-Orthopedic assessment

Subjective assessment
Demographic data
 Name
 Age
 Gender
 Occupation
 Place
 Hand dominance
 Hospital no

History of present illness (HOPI)

 Mechanism of injury or disease including date of onset pattern of

symptoms and course of events
 Concerns that led the individual to seek services of physiotherapist
 Current therapeutic intervention (medical ,surgical , PT and others)
 Patient ,family and other caregivers expectations and goals for
therapeutic intervention
Pain history

 Body chart

 Area of symptoms
 Onset of symptoms
 Type of pain
 Depth of symptoms
 Clearing area
  Behavior of symptoms

 Aggravating factors
 Relieving factors
 Irritability – mild, moderate or high
 Severity (VAS)
 Nature of pain
 24 hour pattern
 Screening questions
 Functional limitations
( Rule out red flags and look if the patient presents with any other flags )

Developmental history (if relevant)

Past history of current condition:

 Onset
 Prior therapeutic intervention
 Prior medications

Medical History
 For present conditions
 For other conditions
Past medical /surgical history
 Prior hospitalization ,surgeries and preexisting medical conditions
 Any history of Tuberculosis
 Bronchial Asthma
 Blood Pressure
 Diabetes
 Cardiac Problems
 Enquiry made for any accidental injury
 Lab and other diagnostic test

Personal history:
 Behavioral risk –smoking, tobacco, alcohol, drugs
 Level of physical fitness
 Sleep
 Appetite
 Bowel and bladder

Family history:
 Hereditary(RA.OA DM,HTN))
 Consanguinity

Socio-economic:
 Family and caregiver resources (education and income)
 Member in the family
 Breadwinner in the family
Functional status activity level :
Prior and current functional status in self care and home management
including ADL .

Special questions for sports population

 Type of terrain
 Type of workout
 Surface, time of the day ,shoe style , type of shoes
 Warm ups, cool down, if stretching included,orthotics used

Environment history
 Living environment
 Community characteristics

Recreational history
 Sports ,gardenig or leisure activities

Objective assessment
Observation:
 General appearance- willing to move , facial expression, movement
pattern
  Built
 Attitude of the limb
 Posture deviations (Static and dynamic posture )

Inspection :
IV lines, dressing cast ,traction – skeleton/skin traction , ryles tube,
urinary catheter , bed –air /water bed
Adaptive aids
Bony structure and alignments
Subcutaneous soft tissues
Tropical changes- color , texture , loss of skin elasticity, shiny skin, hair
loss on the skin, nail changes (brittle and ridged)
Scars – Area, healed/on healed

Palpation
 Temperature variation of skin
 Type of skin – Dry or Excessive moisture
 Oedema
 Tissue tension and texture
 Spasm
 Swelling
 Vessels palpation
 Tenderness
Grading
1 : Patient complains of pain
2 : Patient complains of pain & winces
3 : Patient winces & withdraws
4 : Patient will not allow palpation of the joint

Measurements:
 Limb length
 Limb girth
 Scar measurement

Sensory examination
 Superficial sensations
 Deep sensations
 Cutaneous

MOTOR EXAMINATION
 Tone
 Reflexes
Selective tissue tension testing
 Active movement
 Passive movement
 Resisted isometrics

Active movements:
 The amount of observable restriction and its nature
 The pattern of movement
 The rhythm and quality of movement
 The movement of associated joints
 The willingness of the patient to move the part
 Painful arc

Passive movement
 Passive physiological movements
 Passive accessory movements

Abnormal end feel

 Muscle spasm –early or late

 Capsular –hard or soft
 Bone to bone
 Empty
 Springy block
Pattern of restriction
 Capsular /non-capsular

Muscle tightness
 Differentiate tightness and contracture
 Mention in degrees
 Record in terms of degree
 Mild, Moderate, severe

Resisted isometrics
 Strength of contraction
 Pain response
Patten of contractile tissue
 Strong and pain free
 Strong and painful
 Weak and painful
 Weak and pain free

Strength testing
 MMT / isometric break test
 Objective methods : biofeedback, dynamometer

Special test:
Balance and co-ordination : (Static , Dynamic)

Gait analysis: (Step length ,cadence , gait deviations)

Functional assessment (FIM ,BARTHEL INDEX, BADL)

Investigations:
 Lab investigations radiology report
 Arthroscopy
 Electrodiagnostic studies

Evaluation of data

Physician diagnosis

P.T diagnosis

Goals
 STG
 LTG
Intervention
 Therapeutic exercise
 Electro therapeutic Modalities
 Functional training
 Manual therapy

Re-examine the patient

Discharge planning
 Instruct for home exercise
 Modification of home environment
 Patient family care giver education
 Plans for appropriate follow up care