UMEM Educational Pearls

Category: Orthopedics

Title: Documenting joint injury

Keywords: joint, documentation, physical examination (PubMed Search)

Posted: 10/9/2010 by Brian Corwell, MD (Updated: 3/29/2024)
Click here to contact Brian Corwell, MD

Previous pearls have described tips for smart and safe documentation of typical ED complaints such as chest pain.  Properly assessing and documenting orthopedic complaints is likewise very important.  No evaluation or chart is complete if it does not include include the following 7 components:

 

The joint above

The joint below

Motor

Sensory

Vascular

Skin

Compartments

The joint above/below is important in cases of shoulder and hip pain actually being radicular pain (from the neck and back respectively).  Also, hip pain from trauma may be due to a femur fracture for example.

For motor and sensory evaluation, test the most distal isolated innervation of a particular nerve (L5 - great toe dorsiflexion for example).

Note distal pulses and check ABIs for injuries with potential subtle vascular  findings.

Note intact skin especially in cases where the joint will be covered by a splint.

Note "soft" compartments especially in cases of forearm and lower leg fractures.

References