Clinical Examinations

in Orthopaedics

Ziang Hu, M.D.;Ph.D.

Orthopaedic Surgery Department
Sir RunRun Shaw Hospital
School of Medicine
Zhejiang University
06-06-2016
 What is Orthopaedics?

 Orthopaedic surgery or orthopaedics is the branch of surgery

concerned with conditions involving the musculoskeletal system.

Including:
Bone Cartilage Ligament Muscle
 Clinical Examination
WHAT is special in Orthopaedics?
Pain Pain

History Disability

Deformity
Disability Deformity
Look Look

Physical Feel
examination
Move
Feel Move
 Basic Skills and Details
Introduction Introduce

Check Explain Question

Setting agenda
Patients’
Problems
and expectations

Pain Listen Record

Making a diagnosis
Identity
Onset and
Consequences

Disability Deformity Comorbidity

Control
Fitness for surgery
Control Closure
 History

in what way
Pain how long/often
how can be managed

Disability Deformity
Loss of function “may look normal”
 Physical Examination

Skin: bruising, redness,wound, scar

Look Soft tissue: swelling, wasting
Bones: deformity

Feel Move
Skin: T, sensation active: within the limits of pain
Soft tissue: tenderness, Passive: Not beyond the active range
Lumps, circulation
Stability: dynamic (muscle power)
Bones: margins, steps,
static (ligament, joint)
Physical Examination
of Spine
Occipital –C2
Lordosis
Cervical
3-7

Thoracic Kyphosis
1-12

Lordosis
Lumbar
1-5

Sacrum Kyophosis
Coccyx
Physical Examination
of Spine
Physical Examination
of Spine
 Physical Examination
of Cervical Spine
Linder test

Skin: sinuses, lymph node

Look Soft tissue: spasm
Bones: lodorsis (lost)

Feel Move
Skin: T, sensation distal to arm active: flexion/extension,
Soft tissue: tenderness, spasm rotation, deviation
Bones: palpate Passive
Linder Test
Stability
 Physical Examination
of Thoracic Spine

Skin
Look Soft tissue Not much
Scoliosis !! Bones

Feel Move

Skin Active:
Soft tissue Not much Passive Not much
Bones Stability
 Physical Examination
of Lumbar Spine

Skin: hairy tufts, dimple

Look Soft tissue: muscle spasm
Bones: Lordosis (flattening buttocks)
Lasègue test Scoliosis
(straight leg raising)
Disc Herniation Feel Move

Skin: sensation distal to limb Active: flexion/extension,

rotation, deviation
Soft tissue: spasm Passive: Lasègue test
Bones: spondylolisthesis straight leg raising
Stability: Wright-schober test
 Physical Examination
of Shoulder

Skin: axilla
Look Soft tissue: deltoid, supra/infraspinatus
Bones: acromioclavicular joint

Feel Move

Skin: sensation distal to arm Active: Thumb point,

Apley’s test
Soft tissue: trapezius
Passive: Crepitus, OA
Bones: palpate sternoclaviclular Dugas sign
Stability: Thumb-down test
Apprehension test
 Physical Examination
of Arm
Elbow Dislocation
Colles Fracture
Look
Grave’s diseaseFeel
OA, Lung Cancer
Skin: sensation distal to arm
Soft tissue: swelling, wasting,
Tinel test, capillary filling
Bones: tenderness, Acropachy
Skin: olecranon, palm
Soft tissue: wasting (N)
Bones: carrying angle, Koilonychias
deformity
Move
Active: flexion/extension,
rotation, pronation/supnation
Passive: resist
Stability: Thumb-down test
prayer test
 Physical Examination
of Hip
(−)
Skin: scar
Look Soft tissue: Gluteal, pelvis tilt

(+) Bones: Not much

Feel Move

Skin: numbness (femoral nerve) Active: Abduction, adduction, rotation

lower leg (sciatic nerve)
Passive: Thomas’s test
Soft tissue: Not much
Stability: The Trendelenburg sign
Bones: Length
 Physical Examination
of Knee
Patella Dislocation
Skin: scar, redness
Look Soft tissue: effusion
Bones: Patella

Feel Move

Skin: T, Sensation Active: flexion/extension

Soft tissue: Baker’s cyst Passive: flexion/extension

Ely Test
Bones: Margin of the patella Stability: Collateral ligaments
femoral condyles Cruciate ligaments
 Physical Examination
of Ankle/Foot
Resist Test

Skin: calluses, corns, bunions

Look Soft tissue: swelling, wasting(claw toe)
Ankle Bones: clawing

Feel Move

Skin: T, Sensation Active: flexion/extension

Soft tissue: pulse, tenderness Passive: flexion/extension

Toe resist
Bones: Tenderness
Stability: Not easy to test
 Physical Examination
Scoliosis
Kyphosis
Lordosis
 Spine
Straight leg raising
Wright-schober test
Lindner test

 Shoulder Dugas sign

acropachy
 Arm
koilonychias
Thomas sign
 Hip
Trendelenburg test

 Knee Ely test

 Ankle/Foot
 Homework

1. What is Acropachy? Do you know the

etiology of it?

2. What is the special tests of the knee and

the hip?
Thank you !
06-06-2016