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1 - General principles of orthopaedic clinical examination

Stanley Jones
Affiliation:
Sheffield Children’s Hospital, Sheffield
Nick Harris
Affiliation:
Department of Orthopaedic Surgery, Leeds General Infirmary
Fazal Ali
Affiliation:
Department of Orthopaedic Surgery, Chesterfield Royal Hospital
Mark D. Miller
Affiliation:
James Madison University, Virginia
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Summary

Clinical examination is an art and has to be learnt, as it does not come naturally. All patients must be respected, made to feel at ease and assured of their confidentiality and dignity.

A detailed history should always be taken followed by clinical examination.

It is often assumed that clinical examination begins on the couch. This should not be the case, as significant information can be gained by observing the patient as they enter the room and walk towards you or as you approach them.

If the patient is seated they should be asked to stand as this is usually the first part of any orthopaedic clinical examination, except when the hand is being examined. You will observe whether the patient is tall, short, fat, thin, ill, well, energetic or slow. Observe if there is pain or if there are stigmata of orthopaedic disease such as blue sclera (osteogenesis imperfecta), café-au-lait spots (neurofibromatosis), multiple exostoses (diaphyseal aclasis; Figure 1.1), etc.

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Publisher: Cambridge University Press
Print publication year: 2014

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References

Apley, AG, Solomon, L. Physical Examination in Orthopaedics. Oxford: Butterworth–Heinemann, 1997.Google Scholar
Beighton, PH, Horan, F. Orthopaedic aspects of Ehlers–Danlos syndrome. J Bone Joint Surg 1969;51:444–453.CrossRefGoogle ScholarPubMed
McRae, R. Clinical Orthopaedic Examination, 6th edition. Toronto: Churchill Livingstone, 2010.Google Scholar
Parvizi, J. Orthopaedic Examination Made Easy, 1st edition. Toronto: Churchill Livingstone, 2006.Google Scholar
Reider, B. The Orthopaedic Physical Examination, 2nd edition. Philadelphia: Elsevier Saunders, 2005.Google Scholar

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