PRIMARY SURVEY AND

GENERAL ORTHOPEDIC
EXAMINATION
 Primary Survey
Indication of cervical collar
Nexus Criteria
1. Neurological deficits
2. Spinal tenderness
3. Altered sensorium
4. Intoxication
5. Distracting pain
 Primary Survey
 Circulation
 Clinical and radiographic (CXR, pelvic XRay evaluation)
 Application of circumferential sheet or binder where indicated
 Application of direct pressure to areas of obvious hemorrhage
 Initiation of resuscitation
 Primary Survey
 Disability
 Neuro evaluation

DISABILITY
(NEUROLIGICAL 1. GCS
EVALUATION) <8 protect airway and intubte
Þ All patient with altered consciousness
in trauma is considered a result from
CNS injury. Drug/ alcohol intoxication
can accompany traumatic brain injury.
EXPOSURE ABD
ENVIROMENTAL
CONTROL
GENERAL SPINE EXAMINATION
INSPECTION

Café au lait
Lipoma
(neurofibromatosis)

Posture
- Kyphosis
Tuft hair (meningocele)
- Lardosis
- Scoliosis
 Palpation
• Carried out in standing, sitting or prone positions

• Palpate both the groups of paraspinous muscles simultaneously for

tenderness and firmness
 Movement
Flexion : forward bending (finger tip floor distance is <7cm)

Extension : in standing position, the patient is ask to arch his back while the examiner steadies the
pelvis & a pull is exerted on the shoulder

Lateral flexion : normal range is 30° (thoracic & lumbar segments are equal)

Rotations : normal range is 40 - 45° (thoracic - 40°, lumbar - 5°)

SHOULDER EXAMINATION
EXAMINATION
• Patient exposed down to waist and examined in sitting
position. Inspection carried out from front, sides, behind and
above.
INSPECTION • Attitude: patient often support the flexed elbow of the injured
side with other hand in fracture of clavicle and ant dislocation.
• From front: look at sternoclavicular joint, clavicle,
acromioclavicular joint, any deltoid muscle wasting
• From behind: look for position of scapula, supra and
infraspinatus muscle wasting
• From above: symmetry of the supraclavicular fossa
• From sides: any swelling, flattening or rounded fullness of the
joint, any drooping
PALPATION

• Local temperature
• Tenderness: try to elicit tenderness
along the following points
Just below the acromion-
supraspinatus tendinitis
Just below acromion when the arm
adducted: Painful arc syndrome
Along coracoid process
All round the joint: in arthritis
PALPATION

2020
MOVEMENT
 ELBOW EXAMINATION
INSPECTION

CARRYING DEFORMITY MUSCLE

ATTITUDE
ANGLE , SCAR WASTING
PALPATION

• Local temperature
• Tenderness
• -Start form lateral condyle,
olecranon, radial head, medial
epicondyle , biceps tendon and
ulnar nerve
MOVEMENT
HAND EXAMINATION

Dorsum, side, palmar- palmar flex wrist to exacerbate dorsal swellings

INSPECTION Deformity e.g. radial deviation after colles, prominent ulna
Swellings e.g. ganglion o Scars, muscle wasting

PALPATION Start radial side & move in a circle around

wrist;
Palpate for tenderness of :
- APL, EPL- de Quervain's
- Anatomical snuffbox
- scaphoid
- Distal Radioulnar joint
- lunate- locate by dorsiflexing wrist –
- ulnar styloid - Hook of hamate –
- Pisiform- pisiform triquetral degen –
- Guyons canal - Over median nerve
MOVEMENT
HIP EXAMINATION
 INSPECTION ( FROM SIDE & BACK )
From side : From behind :

 Lumbar region is  Look at shoulder ( asymmetry : limn length

inspected to see is there discrepancy or spinal deformity )
increase in lordosis  Look at the spinous processes
which implies flexion  Symmetry of gluteal fold ( gluteal muscle
deformity at the hip. wasting, dislocation of hip, pelvic obliquity
)
 Note the position of the
knee
INSPECTION ( LYING DOWN )

 With patient lying comfortably on bed, this few component is observe Attitude of the limb

1. Scar, sinus, swelling, and muscle wasting

2. Look at the gap between lumbar and bed ( gap obvious is exaggerated lumbar lordosis )
3. Compare the alignment between medial malleolus
PALPATION

 1. check on temperature
 Palpation of femoral artery ( feeble or absent is called narath sign )
 Tenderness
 Bony structure

1. Greater trochanter : palpate the lateral surface of upper thigh feeling the bony resistance from below
upwards. The end of the bony resistance corresponds to the tip of greater trochanter
2. Pubic tubercle : bony prominence felt 2-2.5 cm lateral to the pubic symphysis.
3. ASIS :
 RAGE OF MOVEMENT
1. Flexion and extension

2. Adduction and
abduction
5. External and internal rotation
CONCLUSION