Chapter 1 Physical Examination
The diagnosis of disorders of the musculoskeletal system begins with compiling a complete history and performing a physical examination. The history is of special significance because physical findings are often minimal. Its importance cannot be overemphasized. Most musculoskeletal conditions should be able to be diagnosed by history and physical examination alone. Referral for elaborate laboratory or radiographic testing is usually unnecessary in the analysis of most orthopedic conditions, at least in the early stages.
History
BIRTH HISTORY
The physical and mental development of the child is then determined, and any deviation from normal progress is noted (Table 1-1).
| Age (mo) | Milestone |
|---|---|
| 1–2 | Holds up chin |
| 6–8 | Sits alone |
| 8–10 | Stands with support |
| 10–12 | Walks with support |
| 14 | Walks without support |
| 24 | Ascends stairs one foot at a time |
* Note: There is frequently a wide variation in physical development, but if a child cannot walk unsupported by 18 months of age, a neuromuscular disorder should be suspected. A wide-based gait is often the first noticeable abnormality when neuromuscular disease is present in the child. In addition, the child should not have hand preference before 18 months of age.
For greatest accuracy, the ages of all children should be listed by years plus months.
PAST HISTORY
The general health of the patient is recorded, as well as any recent weight loss or gain. The patient’s exact occupation should be determined and any relevant military history noted, especially if a disability rating resulted from time spent in the service. The disorder that prompted the rating is noted, and impairment ratings from other sources are also recorded. All chronic renal, metabolic, pulmonary, and previous orthopedic disorders should be assessed in view of the initial complaint. Any drug or alcohol use is recorded. The smoking history is especially important, because tobacco use may adversely affect multiple musculoskeletal conditions, including osteoporosis, fracture healing, and low back pain.
