Orthopedic surgery

ROUTINE CLINICAL EXAMINATION IN SUSPECTED DISORDER OF THE NECK

Patient presented withpain ,parasthesia , stiffness , swelling, deformity etc….

How to Start

• IPEEP
• INTRODUCE.
• PERMISSION.
• EXPLANTION.
• EXPOSURE.
• POSITION.

The Apley System

• Radiograpgy.


INSPECTION
BONE CONTURES.
SOFT TISSUE CONTOURES.
COLOUR AND TEXTURE OF THE SKIN.
SCARS OR SINUSES.

PALPATION

SKIN TEMPERATURE.

BONE CONTOURS.
• Bony projections.


SOFT TISSUES CONTOURS:
Palpate swellings, tendons, muscles.

LOCAL TENDERNESS.

MOVEMENTS
FLEXION - EXTENSION.
LATERAL FLEXION.
ROTATION.
PAIN ON MOVEMENT.
CREPITATION ON MOVEMENT.

NEUROLOGICAL STATE OF UPPER LIMB

MUSCULAR SYSTEM.
The muscle of the ,shoulder, arm, forearm, and hand
Must be examined for
Wasting, fasciculation, comparison for both sides.

Tone and power should be carried on also.

SENSORY SYSTEM


For touch ,pin prick.
Deep stimuli .
Joint position.
Vibration.
Heat and cold examination.

SWEATING.

Feel the digit if it is moist , or dry.
Sweating depend upon intact sudomotor nerve fibers.

REFLEXES

Compare on the two sides :
Biceps jerk mainly C 6.
Triceps jerk mainly C 7.
Brachioradialis mainly C 6.
So to identify upper or lower motor lesion.
The neurological disturbance in , Root , trunk, bracnches.

VASCULAR SYSTEM OF UPPER LIMB

COLOUR.
TEMPERATURE.

PULSES

Comparison of radial pulses on both sides ,colour,warmth.

Examination at rest.
Then depress the shoulder and rotate the head to the examined side

Examination of potential extrinsic sources of neck symptoms.

Ear , throat.

Symptom of the upper limb may be from

Shoulder .
Elbow.
Or nerve trunk in their peripheral way.

General examinations

Classification of disorders of the neck and cervical spine
Deformites.
Infantile torticolis.
Congenital short neck.
Congenital high scapula.

Infection of the bone

Tuberculosis of the cervical spine.
Pyogenic infection of cervical spine.


Arthritis of the spinal joints.
Rheumatoid arthritis.
Ankylosing arthritis.
Cervical spondylosis.

Mechanical derangment

Prolapse intervertebral disc.
Cervical rib.
Cervical spondylolisthesis.

Tumors

Benign and malignant tumors in relation to spine and nerve root.

Miscellaneous

Cervical fibrositis.

EXAMPLES FOR THE CERVICAL INJUIRES

Radiography

Arteriography

Mri