orthopaedic

1. NURSING ASSESSMENT AND
SYSTEMIC EXAMINATION OF
ORTHOPAEDIC SYSTEM
-BY SHWETA SHARMA
M.SC.NURSING
I YEAR

2. INTRODUCTION
• ALSO KNOWN AS THE LOCOMOTOR
SYSTEM, AND PREVIOUSLY THE
ACTIVITY SYSTEM
• PROVIDES SHAPE, SUPPORT,
STABILITY, AND MOVEMENT TO THE
BODY.
• MAIN STORAGE SYSTEM FOR
CALCIUM AND PHOSPHORUS AND
CONTAINS CRITICAL COMPONENTS
OF THE HEMATOPOIETIC SYSTEM

3. ANATOMY OF SKELETAL SYSTEM
• TYPES OF BONES
• 1) LONG BONES – BONES OF THE UPPER
AND LOWER ARMS AND LEGS AS WELL
AS THE METACARPALS AND
METATARSALS.
• 2) FLAT BONES – STERNUM, RIBS,
SCAPULAE, CRANIUM
• 3) SHORT BONES – CARPALS AND
TARSALS
• 4) IRREGULAR BONES – VERTEBRAE
• 5) SESAMOID BONES – PATELLAE

4. SKELETAL DIVISIONS
1) AXIAL SKELETON – Skull, sternum, ribs, and vertebrae
(including sacrum)
2) APPENDICULAR SKELETON – Bones of the pectoral and
pelvic girdles and of the arms, legs, wrists, hands, ankles, and
feet.

5. CLASSIFICATION OF JOINTS
1. Fixed joint or synarthroses or fibrous joint
2. Slightly movable joint or amphiarthroses or cartilaginous
joint
3. Freely movable joint or synovial joints

6. FUNCTIONS OF ORTHOPAEDIC
SYSTEM
•SUPPORTS THE BODY
•FACILITATES MOVEMENT
•PROTECTS INTERNAL
ORGANS
•PRODUCES BLOOD CELLS
•STORES AND RELEASES
MINERALS AND FAT

7. NORMAL PHYSICAL ASSESSMENT OF
ORTHOPAEDIC SYSTEM
1.NORMAL SPINAL CURVATURES.
2.NO JOINT SWELLING,
DEFORMITY OR CREPITATION.
3.NO TENDERNESS ON PALPATION
OF SPINE, JOINTS OR MUSCLES.
4.FULL RANGE OF MOTION OF ALL
JOINTS WITHOUT PAIN.
5.MUSCLE STRENGTH OF 5.

8. NURSING ASSESSMENT OF ORTHOPAEDIC
SYSTEM
POINTS TO REMEMBER
•MAINTAIN PRIVACY.
•CLOSE NEARBY DOORS OR EXAMINATION ROOM PRIOR TO BEGINNING
PHYSICAL EXAMINATION
•VISUALIZE ONE AREA OF THE BODY AT A TIME.
•BE SENSITIVE TO THE PATIENT’S FEELINGS AND PHYSICAL COMFORT.
•MAKE THE PATIENT COMFORTABLE AFTER EXAMINATION
•BE SURE TO LOWER THE BED COMPLETELY, AND MAKE SURE SIDE RAILS
ARE UP AND CALL BELL IS IN THE PATIENT’S REACH
•WASH YOUR HANDS WHEN LEAVING.

9. HISTORY TAKING
1.BIO-DEMOGRAPHIC DATA
2.PRESENT HEALTH HISTORY
3.PAST HEALTH HISTORY
4.MEDICATIONS
5.PERSONAL HISTORY
6.SURGERY OR OTHER
TREATMENTS
7.FAMILY HISTORY

10. FUNCTIONAL HEALTH PATTERNS
1.HEALTH PERCEPTION
2.NUTRITIONAL PERCEPTION
3.ELIMINATION PATTERN
4.ACTIVITY-EXERCISE PATTERN
5.SLEEP REST PATTERN
6.COPING – STRESS
TOLERANCE PATTERN

11. PHYSICAL ASSESSMENT
1.INSPECTION
•START FROM HEAD AND NECK AND PROCEED TO
UPPER EXTREMITIES, LOWER EXTREMITIES AND
TRUNK.
•OBSERVE ANY LACK OF SYMMETRY AND ANY
EVIDENCE OF TRAUMA OR DISEASE.
•INSPECT THE JOINT CONTOUR (SHAPE) AND
OBSERVE ANY EVIDENCE OF SWELLING,
DEFORMITY, INFLAMMATION, NODULES,
DISCREPANCIES IN LIMB LENGTH OR MUSCLE SIZE.
•USE THE PATIENT’S OPPOSITE BODY PART FOR
COMPARISON.

12. 2.PALPATION
•PERFORM PALPATION
CEPHALO-PEDALLY.
•BOTH SUPERFICIAL AND DEEP
PALPATION ARE USUALLY
PERFORMED CONSECUTIVELY.
•WARM HANDS BEFORE
PALPATION TO PREVENT
MUSCLE SPASM.

13. MOTION
• RANGE OF MOTION-
ASSESSED WITH
GONIOMETER WHICH
MEASURES THE ANGLE OF
JOINTS
• ACTIVE
•PASSIVE

14. ANATOMICAL TERMS OF MOTION

15. • ASSESSMENT OF GAIT
•ASK THE PATIENT TO WALK BACK AND FORTH ACROSS THE ROOM.
•OBSERVE FOR EQUALITY OF ARM SWING, BALANCE AND RAPIDITY AND EASE
OF TURNING.
•NEXT, ASK THE PATIENT TO WALK ON HIS TIPTOES, THEN ON HEELS.
•ASK THE PATIENT TO TANDEM WALK.
•TEST PATIENT'S ABILITY TO STAND WITH FEET TOGETHER WITH EYES OPEN
AND THEN CLOSED. (ROMBERG'S TEST). REASSURE PATIENT THAT YOU WILL
SUPPORT HIM, IN CASE HE BECOMES UNSTEADY.
•NORMAL: PERSON CAN WALK IN BALANCE WITH THE ARMS SWINGING AT
SIDES AND CAN TURN SMOOTHLY. PERSON SHOULD BE ABLE TO STAND
WITH FEET TOGETHER WITHOUT FALLING WITH EYES OPEN OR CLOSED.

16. POSTURE

17. MUSCLE-STRENGTH TESTING

18. DIAGNOSTIC STUDIES
1.RADIOLOGIC STUDIES
•STANDARD X-RAY

19. DISKOGRAM

20. CT SCAN AND MRI

21. MYELOGRAM WITH OR WITHOUT CT

22. 2. BONE MINERAL DENSITY (BMD) MEASUREMENTS
• DUAL ENERGY X-RAY ABSORPTIOMETRY (DXA
OR DEXA)

23. QUANTITATIVE ULTRASOUND (QUS)

24. 3. RADIOISOTOPE STUDIES
• BONE SCAN

25. 4. ENDOSCOPY
• ARTHROSCOPY

26. 5. MINERAL METABOLISM
• ALKALINE PHOSPHATASE
• CALCIUM AND PHOSPHORUS
6. SEROLOGIC STUDIES
• RHEUMATOID FACTOR (RF)
• ERYTHROCYTE SEDIMENTATION RATE (ESR)
• ANTI-NUCLEAR ANTIBODY (ANA)
• URIC ACID
• CRP
• HUMAN LEUKOCYTE ANTIGEN (HLA)-B27

27. 7.MARKERS OF MUSCLE INJURY
•CREATINE KINASE
•POTASSIUM
•ALDOLASE
8.INVASIVE PROCEDURES
•ARTHROCENTESIS

28. ELECTROMYOGRAPHY (EMG)

29. MISCELLANEOUS
• DUPLEX VENOUS DOPPLER • THERMOGRAPHY

30. • SOMATO-SENSORY EVOKED POTENTIAL [SSEP]

31. TESTS FOR ORTHOPAEDIC SYSTEM
• 1.FOR HEAD
THE SPURLING'S TEST (ALSO KNOWN AS MAXIMAL CERVICAL
COMPRESSION TEST AND FORAMINAL COMPRESSION TEST)

32. 2. FOR SHOULDER-
• PAINFUL ARC TEST

34. APPREHENSION SIGN

35. 3. FOR ELBOW-
• WRINGING TEST

36. COZEN’S TEST

37. 4. FOR SPINE-
• STRAIGHT LEG RAISING TEST
(SLRT)/LASÈGUE'S SIGN

38. 5.FOR HIPS-
•TRENDELENBURG’S TEST

39. THOMAS TEST

40. 6. FOR KNEE-

41. 7.FOR ANKLE-
•TINEL’S SIGN /DISTAL TINGLING ON
PERCUSSION OR DTP SIGN

42. NEW TECHNOLOGY
• 1. ROBOTIC ORTHOPAEDIC SURGERIES INVOLVE FEWER AND
SMALLER INCISIONS, REDUCING POSTOPERATIVE CARE,
SHORTER HOSPITAL STAYS AND FASTER RECOVERY TIMES.
• 2. ORTHO-BIOLOGICS ARE MADE FROM SUBSTANCES
NATURALLY FOUND IN THE BODY AND ARE USED TO IMPROVE
THE HEALING OF BROKEN BONES AND INJURED MUSCLES,
LIGAMENTS AND TENDONS. THEY INCLUDE BONE GRAFTS,
GROWTH FACTORS, STEM CELLS, PLATELET-RICH PLASMA,
AUTOLOGOUS BLOOD, AND AUTOLOGOUS CONDITIONED
SERUM.

43. RESEARCH ARTICLES
• 1.ASSOCIATION BETWEEN BONE MINERAL DENSITY AND CLINICAL CONSEQUENCES:
CROSS-SECTIONAL STUDY OF KOREAN POSTMENOPAUSAL WOMEN IN AN
ORTHOPAEDIC OUTPATIENT CLINIC-
A cross-sectional study was conducted to identify the characteristics of BMD
and the related clinical consequences. A total of 1,281 postmenopausal women
were enrolled nationwide and underwent measurement for BMD using dual
energy x-ray absorptiometry. The distribution of the normal, osteopenia and
osteoporosis group was 25.9%, 37.0%, and 37.2% in lumbar spine, and 31.4%,
45.3%, and 23.3% in femur neck, respectively. BMD in subjects with symptomatic
or asymptomatic vertebral fracture was significantly lower than those without
fracture. The femur neck and total hip BMDs were significantly lower in hip fracture
group (0.646 g/cm2 and 0.643 g/cm2, respectively) and wrist fracture group (0.661
g/cm2 and 0.712 g/cm2, respectively) than in subjects without fracture (0.721
g/cm2 and 0.712 g/cm2, respectively). It concluded that in Korean
postmenopausal women, the prevalence of osteoporosis and
vertebral, hip and wrist fracture increase and quality of life
decreases with lower BMD.

44. • 2. FACTORS INFLUENCING DIAGNOSIS AND TREATMENT OF OSTEOPOROSIS AFTER A
FRAGILITY FRACTURE AMONG POSTMENOPAUSAL WOMEN IN ASIAN COUNTRIES: A
RETROSPECTIVE STUDY-
• A RETROSPECTIVE STUDY WAS CONDUCTED TO CHARACTERIZE PATIENT AND
HEALTH SYSTEM CHARACTERISTICS ASSOCIATED WITH THE DIAGNOSIS AND
MANAGEMENT OF OSTEOPOROSIS AMONG POSTMENOPAUSAL WOMEN HOSPITALIZED
WITH A FRAGILITY FRACTURE IN ASIA. THE MEAN (SD) AGE WAS 72.9 (11.5) YEARS. A BMD
MEASUREMENT WAS REPORTED BY 28.2% OF PATIENTS, 51.5% WERE INFORMED THAT
THEY HAD OSTEOPOROSIS, AND 33.0% RECEIVED PRESCRIPTION MEDICATIONS FOR
OSTEOPOROSIS IN THE 6 MONTHS AFTER DISCHARGE. A HISTORY OF FRACTURE WAS
NOT INDEPENDENTLY ASSOCIATED WITH AN OSTEOPOROSIS DIAGNOSIS. YOUNGER AGE
REDUCED THE ODDS OF RECEIVING MEDICATION FOR OSTEOPOROSIS WHILE HAVING A
BMD MEASUREMENT INCREASED THE ODDS. IT CONCLUDED THAT OSTEOPOROSIS
DIAGNOSIS AND TREATMENT IN ASIAN COUNTRIES WERE DRIVEN BY BMD
MEASUREMENT BUT NOT BY FRACTURE HISTORY. FUTURE EFFORTS SHOULD
EMPHASIZE EDUCATION OF GENERAL PRACTITIONERS AND PATIENTS ABOUT
THE IMPORTANCE OF FRACTURE.

45. SUMMARY
TODAY WE LEARNED ABOUT –
• ORTHOPAEDIC ASSESSMENT
• ANATOMY AND PHYSIOLOGY OF ORTHOPAEDIC SYSTEM
• NORMAL PHYSICAL ASSESSMENT OF ORTHOPAEDIC SYSTEM
• NURSING ASSESSMENT OF ORTHOPAEDIC SYSTEM AS HISTORY
TAKING, PHYSICAL ASSESSMENT/SYSTEMIC EXAMINATION AND
DIAGNOSTIC STUDIES
• TESTS FOR ORTHOPAEDIC SYSTEM
• NEW TECHNOLOGY AND RESEARCH ARTICLES.

46. CONCLUSION
AS DISCUSSED THROUGHOUT THE PRESENTATION, LEARNING ABOUT
ASSESSMENT OF ORTHOPAEDIC SYSTEM WILL HELP NURSES TO CARE
FOR AN ORTHOPAEDIC PATIENT.
NURSES CAN PERFORM HISTORY COLLECTION AND PHYSICAL
ASSESSMENT TO PROVIDE THE NECESSARY NURSING CARE AND
SUPPORT THE PATIENT PSYCHOLOGICALLY.
NURSES CAN ALSO COUNSEL THE PATIENTS AND THEIR FAMILY FOR
VARIOUS OPTIONS AVAILABLE IN ORTHOPAEDIC TREATMENT.
NURSES CAN ALSO TEACH PATIENTS ABOUT THE VARIOUS EXERCISES
FOR IMPROVEMENT OF SKELETAL SYSTEM FUNCTIONING.

47. BIBLIOGRAPHY
• LEWIS. MEDICAL SURGICAL NURSING ASSESSMENT AND MANAGEMENT OF CLINICAL
PROBLEMS.2015. NEW DELHI. ELSEVIER. 2ND EDITION. VOLUME I. PG. NO. 1548-1563.
• JOYCE M. BLACK, JANE HOKANSON HAWKS. MEDICAL SURGICAL NURSING CLINICAL
MANAGEMENT OF POSITIVE OUTCOMES.2015. NEW DELHI. REED ELSEVIER INDIA PRIVATE
LIMITED. VOLUME II. PG. NO. 460-468
• J. MAHESHWARI. ESSENTIAL ORTHOPAEDICS. 2015. NEW DELHI. THE HEALTH SCIENCES
PUBLISHER. FIFTH EDITION. PG. NO. 346-360.
• LEE JH, LEE YH, MOON SH; ASSOCIATION BETWEEN BONE MINERAL DENSITY AND CLINICAL
CONSEQUENCES: CROSS-SECTIONAL STUDY OF KOREAN POSTMENOPAUSAL WOMEN IN AN
ORTHOPAEDIC OUTPATIENT CLINIC. AVAILABLE FROM
HTTPS://WWW.NCBI.NLM.NIH.GOV/PUBMED/25120328 [CITED 8 SEP 2019]
• KUNG AW ET AL. FACTORS INFLUENCING DIAGNOSIS AND TREATMENT OF OSTEOPOROSIS
AFTER A FRAGILITY FRACTURE AMONG POSTMENOPAUSAL WOMEN IN ASIAN COUNTRIES:
A RETROSPECTIVE STUDY. AVAILABLE FROM
HTTPS://WWW.NCBI.NLM.NIH.GOV/PUBMED/23410131 [CITED 8 SEP 2019]