & legs

Deformity

Varus / Valgus

Erythema

Inflammation RA, Gout, Septic arthritis

Sinus

Post operative infection

Muscle wasting

Disuse (Previous trauma); Neurological lesion

VARUS / VALGUS

FEEL
FEEL

Interpretation

Pain

Joint line Meniscus


Patellar tendon Tendonitis

Effusion

Patellar Tap
Cross - Fluctuation

Flexion deformity

Correctable extensor lag


Fixed - OA

MOVE
MOVE

Intrepretation

Extension

0-10
>10 hyperextension / recurvatum

Flexion

150

Crepitus

OA

Straight leg raise

Extensor mechanism

SPECIAL TESTS
SPECIAL TEST

Interpretation

Posterior Sag

PCL

Posterior / Anterior
drawer

PCL / ACL

Varus / Valgus
instability

LCL / MCL

McMurrays

Meniscus

Patella
apprehension

Recurrent patellar subluxation / dislocation

FOR COMPLETION
COMPLETION

Interpretation

Joint above & below

Hip & Ankle

Distal neurovascular
status

Pulse, dermatomes, myotomes

QoL impingement &


Sleep
Help patient dress
Radiographs

SHOULDER - LOOK
LOOK

Interpretation

Scapula Winging

Lesion to long thoracic nerve

Scars

Traumatic / Iatrogenic

Swelling

Dislocation of ACJ / SCJ


Ruptured biceps

Symmetry
Deformity

ACJ / SCJ lesion


Shoulder dislocation

Erythema

Inflammation

Sinus

Post-op, infective

Muscle wasting

FEEL
FEEL

Interpretation

Pain

Systematic approach, e.g.


SCJ Clavicle ACJ
Trapezius Supraspinatus Infraspinatus
Deltoid
Bicipital groove

Axilla

Lymphadenopathy

MOVE
MOVE

ROM

Abduction

180

Flexion

165-180

Extension

60

Adduction

Opposite shoulder

Internal rotation

Tip of scapula

External

90

ROTATOR CUFF

ROTATOR CUFF
MUSCLE POWER

Test

Supraspinatus

Empty can / Jobes test

Infraspinatus

External rotation arm in neutral

Teres minor

External rotation arm in 90 degrees


abduction

Subscapularis

Internal rotation lag

SPECIAL TESTS
SPECIAL TEST

Interpretation

Apprehension Relocation

Anterior joint instability

FOR COMPLETION
COMPLETION

Interpretation

Joint above & below

Neck & Elbow

Distal neurovascular
status

Pulse, dermatomes, myotomes

QoL impingement &


Sleep
Help patient dress
Radiographs