1.THE LOCOMOTOR SYSTEM C1 (2)..........ppt
- 1. Daniel Teferi(Orthopedic Surgeon ), Aug 24 ,2021 1
- 2. • Includes the bones, muscles, tendons and ligaments – the skeletal system and all that makes it move • The art and science of the Diagnosis and Treatment of all the disorders of the human locomotor system – Orthopaedics 2
- 3. • Some of the conditions that affect these structures are :- 1. Congenital and developmental abnormalities 2. Infection and inflammation 3. Arthritis and Rheumatic disorders 4. Metabolic and endocrine disorders 5. Tumours and lesions that mimic them 6. Sensory disturbances and muscle weakness 7. Injury and mechanical derangement 3
- 4. • As in all of medicine, –identification of disease/disorder –having a picture of • Pathological process • Functional loss • Disability 4
- 5. • Careful history taking and then physical examination is performed • Physical examination basically Physical examination basically • observation of gait gait and trunk trunk deformities and • examination of the individual joints joints and muscles muscles 5
- 6. • Presenting compliant: – traumatic or non traumatic, acute or chronic, congenital or acquired, night pain, relieving & exacerbating factors • Social history & Functional Status • Family History • Obstetrics history • Growth & developmental history • Immunization status • Past medical History • Treatment History 6
- 7. • Trauma • Pain = is the MC Sx • Stiffness • Loss of function • Swelling • Deformity • Instability • Weakness • Altered sensibility • Developmental Delay 7
- 8. Pain Pain • most common most common symptom • character character – Throbbing –(abscess) – Aching – (chronic arthritis) – Burning – (neuralgia) – Stabbing – (ruptured tendon) • Site Site • Radiation Radiation • Severity Severity Grade I (mild) Grade I (mild) – that can be easily ignored Grade II (Moderate Grade II (Moderate) - that cannot be easily ignored, interferes with function and needs treatment from time to time Grade III (severe) Grade III (severe) – pain that is present most of the time, demanding constant attention Grade IV (excruciating) Grade IV (excruciating) - totally incapacitating 8
- 9. Stiffness • Localized/Generalized • When it occurs • Verify painful movements and locking Swelling • Site – soft tissues Joint or bone • Does it appear following an injury? • Appeared rapidly or slowly. • Associated pain? • Whether it is constant or comes and goes • Continuing to enlarge 9
- 10. • Deformity Shoulders –round/flat Shoulders –round/flat Spinal curvature Spinal curvature Knock knees Knock knees Bow legs Bow legs Some are variations of the normal Some are variations of the normal Weakness • Generalized/localized Loss of function Is more than the sum of individual symptoms and its Is more than the sum of individual symptoms and its expression depends upon the needs of the patient expression depends upon the needs of the patient 10
- 11. Instability • Pt complaint of a joint giving way • Ligamentous deficiency from laxity or rupture Change in sensibility Its exact distribution Its exact distribution 11
- 12. • General appearance, posture and gait • Walk freely?, use stick?, are they in pain?, do their movements look natural?, characteristic facies ?, spinal curvature?, A short limb? • The routine is – examine the good limb, then the bad. – LOOK – FEEL – MOVE 12
- 13. Gait cycle • Stance Phase (60%) – Heel strike – Foot flat – Midstance – Push-of • Swing Phase (40%) – Acceleration – Midswing – Deceleration 13
- 14. Types of gait • Antalgic • Stiff hip Gait • Unstable hip gait – Trendelenberg gait – Gluteus medius gait • Gluteus Maximus gait • Quadriceps gait • High stepping gait • Short leg gait 14
- 15. • Skin – scars & colour changes, abnormal creases • Shape – swelling, wasting or is there a definite lump • Position – see for a deformity in three planes 15
- 16. • Varus / Valgus • Kyphosis / Lordosis • Scoliosis • Equinus • Calcaneovarus/valgus • Cavus 16
- 17. • Skin Skin – Warm / cold, moist / dry, sensation • Soft tissues Soft tissues – lump, its characteristics, pulses • Bones & Joints Bones & Joints – outline normal?, Synovium thickened? Excessive joint fluid • Tenderness Tenderness 17
- 18. • Movement Movement Active – degree of mobility and whether it is painful or not, to assess muscle power = you try to move pts limb. you try to move pts limb. Passive Abnormal or Unstable you order the pt. to move his leg you order the pt. to move his leg 18
- 19. • Flexion / Extension • Adduction / Abduction • External Rotation / Internal Rotation • Pronation / Supination • Circumduction • Opposition • Inversion / Eversion • Lateral flexion and rotation – (spine) 19
- 20. 20
- 21. 21 The elbow flexes from 300 to 900 (300 900 ) The elbow has a flexion contracture of 300 with further flexion to 900 (300 FC 900 )
- 23. 23 Hip The hip flexes from 300 to 900 (300 900 ) The hip has a flexion contracture of 300 with further flexion to 900 (300 FC W/FF 900
- 24. 24
- 25. 25 Knee & Ankle The knee flexes from 300 to 900 (300 900 ) The knee has a flexion contracture of 300 with further flexion to 900 (300 FC W/FF 900 )
- 26. 26 Foot
- 28. 28 Spine Double inclinometer method Tape measurement of lateral bend lumbar flexion
- 30. 30 Special tests FABER or Patrick's test Trendelenberg test Anterior drawer test - Lachman test Straight leg raise manoeuvre LASÈGUE’S TEST
- 32. 32 Neurological Neurological examination examination Look for Look for motor motor weakness and weakness and sensory sensory deficiencies deficiencies Superficial & Deep Superficial & Deep reflexes reflexes Compare to the Compare to the contralateral side contralateral side Observe Observe color color and and hair hair distribution distribution Feel the Feel the temperature temperature of the skin of the skin Palpate the peripheral Palpate the peripheral pulses pulses Vascular examination Vascular examination
- 33. 33 Muscle strength testing • Tone & Power Muscle power grading Muscle power grading • Grade 0 – no movement • Grade 1 – only a flicker of movement • Grade 2 – movement with gravity eliminated • Grade 3 – movement against gravity • Grade 4 – movement against resistance • Grade 5 – normal power
- 34. 34 Investigations Lab. Invest Lab. Invest. Haematology Biochemical Synovial fluid analysis Culture & sensitivity Radiography Radiography Plain radiography - at least two veiws Contrast radiography Sinography Meyelography Arthrography Radio Nuclede Bone scanning Radio Nuclede Bone scanning CT scan MRI Ultrasound Arthroscopy Electrodiagnosis EMG Nerve conduction test Biopsy – Closed / Open
- 35. 35 History + Ph./ exam. Anatomical Diagnosis (Is the condition congenital, Traumatic, Inflammatory, Degenerative or neoplastic?) Essential investigations Pathological Diagnosis Diagnosis Clinical Clinical Diagnosis Diagnosis
Editor's Notes
- #6: Social background –occupation travel recreation, home circumstances the level of support from a family and friends
- #7: Trauma-blunt,penetrating,burns,isolated,affecting-bone,st tissue,nerves,vessels-hematoma,comp syn,sequle of previous trauma-non malunion,arthrities,systemic cpx of trauma-fat embolism,PE DVT
- #8: For Bone lesion PAIN is MC SXS and for soft tissue MASS is the MC SXS
- #30: FABER TEST= FLEXION, ABDUCTION, EXTERNAL Rotation is to evaluate pathology of HOP JOINT OR SI JOINT. LASGUES TEST = STRAIGHT LEG TEST = If pain is elicited during streching = irritation of dura mated
- #31: Obers test is to identify tightness of iliotibial band.