1. Move Active Vs. Passive Active Always to start with / not to cause pain More used in upper limb Must for assessment of muscle power Passive If need to see difference from active More used in lower limbs

2. Range of movement Recorded in degrees Range of motion: Starting from resting xx degrees to xx degrees where motion stops Zero is the neutral or anatomical position of the joint e.g, ‘knee flexion 0–140 o means range of flexion from zero (the knee absolutely straight) through an arc of 140 o e.g, ‘knee flexion 20–90 o means flexion begins at 20 o (i.e. the joint cannot extend fully) and continues only to 90 o Do NOT use the words: ‘full’, ‘good’, ‘limited’, ‘poor’

3. Special tests Different for different joints e.g. Anterior Drawer Test for ACL tear in Knee e.g. Patellar tap for knee effusion e.g. Thomas Test for fixed flexion deformity of Hip Weight-bearing / gait Examination of all weight-bearing joints is not complete until weight-bearing is assessed!

4. Motor power grading 0 = No power I = fasciculation of muscle fibers – no movement II = move with gravity eliminated III = move against gravity VI = less than full power V = full power - normal www.orthopaedicsone.com/

5. Structures affected Bones Joints Muscles Tendons Nerves

6. Diseases

7. Congenital

8. Diseases Congenital

9. Diseases Congenital Developmental

10. Diseases Congenital Developmental Infections / Inflammations

11. Diseases Congenital Developmental Infections / Inflammations

12. Diseases Congenital Developmental Infections / Inflammations Metabolic

13. Diseases Congenital Developmental Infections / Inflammations Metabolic Tumors / tumor-like

14. Congenital Developmental Infections / Inflammations Metabolic Tumors / tumor-like Neuromuscular Diseases

15. Congenital Developmental Infections / Inflammations Metabolic Tumors / tumor-like Neuromuscular Traumatic Diseases

16. Investigations Blood Imaging Special

17. Investigations – Blood Tests CBC, differential WBC, ESR C reactive protein Biochemistry Hormones Vitamin D Special

18. Investigations - Imaging X-rays: Low of 2s Two views: AP and Lateral Two joints: Above and Below Two sides: Right and Left Two occasions Two Doctors ! Special views: Obliques, Tunnel view, skyline, functional flexion / extension Arthrography: Shows intra-articular structures Functional in hip

19. Investigations - Imaging Other imaging techniques CT scan Bone components and fragment relations MRI (with / without contrast) Soft tissue Tumors Bone scan Functional: blood supply, infection

20. Investigations - Special Culture / sensitivity Manteaux test Serology Factors Sickling Genetic Biopsy Arthrocentesis (aspiration) Arthroscopy

21. Summary Orthopedic course is interesting, logic, makes sense, mechanics History Relate to function Detailed mechanism of injury in trauma Examination: Look, Feel, Move, Special Diseases All types of disease and injury