History taking in Orthopaedics

and Traumatology
Dr. Mcharo
 Introductions
• Orthopaedics is a branch which deals with the
musculoskeletal (locomotory) system – tissues
needed to move i.e. Bones, muscles, nerves,
joints, etc
• Ortho – straight
• Pedis –child
 Presentation
Patient’s main complaints:
• Pain
• Deformity
• Loss of function of joints and extremities
• Swelling
 Amplification
a) Pain – characteristic
- Stabbing
- Cutting
- Burning
- Throbbing
- Colicky
- Gnawing (characteristic of tumors)
- Dull

• Does the pain radiate?

• What was the onset of the pain - Insidious or sudden?
• Is the pain progressive i.e. Does the severity increase with time?
• Is the pain intermittent, periodic or constant?
– What is the duration between episodes of pain?
– Is the duration between periodicity of pain
increasing/decreasing?
• Is the pain mild, moderate, severe, unbearably
severe?
• What are the exacerbating factors?
• What are the relieving factors?
• What position causes discomfort?
• What affects the severity of the pain?
• Does any medication affect the severity of the
pain?
• Is the pain associated with fever?
• Is the pain associated with any neurological
disorders e.g. Numbness?
• Is the pain associated with any other changes
e.g. Swelling, ulceration, discharge?
• Does the appearance of the swelling
increase/decrease the pain?
• Does the pain interfere with daily activities?
How much?
• Is there any loss of function?
b) Loss of function
- Onset?
- Traumatic/non-traumatic?
- What function has been lost?
- Is the loss of function intermittent or
permanent?
- Are there factors which affect the functioning
of the particular site/limb?
- Are there any exacerbating/relieving factors?
c) Swelling
- Relation of the swelling to pain? Was the swelling
preceding by the pain? Or came afterwards? E.g.
In osteosarcoma, the pain is felt by the patient a
month before swelling appears, where is
abscesses the swelling precedes the pain
- Has it caused any loss of function?
- Is the swelling associated with fever or any other
systemic symptoms e.g. loss of appetite, loss of
weight.
- Any history of sinus formation?
• Any history of discharge? Purulent/
haemorrhagic?
• Any history of ulceration?
• Are there any other associated symptoms?
• Are there constitutional symptoms?
• History of changes/difficulties in other
systems? E.g. GIT, RS, GUT?
• Any investigation/treatment done?
d) Deformity
- Congenital or acquired?
If Acquired:
- How did it happen?
- Onset? Slowly occurring progressive deformity v/s
sudden traumatic deformity?
- Is the deformity progressive?
- How much does the deformity affect daily activities?
- Does he need any aid? Walking aid/wheelchair?
- Have any correcting measures been attempted?
- Is there a family history of the same problem?
 Family and social history
• Living conditions
• Number of dependants?
• Depending on someone else?
• Married? Relatives?
• Occupation?
• Personal habits? Alcohol intake? Cigarette
smoking?
 Past medical history
• Any long-term medication? E.g. Steroids
• Any surgical procedures?
• Any other medical illnesses? E.g. DM
• Any history of chronic illnesses such as TB
 Physical Examination
• General survey of the patient:
- Gait – limping?
- Assistance? Walking aid/wheelchair/stretcher/
crutches
- Can the patient stand properly? Shortening on
one side?
- Any obvious deformities of the spine, upper
limb, lower limbs, knee joint, feet?
 Examination of the knee joint
• Any obvious divergence of the axis of the knee joint
from the normal (7-8o vulgus)
• Bow legs – varus deformities
• Knock knees – vulgus deformities
• Swelling on the knee?
• Skin over the swelling? – color, margins, well-
circumscribed or not? Regular or irregular?
Hypervascularization? Any ulceration, discharge,
sinus?
• Temperature changes?
• Maximum area of tenderness
• Consistency of the swelling?
• Margins of the swelling?
• Is the swelling mobile or fixed to the
underlying tissues?
• Does the swelling arise from bone/muscles?
• Examine the joints near the swellings and to
what extent they are affected?
 Other Examinations
• Examination of lymph nodes
• Examination of liver, spleen, chest
• Perform a full neurological examination i.e.
Examination of the CNS and PNS