Orthopedics - Oleksa A.P. 2006

Examination of the orthopedic patient
Auscultation

Auscultation is widely used to assess the Functions and condition of the thoracic and abdominal Organs, as well as in the Diagnosis of traumatic and orthopedic disorders. There is a known method for diagnosing bone fractures through auscultation, although it is rarely used in practice. It is based on the loss of bone sound conduction when tapping one bone fragment and auscultating the other. Once the fragments unite, sound conduction is restored, serving as a diagnostic sign. Sound conduction may be reduced in cases of pseudoarthrosis, certain tumors, etc.

Auscultation of joints is also quite informative. When moving a limb, various sounds are produced within the joint cavity, which can be heard using a phonendoscope placed near or directly on the joint.

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Fig. 10. Bryant's triangle: a - normal, b - in hip dislocation.

Healthy children produce no joint sounds during movement. In older adults, clicking or crunching may sometimes be heard during movement; these are not caused by pathological processes but represent a physiological norm of relaxed joint structures.

In pathological joint conditions, a phonendoscope and a palpating palm can detect crepitus, squeaking, crunching, and other sounds caused by various factors, sometimes accompanied by pain. For instance, in deforming arthrosis, a constant friction sound indicates a "dry" joint, while a coarse crunch points to the destruction of the articular Cartilage. A characteristic sound is heard in chondromatosis and osteoarthritis, dominated by crunching whose character and intensity may change with every joint movement. Pathological changes in joints are accompanied by amyotrophy, hypotonia, reduced joint stability, etc.

Auscultation is used in thoracic and abdominal trauma to evaluate the functional state of the Lungs, intestines, and other organs. Listening allows for determining the localization and Nature of the pathological process, pleural friction rubs, the character of pulmonary rales (dry or moist), diminished or absent breath sounds, which assists the physician in establishing a diagnosis.

In hemothorax, the pulmonary sound changes and becomes fainter, while in pneumothorax, it may be entirely absent. Assessing the character of intestinal peristalsis (normal, enhanced, sluggish, or absent) also facilitates the diagnosis of pathological conditions. Auscultation is likewise employed to diagnose aneurysms of major Blood Vessels, vascular tumors, etc.