Orthopedics - Oleksa A.P. 2006

Examination of the orthopedic patient
Complaints

Patients may seek medical attention due to the following complaints: pain caused by trauma, inflammatory or neoplastic processes, articular surface incongruity, etc.; functional impairment associated with various pathological Changes in the joints, contractures, limb shortening, etc.; deformities (curvatures) of the limbs and spine, Swelling, etc.; and cosmetic defects.

The majority of patients consult a physician complaining of pain. Pain is a subjective sensation caused by irritation or pathological changes in body Tissues. It serves as a danger signal that triggers protective responses. Nociceptive impulses travel along nerve pathways to the Central Nervous system, where the interaction between the Cerebral Cortex AND subcortical centers generates a conscious perception of pain (Studenikin M.Ya., Yakovleva A.A., 1987).

Pain originating in The Musculoskeletal System is typically projected to the site of the pathological process, although it can sometimes be referred. For instance, in Pathologies of the hip joint, children often experience knee pain due to the irritation of the femoral and obturator nerves, which misleads the clinician and leads to diagnostic errors. This occurs in conditions such as coxitis and Legg-Calve-Perthes disease. It is worth noting that pain perception is particularly pronounced in areas of the musculoskeletal system rich in innervation (periosteum, bone epiphyses, periarticular tissues, Joint Capsule, etc.).

It is essential to determine The Nature of the pain (sharp, aching, throbbing, etc.) and its duration (intermittent, occurring after limb overload, constant, resting at night, etc.). Pain largely depends on the state of the receptor apparatus and the central nervous system, as well as on individual sensitivity. The character, intensity, and duration of pain vary across different pathological conditions. For example, pain associated with arthrosis differs sharply from that caused by synovitis or acute Purulent Arthritis.

Congenital musculoskeletal anomalies are generally painless; patients seek medical advice regarding functional impairments of the limbs or spine resulting from these defects.

Among Congenital Malformations causing limb dysfunction, Arthrogryposis, bone defects, Clubfoot, and most notably developmental Dysplasia of the hip and congenital hip dislocation should be highlighted. Therefore, It is important to clarify details regarding heredity, the course of Pregnancy and Childbirth, harmful living and occupational conditions of the mother, when and by whom the pathology was first detected, and whether any Treatment was administered. The overwhelming majority of patients with limb and spinal dysfunction seek help following improperly treated trauma, inflammatory and degenerative-dystrophic joint processes, Scoliosis, lower limb shortening, and segmental curvatures. Most frequently, limb dysfunction results from restricted joint motion or excessive pathological mobility, i.e., movements uncharacteristic of the specific joint.

Motion restriction (contracture) can be caused by an antalgic—that is, protective—reaction to pain and resolves once the ROOT cause is eliminated.

Any inflammatory process in a joint begins with an antalgic contracture caused by the spasm of stronger flexor and adductor Muscles. However, if left untreated or if the inflammation progresses to cause Cartilage destruction and intra-articular adhesions, a persistent arthrogenic contracture develops. Sometimes this leads to joint stiffness (rocking motion) or ankylosis—the complete absence of joint movement.

A significant number of patients consult a doctor complaining of persistent contracture caused by intra-articular destruction, periarticular scar tissue, pathological Muscle changes, etc.

It is important to note a specific type of joint stiffness observed in patients with rheumatoid arthritis. Upon waking in the morning, they experience joint "stiffness" and restricted movement, which subsides after they "warm up" and get moving. This condition is attributed to nighttime hypocortisolism, increased synovial fluid viscosity, and thickening of the periarticular tissues.

In Marfan and Ehlers-Danlos syndromes, as well as in congenital hypermobility, the increased range of joint motion is caused by inherited weakness of the musculo-ligamentous apparatus. Hypermobility, i.e., increased physiological joint mobility, is typical in childhood. As the child grows, it gradually diminishes and eventually disappears.

In dysplastic joint processes (such as the knee), paralysis resulting from poliomyelitis, and other pathological conditions, the range of motion may even progressively exceed the physiological norm under METABOLISM/18.html">The Influence of limb load.

In orthopedic deformities where functional impairment is absent or the patient adapts to their congenital defect, parents frequently seek medical help to address a cosmetic defect in their children. Parents are particularly insistent on surgery for polydactyly, Syndactyly, Torticollis, Clubhand, etc.

However, when taking a medical history in pediatric cases, clinicians should approach information provided by parents with a degree of skepticism. Parents typically attribute a child's condition to a cold, a bruise, or another minor injury whenever a joint is involved. Therefore, a physician must be able to filter out unreliable or incorrect historical data and focus on the most dependable findings to establish an accurate Diagnosis. It is also advisable to review the patient's outpatient chart regarding past illnesses, test results, radiographs, and similar records.