Chief complaint in orthopaedics
Reading File
Searching sources...
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Reading File
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Here is a thorough breakdown of chief complaints in orthopaedics - the presenting symptoms that bring patients to an orthopaedic surgeon or clinic.
Chief Complaints in Orthopaedics
A chief complaint in orthopaedics is the primary symptom or problem that brings the patient for evaluation. Orthopaedic chief complaints can be grouped into 8 core categories:
1. Pain
Pain is the most common chief complaint in orthopaedics.
When evaluating orthopaedic pain, always characterize it using SOCRATES or equivalent:
| Parameter | What to ask |
|---|---|
| Site | Exact location - joint, bone, muscle, spine |
| Onset | Sudden (trauma, fracture) vs. gradual (arthritis, tumor) |
| Character | Aching, burning, shooting, stabbing |
| Radiation | Does it radiate? (e.g., sciatica, cervical radiculopathy) |
| Associated symptoms | Swelling, numbness, weakness |
| Timing | Morning stiffness (inflammatory), rest pain (tumor/infection), activity-related (mechanical) |
| Exacerbating/relieving factors | Movement, rest, NSAIDs |
| Severity | VAS/NRS scale 0-10 |
Key orthopaedic pain patterns:
- Mechanical pain - worse with activity, relieved by rest (OA, ligament injury)
- Inflammatory pain - worse at rest/morning, improves with use (RA, spondyloarthritis)
- Rest/night pain - raises concern for tumor or infection
- Radicular pain - shooting/burning along a nerve distribution (disc prolapse, stenosis)
- Referred pain - hip pathology referring to knee; shoulder pathology referring to arm
2. Swelling
The second most common chief complaint. Assess:
- Duration - acute (<48 hrs) vs. chronic
- Onset - traumatic (hemarthrosis) vs. gradual (synovitis, effusion)
- Location - intra-articular vs. extra-articular vs. bony
- Associated features - warmth, redness (septic arthritis, gout, cellulitis)
Key causes:
- Hemarthrosis (immediate post-trauma) - suspect ACL tear, fracture
- Effusion (6-24 hrs) - meniscal tear, soft tissue injury
- Synovitis - inflammatory arthritis
- Bony swelling - osteosarcoma, osteochondroma, Paget's disease
- Soft tissue swelling - bursitis, ganglion cyst
3. Deformity
Includes:
- Angular deformities: genu varum (bow leg), genu valgum (knock knee), hallux valgus, cubitus varus/valgus
- Rotational deformities: femoral anteversion, tibial torsion
- Shortening: limb length discrepancy (LLD)
- Kyphosis/scoliosis/lordosis: spinal deformities
- Post-traumatic deformity: malunited fractures
- Joint deformity: boutonniere, swan-neck (RA), Charcot joint
Always note: onset (congenital vs. acquired), progression, and functional impact.
4. Loss of Movement / Stiffness
- Reduced range of motion (ROM) - active and passive
- Morning stiffness >1 hour - inflammatory arthritis
- Locking: inability to fully extend a joint (mechanical block - torn meniscus, loose body)
- Pseudolocking: pain-inhibited movement
- Stiffness after inactivity ("gelling") - osteoarthritis
- Frozen shoulder - global restriction in all planes
5. Weakness / Inability to Use a Limb
- Muscle weakness: nerve injury, myopathy, disuse atrophy, compartment syndrome
- Drop foot: common peroneal nerve injury
- Wrist drop: radial nerve palsy
- Claw hand: ulnar nerve palsy
- Inability to weight-bear: fracture, infection, AVN
- In children: refusal to use a limb (Pseudoparalysis of Parrot in syphilis, pulled elbow, septic arthritis)
6. Instability / Giving Way
- Joint instability after ligament injury (ACL, collateral ligaments)
- Shoulder subluxation/dislocation
- Ankle instability (chronic lateral ligament laxity)
- Patellar instability
- Spinal instability (spondylolisthesis)
Distinguish:
- True instability: ligamentous laxity with joint translation
- Giving way due to pain inhibition: quadriceps weakness, patellofemoral pain
7. Numbness / Tingling / Neurological Symptoms
- Paresthesia: nerve compression (carpal tunnel, cubital tunnel, cervical/lumbar disc)
- Dermatome distribution: helps localize level of nerve root compression
- Saddle anesthesia + bladder/bowel dysfunction = cauda equina syndrome (emergency)
- Peripheral neuropathy (diabetic, etc.)
- Complex Regional Pain Syndrome (CRPS)
8. Trauma / Injury
- Mechanism of injury: fall, road traffic accident, sports, direct blow
- Time since injury
- Previous treatment received
- Functional status before injury
- Tetanus immunization status (open injuries)
Summary Table: Common Orthopaedic Chief Complaints
| Chief Complaint | Common Causes |
|---|---|
| Pain | OA, RA, fracture, infection, tumor, nerve compression |
| Swelling | Effusion, hemarthrosis, synovitis, tumor, bursitis |
| Deformity | Fracture, congenital, developmental, arthritic |
| Stiffness/loss of ROM | OA, inflammatory arthritis, adhesive capsulitis |
| Weakness | Nerve palsy, muscle injury, disuse |
| Instability | Ligament tear, joint laxity |
| Numbness/tingling | Nerve compression, radiculopathy |
| Trauma | Fracture, dislocation, ligament/muscle tear |
Mnemonic: "PSDWINT"
Pain - Swelling - Deformity - Weakness - Instability - Numbness - Trauma
Important Red Flag Symptoms in Orthopaedics
Always screen for:
- Night pain / rest pain - malignancy or infection
- Constitutional symptoms (fever, weight loss, night sweats) - infection or malignancy
- Bilateral symptoms - systemic disease
- Saddle anesthesia + sphincter dysfunction - cauda equina (surgical emergency)
- Rapidly worsening neurological deficit
- History of malignancy - metastatic bone disease
Sources: Campbell's Operative Orthopaedics 15th Ed 2026; Miller's Review of Orthopaedics 9th Ed; Rheumatology 2-Volume Set (2022, Elsevier)
This is a shared conversation. Sign in to Orris to start your own chat.