THE LOCOMOTOR SYSTEM is a system of structures that move the body
- 1. Daniel Teferi(Orthopedic Surgeon )February 3, 2025 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 • observation of gait and trunk deformities and • examination of the individual joints and 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 • Stiffness • Loss of function • Swelling • Deformity • Instability • Weakness • Altered sensibility • Developmental Delay 7
- 8. Pain • most common symptom • character – Throbbing –(abscess) – Aching – (chronic arthritis) – Burning – (neuralgia) – Stabbing – (ruptured tendon) • Site • Radiation • Severity Grade I (mild) – that can be easily ignored Grade II (Moderate) - that cannot be easily ignored, interferes with function and needs treatment from time to time Grade III (severe) – pain that is present most of the time, demanding constant attention 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 – Warm / cold, moist / dry, sensation • Soft tissues – lump, its characteristics, pulses • Bones & Joints – outline normal?, Synovium thickened? Excessive joint fluid • Tenderness 17
- 18. • Movement Active – degree of mobility and whether it is painful or not, to assess muscle power Passive Abnormal or Unstable 18
- 19. • Flexion / Extension • Adduction / Abduction • External Rotation / Internal Rotation • Pronation / Supination • Circumduction • Opposition • Inversion / Eversion • Lateral flexion and rotation – (spine) 19
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- 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 Schober Test
- 30. 30 Special tests FABER or Patrick's test Trendelenberg test 1.Anterior drawer test -2.Lachman test3.pivotshifttest Straight leg raise manoeuvre LASÈGUE’S TEST ForACLinjury
- 32. 32 Neurological examination Look for motor Look for motor weakness and weakness and sensory deficiencies sensory deficiencies Superficial & Deep Superficial & Deep reflexes reflexes Compare to the Compare to the contralateral side contralateral side Observe color and Observe color and hair distribution hair distribution Feel the temperature Feel the 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 • 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. Haematology Biochemical Synovial fluid analysis Culture & sensitivity Radiography Plain radiography - at least two veiws Contrast radiography Sinography Meyelography Arthrography 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