Question

What is the organized physical examination that follows the orthopedic examination outline?

8. A 70 year old left hand dominant male presents to the clinic for evaluation of right
shoulder pain for the last 3 months. He is a swimmer and about 3 months ago decided he would
begin weight lifting to help with his swimming. He notes pain in the posterior shoulder and along
the side of the upper arm. He says he has pain when he raises the arm up to about shoulder
height and then the pain seems to get a little better. He denies any weakness but notes that he
always feels weaker on his left side. His symptoms are alleviated by rest and worsened by lifting
weights. He denies any specific injury that he can remember. No radiation of the pain down the
arm. No numbness or tingling. No significant past medical history.

Answer 1

Orthopedic Examination:

History:

• Collect demographic details such as age, sex, name, gender.
• Collect the chief complaints: pain present when hand raised up. Felling of weakness on left side. No history of numbness, tingling, weakness, coldness.
• Assess the onset, location, intensity, and radiation of pain.
• Past medical history: No significant past medical history.
• Allergies to medications
• Psychosocial history.

Physical Examination

Inspection:

• Asess for any discoloration on the skin such as redness, white patches, or any black spots.
• Assess for asymmetry on both the hands.
• Assess for deformities on the hand such as osteoarthritis, RA.
• Assess for muscular atrophy such as damage to any tissue.
• Assess for muscle strength.
• Assess for any swelling on the upper hand and shoulder of the right side.

Palpitation:

• Assess the skin temperature.
• Palpate for any mass on the lymph node.
• Palpate for any tenderness due to infection or inflammation.
• Palpate for any joint effusion.

Range of Motion:

• Assess for active and passive movement of the right hand and pain interferes with the movement. assess for any joint stiffness.

Stability:

• Compare both hands by stressing on the patient's joint.
• Identify the variability of flexion and extension between the two hands.

Tendon reflexes:

• Assess the Tendon reflexes and nerve sensibility to temperature, light, pain.