Examination
Time:9/12/2008 5:10:34 PM
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Examination,Traumatology and Orthopedics,traditional Chinese medical science,Chinese medicine,TCM
Examination

General examination

Inspection
 
Inspection of the whole body
Inspection of spirit and complexion: Inspection of spirit and complexion can judge the strength of the healthy qi and changes during the course of trauma. Generally, a normal complexion indicates a mild condition; if the complexion is wan and listless or gloomy, it means the healthy qi is damaged, and the condition of trauma is serious. In the case of trauma or massive bleeding, if the symptoms are pale complexion, coma, weakness of respiration or hyperpnea, cold limbs, profuse sweating, platycoria or miosis, it indicates a critical condition.
 
Inspection of posture: The change of limb in posture is often a reflection of fracture, dislocation or serious injury of the muscle and tendon. For example, the patient with fracture of lower limb usually can not stand up and walks uprightly. In the case of injury of the shoulder or the elbow, the patient may hold his sick forearm with his healthy arm and inclines with his body toward the sick side. In the case of injury of the waist, the patient can not move his waist and holds the waist with his arm.
   
Inspection of local areas
Inspection of deformity: The common deformities of the limbs are shortening, stretching, rotation, angulation, protruding, sunken, etc.. A deformity indicates that there exists fracture or dislocation. Some deformities are of decisive significance in diagnosis, such as dinner-fork deformity of straightening fracture of lower part of radius.
 
Inspection of swelling and ecchymosis: If there are swelling and ecchymosis in the limb, the extent of swelling and the color of ecchymosis may be used for judging the nature of trauma. For example, the case of serious swelling with purplish ecchymosis suggests that there may exist fracture or severe injury of tendons. The case of swelling with a little or no ecchymosis generally indicates a mild trauma. In the early stage of trauma, if there is remarkable localized swelling, it may be a fissured fracture or an avulsed fracture. The case of serious swelling with purplish color of the skin is a fresh trauma. A large area of swelling with purplish or dark color of the skin is usually indicative of a severe crush injury. The case of mild swelling with purplish or yellowish green color of the skin usually indicates an old trauma.
 
Inspection of wound: If there is wound, the wound should be investigated about its size and depth, the evenness of its margin, whether its color is brightly red or dark or pale, the amount of secreta or pus on its surface, whether there is bleeding. For an infectious wound, if the granulation tissue is red, fresh and tender, it means there is no pus; if it is pale or dark, there is pus.
 
Inspection of the functions of limbs: Inspection of functions of the limbs, such as whether the upper limb can lift, or whether the lower limb can move, may approximately determine the range of trauma and osteopathy. This should be applied in combination with measurement examination.
 
Auscultation and olfaction
Besides listening to noise, respiration, cough and groan; and smelling the odor of vomit and secreta of the wound, feces, urine or other secreta, the following several aspects should be done in auscultation.
     
Listening to bony crepitus 
Bony crepitus is one of the special signs of fracture. For the complete fracture without impaction, when the sick limbs is swayed or felt or touched, the ends of fracture may collide and give rise to sound, which is called bony crepitus. So, when there is bony crepitus, it indicates fracture. After treatment, if the crepitus disappears, it means the fractured bones have met. But, one should not repeatedly seek bony crepitus in order not to increase the injury and sufferings of the patient.
    
Listening to sound entering-the-cotyle 
The click that is often heard as a successful reduction of a dislocated joint is performed is called entering-the-cotyle sound. So, when the sound is heard as reduction is being done, it means the joint has been reduced, and the operation should be stopped, otherwise it may do harm.
 
Listening to sound of tendon injury
An audible special rub or snapping sound may occur when some cases of injury of tendon are examined. The common sounds are as follows.
 
Rub of joint: The operator puts one hand on the joint of the patient, and holds the distal part of the joint with the other hand; when he moves the joint, he may hear or feel friction sound of the joint. A gentle sound of rub of joint may occur in some chronic subacute disorders of joint; and a coarse sound of rub of joint may be heard in bony arthritis. When a joint moves to a certain angle, there may appear shrill and tiny snapping sound inside the joint; then it indicates there is dislocated cartilage or corpus liberum.
 
Rub in tenosynovitis and perimyotenositis: There may appear rub in extension-flexion movement in the case of tenosynovitis. For example, when a patient with tendovagititis of flexor digitorum is doing extension-flexion movement of finger in examination, a snapping sound may be heard. When a patient with perimyotenositis is examined, a sound like twirling a hair, which is called crepitant rales, can be heard or felt. It often occurs when there is inflammatory exudation around the muscle tendon, usually in the extensor muscles of forearm, or quadriceps muscle of thigh, or Achilles tendon.
 
Snapping sound of joint: In the case of semilunar plate injury of knee joint or corpus liberum within joint, there may appear snapping sound of joint. When the patient does extension-flexion or rotation movement of knee joint, a clear and melodious snapping sound may be heard.
    
Listening to cry 
When examining a child patient, the doctor should pay attention to the change of the child's cry, which may be an aid for determining the traumatic part. Children can not describe their conditions of trauma, some times the parents can not give a reliable history. So when palpation is done in a certain part of limb, the cry or increased cry may indicate the traumatic site.

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