1. Orthopedics Deals with the skeletal system and all structures that makes it move; bone, joint, muscle, tendons and nerves.

2. symptoms Pain: most common complain. – Throbbing; abscess. – Stabbing; cut tendon. – Aching ; arthritis. – Referred pain; e.g. knee pain with hip jt problems, gluteal pain from lumbr spine,…

3. Symptoms Stiffness; – Generalized early morning in rheumatoid arthritis, – Localized after immobilization in osteoarthritis. Swelling; – Sudden; eg hemarthrosis, – Gradual ; tumor. Infection. Deformity; – Sudden; eg elbow dislocation, – Gradual; eg knock knees of rickets

4. Heberden nodes

5. Knee Joint effusion

6. Lipoma

7. Genu varum and valgum

8. Symptoms Weakness; suggest neurological or muscle disorder. Instability (giving way); ligament laxity or rupture. Change in sensibility; tingling or numpness eg nerve root compression from prolapsed intrvertebal disc, median nerve entrapment in carpal tunnel syndrome, peripheral neuropathy in DM,…

9. Symptoms Loss of function; eg inability to climb stairs in knee OA, inability to comb hair in frozen shoulder,…. Past history; – Ankle trauma; secondary OA. – Corticosteroid therapy; osteoporosis, – Chronic diarrhea; ankylosing sponylitis,…

10. Examination Generalized appearance, posture, and gait. Undress the patient properly. LOOK, FEEL, MOVE.

11. LOOK Skin; scars, color (eg red inflamed), Shape; swelling, wasting, lump, deformity. Position; eg fixed flexion of the knee,…

12. Skin; psoriatic arthritis

13. Bow leg deformity

14. Localized swell ing of infrapatellar bursa

15. Skin ulcer of sarcoma

16. Finger gangrene; Raynaud’s disease

17. Feel Skin temperature, Lump, Effusion, Tender points.

18. Move Active movement; range of motion (ROM), and power. Passive; ROM, crepitus. Provocative tests; eg induce dislocation in unstable joints.

19. Move

20. Joint stiffness All movements absent; – Ankylosis (pathological) eg fibrous ankylosis of TB. – Surgical (arthrodesis). All movements limited; eg post traumatic adhesions. Some movements limited; eg torn meniscus block full knee extension.

21. Joint laxity Normal in children. 5% of people have persistent hypermobility and are more susceptible to dislocation (eg shoulder and patella) and arthralgia.

22. Deformity Varus; part distal to the joint displaced toward the midline. Valgus; part distal to the joint displaced away from the midline. Kyphosis; increased posterior convexity of the spine. Scoliosis; lateral curvature of the spine.

23. Cubitus Varus

24. Arthrogriposis

25. Neurological examination Appearance: – Abnormal posture; eg claw hand of ulnar nerve injury. – Abnormal gait; foot drop of sciatic nerve injury. – Muscle wasting, trophic ulcers, shiny skin and hair loss. Tone and power. Tendon reflexes. Sensibility.

26. Claw hand of ulnar nerve injury

27. Diagnostic imaging Plain film radiography; most useful diagnostic imaging. How to read an X-Ray: – The patient name, age, date, clinical summery. – Projection; eg AP and lateral. – Side; left or right. – Soft tissue: Shape: swelling, wasting, effusion. Density: calcification, FB,…

29. Bones Shape: – Deformity; eg bow legs. – Periosteal reaction; eg fracture, infection, tumor. – Cortex distruction; eg fracture, tumor. density: – Increased density; sclerosis. – Decreased density; oseoporosis. – Bone defects or cysts.

30. Bone cyst

31. Myositis ossificans

32. Joints Shape: – Decreased joint space and oseophytes in osteoarthritis. – Dislocation or subluxation. Density: increased in chondrocalcinosis, loose bodies…

33. Calcification in knee joint synovial carcinoma

34. X-ray with contrast media Water soluble based iodine liquids. Sinography in chronic discharging sinus. Arthrography in joints. Myelography in spinal disorders.

35. Arthrography of shoulder joint

36. C-T scan Indications: – Segmental bone necrosis. – Depressed fracture in cancellous bone. – Small radiolucent lesion; eg oseoid osteoma. – Bone and soft tissue tumors. – Complex fractures of spine, pelvis, tarsal and carpal bones. – 3-D reconstructed images. Disadvantage: high radiation exposure.

37. 3-D C-T in fracture pelvic ilium

38. C-T of shoulder

39. MRI Reading of radiofrequency emissions from atoms and molecules of tissues exposed to static magnetic field. Indications: – Bone tumors; size and spread. – Spinal disorders; eg disc prolapse. – Cartilage and ligament. Eg meniscus and anterior cruciate ligament injuries.

40. MRI of osteosarcoma of femur

41. MRI Free of ionizing radiation. Limitations: – Metallic foreign bodies and implants. – Overweight. – Fear of closed spaces. – Irritable patients and children.

42. Diagnostic ultrasound Advantages: simple, portable, applied anywhere, no side effects. Indications: – Cystic lesion, eg abscess, hematoma, aneurism. – DDH. – Rotator cuff tear. – Knee problems; eg ACL injury, meniscal tear, synovial cysts….

44. Radionucleide imaging Technitium-99m (Tc 99m) for bone scanning. Selectively concentrated in skeletal tissues. Increased activity (hot spots) in inflammation, infection, metastatic tumors, healing (stress) fractures. Decreased activity (cold spots) in ischemic necrosis (eg Perthe’s disease).

45. Radioisotope scan

46. Bone Meniral densitometry (BMD) Double Enrgy X-ray Absortiometry (DEXA) is the most reliable in measurement of osteoporosis

47. Blood tests Leukocytosis: in infection, rheumatoid arthritis, gout… High ESR- acute and chronic inflammatory disorders and injury, multiple myeloma. C-reactive protein (an acute phase protein); in chronic inflammatory arthritis. Rheumatoid factor; negative in seronegatve arthritis eg ankylosing spondylitis, reiter’s disease, psoriatic arthritis,… Tissue typing; eg HLA B27 on chromosome 6 In seronegative arthritis.

48. Synovial fluid analysis Indications: – Swelling after injury- hemarthrosis. – Suspected infection. – Gout and pseudogout. – Chronic synovitis- eg TB.

49. Bone biopsy Fine Needle Aspiration (FNA) or open biopsy. For suspected tumors. Primary or secondary. Benign or malignant.

50. Arthroscopy Diagnostic- eg meniscal injury, cruciate ligament injury, biopsy. Therapeutic: eg menisectomy, repair of cruciate ligament, loose body removal.

51. Electrodiagnosis Nerve conduction study (NCS): – Measurement of velocity of nerve conduction; normally 50-60 m/second. – Slowed in peripheral nerve damage or compression. Elecromyography (EMG): – For diagnosis myopathy or muscle denervation.