Session-1-
Dr.Muthana
19/10/2016wednesday
orthopedic
Any fracture try to know definition,which age group mostly
affect,mechanism.
o
Colle's fracture:-is
fracture of distal end of radius with displacement of
distal fragment posteriorly.
o Age :-in old osteoporotic pts or in middle aged.
Hx taking according to mechanism of injury
How to approach to pt with road traffic accident (avoid brief symbols in Hx).
road traffic accident for(3)days duration.
-
C.c:
Firstly
Since 3 days
مثال اذا نكتب من
3
أيام
HPI:-
1-
type of vehicle:-track,long vehicle,saloon car
.
2-
was he passenger ,driver.
3-was he in the front seat ?in the back seat ?
4-seat belt was put on? As there is seat belt injury"visceral injury".
Another mechanism of injury
fall from height.
1-the height of the place from which the pt fall?
To the ceiling
3m.
From 2
nd
floor
6m.
2-the nature of the surface the pt fall from?
Rough,smooth,flexible.
**fall from height usually is associated with calcaneum fracture,hip
fracture,vertebral fracture,c1 fracture "atlas": as you move the head
there will be severe injury and shock even can occur.
diving injury
compression on the head"C1 atlas injury".
Dashboard injuryhip dislocation
another mechanism of injury
direct trauma "knight stick
injury"
ulnar fracture.
Indirect trauma
fall on outstretched hand.
Bullet injury,blasts injury.
Stress fracture( march fracture,osteoclasts activation
remodelling of bone weak bone ) يصيب العدائين
Sport injury:twisting injury.
Knee twisting
meniscus injury.
Examination
Before every exam WIPwash your hand,,introduce your self,,permission.
1-vital signs.
2-general exam.
3-local exam.
a-look.
2-feel.
3-move.
4-related site examination"back pain caused by
pathology in the hip,,in perthe's disease&slipped
femoral head:-child complains from knee pain always
although the pathology is in the hip,,shoulder pain
from cervical spine illness".
5-neurovascular exam.
Method of exposure during exam:
1.shoulder from shoulder to umbilicus.
2-back all exposed except underwear is left.
-How to examine shoulder joint?(shoulder jointball & socket joint).
كل الحركات بيه
ممكنة
1-
From front.
2-from side.
3-from back.
4-abduct shoulder & examine the axilla(the weak point in shoulder joint).
o
Look for scar,bruises,ecchymoses,contour deformity,sinus"chronic infection".
o
Feel for
TENDERNESS+TEMPERATURE
.
Which part of hand we use in palpation?
Dorsum of hand as the nerves here is distributed dorsal to the vessels .
*
Don't forget to look to pt's face while you examine him—examine both sides of the joint to
compare.
*The constant sign of fracture is
TENDERNESS
even in diabetic pts.
Which test is special for impingement syndrome?Hawkin test lift the hand then internally rotate
it.
For supraspinatus tendinitis ,how to examine it?
Empty cann test.
Subscapularis muscle injury tested bylift off test:ask pt to put the hands between his shoulder
blades.
How to test teres minor muscle?by abduction of shoulder joint.
Shoulder area which dermatome is responsible for it?C5.
1) Sensory exam ask the pt to close they eyes and then by pin prick + cotton exam.
2) Motor exam:power (5grades) & tone exam(hypertonia 2types:spastcicity:extrapyramidal
system is responsible&rigidity:pyramidal system ,which is"rigidity"also 2
types:cogwheel:on whole movement rigidity is present&lead pipe:rigid then relax&glasp
knife rigidity:only at the beginning rigidity is present )
3) Proprioception:-
Maneuver
learn the pt on fingers & toes position(above,below ,in the middle).
Fix the joint
Close his eyes
Then move fingers or toes in the direction listed above.
In which condition we have hyper&hypo tonia?
In MND"motor neuron disease demylinating disease"or amyotrophic disease ,VITB12 deficiency.
Dermatomal segments
Triceps:C7
Biceps :C5.
Brachioradialis:C6
Knee:L4
Achilles :S1
Knee exam try to kneel down while you examine him.