Orthopedic examination is a systematic evaluation of the musculoskeletal system to diagnose and manage injuries and conditions affecting bones, joints, muscles, ligaments, and tendons. It is essential for identifying movement impairments, pain generators, and functional limitations in patients. Physiotherapists use orthopedic examinations to design evidence-based treatment plans tailored to individual needs.

This article provides a detailed exploration of orthopedic examination, focusing on its components, techniques, and clinical significance.

Purpose of Orthopedic Examination

The primary goals of an orthopedic examination include:

Identifying Dysfunction: Detecting structural or functional abnormalities.
Diagnosing Conditions: Differentiating between musculoskeletal and non-musculoskeletal issues.
Planning Rehabilitation: Developing treatment strategies for pain relief and functional restoration.
Monitoring Progress: Evaluating the effectiveness of interventions over time.

Components of Orthopedic Examination

Orthopedic evaluation involves a step-by-step process, ensuring a thorough assessment of the affected region and the entire musculoskeletal system.

1. Patient History

a) Chief Complaint

Identifying the primary issue (e.g., pain, weakness, instability).
Establishing the onset, duration, and intensity of symptoms.

b) Mechanism of Injury

Determining whether the injury was traumatic (e.g., fall, accident) or insidious (e.g., repetitive strain).

c) Aggravating and Alleviating Factors

Activities or positions that exacerbate or reduce symptoms.

d) Past Medical History

Previous injuries, surgeries, or chronic conditions (e.g., arthritis).

e) Lifestyle Factors

Physical activity levels, occupational demands, and hobbies.

2. Observation and Inspection

a) Posture

Assessing alignment in standing and sitting positions for abnormalities like scoliosis or kyphosis.

b) Gait

Observing walking patterns to identify deviations or compensations.

c) Skin and Soft Tissue

Checking for swelling, bruising, scars, or muscle wasting.

3. Palpation

Palpation helps identify:

Tenderness: Localized pain on touch, indicating inflammation or injury.
Swelling: Suggesting fluid accumulation due to trauma or infection.
Crepitus: Grinding sensations during joint movement, often associated with arthritis.

4. Range of Motion (ROM)

a) Active Range of Motion (AROM)

Assessing the patient’s ability to move joints independently.

b) Passive Range of Motion (PROM)

Therapist-assisted joint movement to determine the extent of motion limitations.

c) Comparison

Comparing ROM of the affected side with the unaffected side.

5. Strength Testing

a) Manual Muscle Testing (MMT)

Grading muscle strength on a scale of 0 (no contraction) to 5 (normal strength).

b) Functional Tests

Assessing strength during functional activities like squatting or lifting.

6. Special Tests

Special tests are condition-specific and designed to assess particular structures.

a) Shoulder

Hawkins-Kennedy Test: For shoulder impingement.
Empty Can Test: For supraspinatus tendon integrity.

b) Knee

Lachman Test: For anterior cruciate ligament (ACL) injury.
McMurray Test: For meniscal tears.

c) Spine

Straight Leg Raise Test: For lumbar radiculopathy.
Schober Test: For spinal mobility in ankylosing spondylitis.

d) Hip

FABER Test (Flexion, Abduction, External Rotation): For hip or sacroiliac joint pathology.

7. Neurological Assessment

a) Reflexes

Testing deep tendon reflexes (e.g., patellar, Achilles).

b) Sensory Examination

Evaluating dermatomes for altered sensation.

c) Motor Testing

Assessing muscle groups innervated by specific spinal levels.

8. Functional Assessment

Functional tests evaluate the patient’s ability to perform daily activities and specific tasks:

Single-Leg Balance: For proprioception.
Timed Up and Go (TUG) Test: For mobility and fall risk.
Sit-to-Stand Test: For lower limb strength and endurance.

Importance of Orthopedic Examination

Orthopedic examination is integral to effective physiotherapy practice for several reasons:

Accurate Diagnosis: Enables precise identification of the injury or disorder.
Tailored Treatment: Facilitates individualized rehabilitation plans.
Injury Prevention: Identifies risk factors to prevent future injuries.
Enhanced Patient Outcomes: Promotes functional recovery and improved quality of life.

Limitations

Subjectivity: Patient-reported symptoms and responses can vary.
Skill Dependency: Accurate assessment relies on the examiner’s expertise.
Complex Cases: Some conditions may require advanced imaging or interdisciplinary collaboration.

Common Conditions Assessed

Orthopedic examination is crucial for diagnosing and managing:

Joint Disorders: Osteoarthritis, rheumatoid arthritis.
Sports Injuries: ACL tears, rotator cuff injuries.
Spinal Conditions: Disc herniation, scoliosis.
Trauma: Fractures, ligament sprains.

Disclaimer

This article is intended for educational purposes only and should not substitute professional medical advice. Orthopedic examinations should be performed by qualified healthcare professionals. Patients experiencing musculoskeletal symptoms should consult a licensed physiotherapist or physician for proper diagnosis and treatment.

References

Kendall, F. P., McCreary, E. K., & Provance, P. G. (2005). Muscles: Testing and Function with Posture and Pain. Lippincott Williams & Wilkins.
Magee, D. J. (2020). Orthopedic Physical Assessment. Elsevier.
Clarkson, H. M. (2020). Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle Strength. Lippincott Williams & Wilkins.
Kisner, C., & Colby, L. A. (2017). Therapeutic Exercise: Foundations and Techniques. F.A. Davis.
Hoppenfeld, S. (1976). Physical Examination of the Spine and Extremities. Prentice Hall.
O’Sullivan, S. B., & Schmitz, T. J. (2019). Physical Rehabilitation. F.A. Davis.