Orthopedic tests

Question 1

The Clinical Encounter - OHIPMNRS

Answer 1

Observe
History
LO DR FICARA
Inspection
Palpation
Motion
Neurovascular
Referred Pain (screening adjacent areas)
Special Tests

Question 2

OBSERVE

Answer 2

Observe:
Patient’s general appearance, posture & mobility (how do they walk into the office?)
Emotional status (happy, sad) – are they comfortable?

Question 3

HISTORY

Answer 3

History (basic considerations)
Where is the problem? Point to it exactly. When did it start?
What makes it better or worse? Prior treatment or injuries?
Quality of issue? (numbness, tingling, sharp, ache)
Severity (scale from 0-10)? Gradual or sudden onset?
What are the patient’s goals for treatment?
Etc – each condition will have its own considerations that we will discuss

Question 4

INSPECTION

Answer 4

Inspection
Posture, gait, bony deformity, trouble with activities of daily living (ADLs)
Obvious discomfort (painful expression, unable to sit comfortably, limp)
Bony & soft tissues (deformity, bruising, swelling, color, sweat/dry, scars, calluses, bunions, atrophy, ulcers)
Foot wear (supportive, wear patterns on shoes, assisting devices such as orthotics or braces)

Question 5

PALPATION

Answer 5

Palpation – Informed Consent Must be Obtained
Temperature, texture, tone, tenderness (4 Ts)
Anatomy review (bone, tendons, ligaments, fascia, blood vessels, nerves, lymph, viscera)
Swelling, pain, inflammation, myospasm, scar tissue

Question 6

MOTION

Answer 6

Motion
Functional screen (ADLs)
Active Range of Motion (AROM)
provides baseline outcome marker
Passive Range of Motion (PROM) with over pressure (joint play)
Resisted Range of Motion (RROM)

Question 7

NEUROVASCULAR SCREEN

Answer 7

Neurovascular Screen
Dermatomes, reflexes (DTRs), cranial nerves, pathologic reflexes
Muscle strength (myotomes), proprioception, coordination
Pulses, capillary refill, temperature

Question 8

Referred Pain (screen adjacent areas)

Answer 8

Referred Pain (screen adjacent areas)
MFTPS referral, nerve root impingement, visceral origin, infection, psychogenic origin/overlay

Question 9

SPECIAL TESTS

Answer 9

Special Tests
Orthopedic tests*
Injectoin of local anesthesia in a specific tissue for pain reduction
Diagnostic: imaging, X-rays, U/S, CT, MRI, thermography
Lab test: blood, urinalysis, biopsy, arthrocentesis etc.