Introduction: At present, the
latest methods have been developed and introduced into medical practice, with the help of which the
structures and functional activity of organs and systems, as
well as the entire human body in health and disease, can be studied . Description of new
and modified research methods, the emergence of new concepts and
terms led to the accumulation of information, the practical use
of which for a specialist has become very difficult. The purpose of
this lecture is to help you to correctly orient yourself in the methods of clinical
and functional examination of a patient with injuries and
diseases of the musculoskeletal system, to correctly interpret the
special terminology and the results of these studies.
Along with the determination of indications, it is necessary to establish the
sequence of certain studies in order to
obtain maximum information with a minimum amount of research and not
to waste the much needed time for timely assistance to the patient.
When examining a trauma patient, a physician should
obtain information on the following main parameters:
1. What is the mechanism of the impact of trauma on an organ, organs, segment
, on the body as a whole, and what damage is
most likely with this mechanism .
2. What specific morphological lesions take place.
3. What are the functional disorders of organs and systems.
4. Which of the found injuries and functional disorders
are dominant in the state of the victim?
5. Conduct a ranking of the proposed medical measures
by urgency, priority and mutual influence.
An orthopedic patient should receive information on the
following main parameters:
1. What morphological and functional disorders the patient has.
2. The beginning, development and interdependence of the existing clinical
and functional disorders of the ODS.
3. To clarify the concordance or discordance of the found
clinical and functional disorders.
4. To establish the feasibility, sequence and scope of
conservative and surgical treatment.
VO Marks writes: “The excellent equipment of clinics with modern
equipment, paradoxical as it may sound, has led to the fact that some
doctors began to consider it possible to do without a complete clinical
examination of the patient. This course of action cannot be considered
correct; it is more of a step backward than forward. “
Patient examination sequence:
SCHEME istopii DISEASES
DURING diseases and damage both
opopno motor
circuit breaker
Full Name.
Age, nationality, education (beginning, middle, higher)
Address: SSSP, region, edge, ACCP; district; settlement, street, house, apartment.
Place of work of the patient: industry of production; department, workshop;
the job or position being performed.
Date of injury, year, hour.
Received – hour, day, month, year.
Trauma (proizv., Household, agricultural, intentional, sportive, unknown).
Complaints of the patient upon admission
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The beginning and further development of painful phenomena: the mechanism of trauma
(in case of fire-firing wounds – to find out the nature and time of the onset of
pain, limitation of movements, the appearance of increased temperature,
previous diseases, trauma, disease profile, allergic) Objective
research data
———————————-
1.Constitutional features (asthenic, normostenic, hyperstenic,
picnic)
2.The patient’s condition (severity, activity, etc.)
Around the vertical axis – outward and inward rotation7
In addition, there are conditional expressions (jargon): elbow and
radial abduction, plantar and dorsiflexion, etc., used by
specialists, but not classical.
Technique for measuring joint movements and documentation:
When measuring, one branch of the goniometer is located along the axis of the central
segment, the
other – along the axis of the peripheral segment (for the
thigh and shoulder, the proximal segment is the trunk). The axis of the goniometer is
aligned with the axis of the studied movement.
From the scale of the transporter,
readings are taken at the initial position of the limb,
then at the final position . The larger is subtracted from the smaller and entered into the
medical history. For example, for the elbow joint – the initial position
is 180 degrees , the maximum flexion is 40 degrees. They write down: “Flexion
– 140 g.” (counting technique 180 g-40 g = 140 g).
Restriction of mobility – contracture (flexion, extensor
, adductor-abductor, flexor-extensor, etc.) by
etiology – desmogenic, cicatricial, arthrogenic, tendon, antalgic
, combined). Rigidity – the range of motion does not exceed
5 degrees.
Ankylosis – complete immobility (bone, fibrous).
Artificial immobility (surgical closure of the joint) –
arthrodesis.
Artificial limitation of joint mobility by surgery
– arthrorisis, with the help of fixation of tendons – tenodesis.
Limb length – absolute (anatomical) and relative.
The shortening, respectively, is anatomical, relative (relative to the
adjacent segment), in addition, functional (determined by
placing wooden wedges until the
load on the lower extremities is fully symmetrical , followed by measuring the height of the
inserted wedges) and projection (full length of the limbs in a
straight line – it is supposed to reveal shortening of the limb due to contracts
).
Spondylolysis – nonunion or pseudarthrosis of the vertebral arch root
.
Spondylolisthesis is the slipping of one vertebra from the body of another
(lying from the underlying one). It is recorded: “spondylolisthesis of the 4th
lumbar vertebra” – which means that the 4th vertebra has shifted relative to the
fifth.
Spondylosis – ossification along the longitudinal ligaments of the vertebrae.
Spondyloarthrosis – the morphological (and
radiological) picture of osteoarthritis of the intervertebral joints is added to the previous one (
meaning arthrosis between the articulating articular processes).
The procedure for examining a radiograph:
1. The area (segment) depicted on the radiograph, its
projection.
As a rule, one of the joints is always captured, the
minimum number of projections is two (straight and lateral). There may also be
additional special styling.
2. The continuity (or breaks) of the cortical
bone is determined .
3. The congruence (or incongruence) of the articular
surfaces is determined . Non-parallelism – subluxation. Complete loss of contact between the
articular surfaces – dislocation. Definition of dislocation and
subluxation of the vertebrae.
4. Bone structure – the presence of zones of destruction, osteoporosis,
osteosclerosis, bone atrophy and hypertrophy.
5. Condition of soft tissues.
In addition, there are fistulography, arthropneumography, vasography
or angiography (lymph, veno_, arteriography), pneumoencephalography
, pneumomyelography, tomography, computed tomography, and
NMR tomography. Calvet arc, Shenton line, Hilgenreiner’s scheme
, acetabular index. Putti’s triad: slope of the acetabular roof
, high standing and lateroposition of the proximal end of the
femur, late appearance and hypoplasia of the ossification nucleus of the
femoral head.
Investigation of the types of displacement of fragments:
dislokatio ad latum-displacement of fragments along the width
dislokatio ad axin-displacement of fragments along the axis with an angle
open… equal to 5-10-15-… gr.
dislokatio ad longitudinale-displacement of fragments along the length by
1-2-3- … see
dislokatio ad peripheria-displacement of fragments along the periphery,
outward, inward …
Delayed consolidation – delayed appearance of
callus elements or non-union of a fracture in the usual time.
Non-union of the fracture – a double period has passed, there is no union, but
there are no characteristic X-ray signs of a pseudarthrosis.
False joint – there is a rounding of the ends of the bone fragments
and the bone canals are closed with a “end plate”.