Traumatology and Orthopedics of TCM PDF

A Newly Compiled Practical English-Chinese Library CM Boric) Coed eee ee es aa oa a ee kee eis neh Uh Cet: Beat} Mac re men] Crane au he ou Rona ee pacer) bos Mea es be (eH ri] fe ie ei 7h 4h aR = 2 b c = F a o a 4 bo 4 =] EA | = i=] zu fl = i] a o a) 3 = = o 4 =] a ir] E BAR, Is LBB aE AE SE. UA OT Br MEL ls JL EAS Pa i FAB Be PE WADE. THM SHA KEA. Ait is RA EMT EK RI. Fr ith ARPA AOE OL AE AB ESR . Tr] AF BR AB] A BK — aE REBT. 2, RR RRS RAW RAAB UMAR. Ae TE, i RE BR. PEA FE, LAR UA RAE Bi. EERE, AM He BS SE ETA RS WM Sh Bee $f. WOOF ah el, Sh Sh) ARB OR, th Se KRAARRG ETAT. 3. PARAM iS ER A EN KAR. (ERA APRA ET. 1 ERR SS FRA Bee YT WBE TP 2~3 MARAE SBR RAL » Be AB Bt FEE Hh. DEGMRER HT. BH+1) General Introduction + 19+ occurs in the junction of the two arcuations without pro- tection of ligaments. Take occult cleft spine of S: as another example, because there is no spinous process, the supraspinal and interspinal ligaments are short of their at- tachments, thus the stability of lumbosacral joint decrea- ses, the weak part is susceptible to trauma. 2.1.1.2.4 Occupation ma is to a certain degree related to occupation. For exam- The occurrence of trau- ple, mechanical workers without necessary safety devices are subject to the trauma of hand. Workers constantly bending over or shouldering heavy load are subject to chronic lumbar strain. Athletes, acrobats and Gongfu ac- tors are subject to various sport injuries. And middle-aged people constantly bending over the desk are subject to cervical spondylopathy. 2.1.2 Pathology of trauma 2.1.2.1 Pathology of fracture 2.1.2.1.1 Fracture displacement The extent and direction of fracture displacement are related, on the one hand, to such external factors as the strength and action direction of the force and the shift condition after trauma; and on the other hand, to such internal factors as the gravity of the distal part of limb, attachment point of the muscle and its contractility. The fracture displacement is of the following five types (see Fig.1), and any type may be accompanied with the others. TA RA: HET LA AR BY BH DA a 9 36 FF Ah. SUI ED fA Bake FE RES a SAPS AN LG RDB ARR ET ARMY BOBUIE T REAR EF BOS AE TE ESS BB RAE BR GH. 4, AMT HH 46S TAA ERA WF PR iS RA HERE wD SBN Bi PE ae PF TPE BL PALA HEEB RB SF BH Be AE FRE SERB LA; JEM PE PB ae Be GR AT BH RED BRAS Hig HH iB BRR LEH PEAR AB SEIS =. RANA (—) ai 1 BRHBE Bie LAY ARISE ArT). — rE FARSI EFA ti Be GE HF DUPE RAK. 3 — Tr ESA BS LA BR a ak Ba He M8 3 Hy EY EARAK. SHB MAK AP TLR COOLER 1) «i RE. RAHA.PRBS + RB ba (1) Angulation displacement (2) Lateral displacement (3) Shortened displacement (4) Separation displacement (svassplacemen BAL MAB HL BAL Fig. 1 Fracture displacement Bl BinHe (1) Angulation displacement: The axial lines of the two ends of fracture cross each other, forming an angle. The angulation may be classified as forward, backward, inward or outward angulation according to the direction of its apex. (2) Lateral displacement; The two broken ends of bone are displaced laterally. bone, according to its displacement direction of the distal The displacement in limb end, is classified forward, backward, inward or outward displacement. In the spine. it is classified according to the displacement direction of the vertebra just above it. (3) Shortened displacement: The two broken ends of bone are overlapped or impacted into each other. The bone hence becomes shorter. (4) Separation displacement: The two ends of fracture separate from each other, the bone hence becomes longer. (5) Rotation displacement: The end of fracture RBA, Hee BAL CG) kA BT BZ ATC BA» WA Fe Fr oN A J TA Sb ARS (2) Ma BL AAT SS FL TT» WO Be PD HEB BOG LL Fr I PR OBST J. 1) SBR SMI DB A 5 PPE DAE RAR AB LDF FR EE 6 (3) eB RST Sa TA RH IRE Hi. DF kB WHT EARS PHC ES. 6) REBER HAR+1 General Introduction +216 rotates round the longitudinal axis of the bone. FESS HAE . 2.1.2.1.2 Classification of fractures 2, BAND (1) According to condition whether the end of CL) ARE Rap RGS SH fracture is open to outside, fractures can be classi- sR Ani DA: fied into: 1) Closed fracture: The skin or mucosa of fracture DAA ATAbK region is not broken, and the end of fracture is not open JARMAN ARBEW. AT AN to the outside. SAF 2) Open fracture: The skin or mucosa is broken in the fracture part, the end of fracture is open to the outside. (2) According to the extent of fracture injury, fractures may be classified into: 1) Simple fracture: There is no injury of nerves, important blood vessels, tendons or organs. 2) Complicated fracture: There is the injury of nerves, important vessels, tendons or organs. 3) Incomplete fracture; The continuity of only the partial bone trabeculae is broken off. In this kind of fracture, generally, there is no displacement. 4) Complete fracture: The continuity of the bone trabeculae is broken off. A tubular bone is broken in two or more segments proximally and distally. There is usually fracture displacement. (3) According to the distribution of fracture lines, fractures may be classified into: (see Fig. 2) 1) Transverse fracture: The fracture line and the diaphysis axis meet at a right angle or almost at a right angle. 2) Oblique fracture; The fracture line and the diaphysis axis meet at an acute angle. 2) FRAT ARK RTA BUTS Oh RA we. (2) ARGH Hy 89 48H 4B BA: D Baar Toit HH 4B ot LR a a a Hit. 2) BRAT HAMA, HE SE a SL Re Be WE ae Bt Hit. 3) REAR AR A 8 SEE A BBO FE KHRAMSAGAL. DCE ARH SESE PIA. BRA ATT JAE ahi i RA WHRA. KHAARLA Bi. (3) ARAB Ha RS FA: OLA 2) LD MA AAS ATO Ae BE A DBA AWAS AT AWMA RBA+ 22+ PRBHAS* BR Hh Ni ‘ke (1) Transverse fracture (2) Oblique fracture (3) Spiral fracture (4) Comminuted fracture (5) Impacted fracture BUTT BERS SR BRAT aT (6) Compression fracture (7) Fissured fracture (8) Greenstick fracture (9) Epiphysiolysis eed BUTT ah AR Fig. 2. Types of fracture 2 Bim 3) Spiral fracture; The fracture line is spiroid. 3) RRB A Bae SRI. 4) Comminuted fracture; The bone is broken into DEAT AAPA RK more than three segments. If the fracture lines forma T 3 4RU_L. @“BSRE BHT”. BE figure, it is called T-shaped fracture; or a Y figure, called #7#RA“ TBR“ VIG. MAK Y-shaped fracture. “TRB CY BAT”.+1 General Introduction +236 5) Impacted fracture; It often occurs in the juncture of compact bone and spongy bone in the metaphysis of long tubular bones. After fracture. the end of compact bone impacts into spongy bone. 6) Compression fracture: The spongy bone changes its shape because of compression, such as fractures of vertebra and calcaneus. 7) Fissured fracture: It is also called bone fissure. The space of fracture looks like a fissure or a line. This kind of fracture usually occurs in cranial bone, scapula, ete. 8) Greenstick fracture: This often occurs in children. Only partial substance and periost of bone are drawn out, folded or cracked. There is in fracture region deformity of angulation or crookedness, just like the breaking of the twig. 9) Epiphysiolysis: It occurs in epiphyseal plate, the epiphysis and the diaphysis separate from each other. It usually occurs in children or youth. (4) According to the stability of the bone after reduction, fractures may be classified into; 1) Stable fracture: Usually, no displacement occurs again after reduction of fracture with a proper external fixation, such as fissured, greenstick, compression, and transverse fractures. 2) Unstable fracture; Displacement easily appears again after reduction, such as oblique, spiral, and comminuted fractures. (5) According to the time seeking for medical service, fractures may be classified into: 1) Fresh fracture: The first visit is made in two or Sa RAE PRAT thin BAS BRA. AT BRAK ATR AA © kei haw FSB iti EE» ANS HE aie. 7) Ws aT RK BQ”, Fr OT Ue BR a MR AR SLE GE ATA Pa RAT SRE JLB ALA RR AU A BE HKG RBA, GLA SS wT BeBe TIN AO HAL 9) PRR RACER WAR ARAL, A STS FE A SBE AYER BOR AE SY BS HN, LPL eA ate, (2) ARAB RIL RRERDA: DRER AtEe BYARD BEB HME BW TR HAST BOLTS. DREAD BE RERBME WORE i RTE BT RTS (5) ARB a aL aT MPA: D RRB Hi 2~3+26 RERGRE BR three weeks after fracture. 2) Old fracture: The first visit is made two or three weeks later after fracture. (6) According to whether the substance of bone is normal before trauma, fractures may be classified into: 1) Traumatic fracture: The bone substance is normal before fracture, the fracture is absolutely caused by external forces. 2) Pathological fracture: The bone substance has already had lesion before fracture, the fracture is caused by a little force. 2.1.2.1.3 Complications of fracture In the attack of a violent force on the body, besides fracture, there may also occur various general or local complications. The serious complications may endanger the life in a short period of time, so it must be treated urgently. Some of the complications need to be treated simultaneously as the fracture is treated, and others may be treated until fracture heals. The common complications are as follows. () Traumatic shock. (2) Infection; If débridement is not done or done incompletely in the case of open fracture, it may cause pyogenic infection, or esteomyelitis or hematosepsis in the severe cases; if it is an anaerobic infection, such as tetanus or gas gangrene, the condition will be more serious. (3) Injury of internal organs 1) Injury of the lung: The case of rib fracture may be complicated by injury of pulmonary parenchyma or rupture of intercostal blood vessels, which may result in hematho- rax, or closed pneumothorax, open pneumothorax, tension pneumothorax, or hematopneumothorax. SEMUARER. 2) IBS fil 2~3 TEMUERES (6) RES PRR GEEDA: D saat Hart ETE HS AUR Sb ER I PEATE 2) waa ARRE BIE BRON te LATE 3. AMHR A WERAG RRERTH. IBM REA FG eS wR BAI Ae HE. HA HF Be HE ay NT FA wd AE a ws BNL A HE RE DRL aT A EN I He Fe aT RAGLR. CD) SPER I 2) RR FRESH OAS Beat 5B) BNE BY AD BEE. iY S| 2 HC HERR I PHY FRA MA WES BR ERE AY ROE 5 BRL AE HRS Ja REMPME (3) ARR 1) i AAT AT EH OBE HS EA i BT) sn ERAS aT | a at HR TEACH. FP BC HE CB. SR 20 HE Hi) NL. UH+1. General Introduction 725 2) Hepatic and splenic ruptures: When the force acts on the lower part of the chest, besides rib fracture, it may result in hepatic rupture or splenic rupture, especial- ly in the case of splenomegaly, serious internal bleeding and shock may appear. 3) Injury of the bladder, urethra and rectum: When the pubic bone and ischium are broken simultaneously, posterior urethral injury may happen. If the bladder is full, it may be stabbed by the fractured and displaced end of bone. The case of sacrococcyx fracture may be complicated by injury of the rectum. (4) Injury of major arteries; It usually occurs in the case of severe open fracture or closed fracture with great displacement. For example, extended supracondylar fracture of humerus may injury brachial artery. In the case of injury of a major artery, there are pain, numbness, coldness, pale or cyanosis in the distal limbs, or no pulse or weak pulse. (5) Ischemic muscular contracture: It is a severe complication caused by compartment syndrome of fascia. In the upper limbs, it often happens in the case of supracondylar fracture of humerus or fracture of ulna and radius; in the lower limbs, it often happens in the case of supracondylar fracture of femur or fracture of the upper end of tibia. The muscle groups of the forearm or leg may undergo necrosis because of ischemia after the injury of the major arteries of the limbs in the case of insufficient blood supply due to injury of artery of the limb, or in the case of a tight bandage for a long period of time. Neuroparalysis or muscular necrosis can give rise to formation of scar tissue through organization of the necrosed tissues. The scar tissue may gradually contract and further cause special deformity of caw hand or caw foot, resulting in severe deformity. (6) Spinal cord injury: The severe displacement of 2) BR BTA MORE PERNT PRA RA TESb EY AE AP SESE MAM EBA, FE RU HE PY PLA. 3) BRE Rh. Ba Sat AAs BT BT AS S8Ua Rw GB icet BEDALE FEARS «AT AS NAT wR. Ka POUFLAGWH. (4) ELDKGG B RFP EOF REST ANB TRA AEA. MOF HP MARLAT HRA KS. BEAK Re TAUPE RA He 7 At EH a (5) oR sok MUR BE 2 AR Ti) BR EP Ae HER. LRERFRER LAR RE FRE RFRGR ERB ALE Di. 1. FRAY a ah WAG Wei» LR HE AS ke FL ee — ey a ak A AO DLEE A He TSK TE. HS PR WAR. AOR FE RIE BH ES I BURA BY BEI FB -F IT FEL AY AU RE. (6) HRA BM+266 PROGAS +R it spine fracture may be complicated by contusion or laceration of spinal cord, giving rise to paralysis below the injured level. (7) Peripheral nerve injury: It may be caused by traction, compression, contusion or stimulation of nerve in the early stage of a fracture. or by compression from external fixation, encapsulation from callus or by traction from deformity of the limbs in the late stage of fracture. In the case of nerve injury, there will appear sensory disturbance or dyscinesia in the limb region controlled by the nerve and neuratrophia in the late stage. (8) Fat embolism: It is a severe complication that is not commonly seen, but it is increasing recently. In adults’ fracture of the diaphysis, the fat droplet of bone marrow, in the case of too big a tension of hematoma in the marrow cavity, may enter the venous blood flow through the ruptured vein, forming fat emboli to block the vessels, resulting in ischemia of the vital organs like the lung and brain or tissues which consequently endangers the life. (9) Hypostatic pneumonia: In the case of fracture of the lower limbs or spinal bone, the patient needs to stay in bed for a long time. It will lead to decrease of pulmonary function, accumulation of sputum difficult to cough up, resulting in respiratory infection. This case is often seen in old people, and often endangers the life. Therefore, in the period of bedtime, the patient should take more deep respiration, or tap the chest actively to help expectoration, and at the same time do more bed functional exercises on the presupposition but not influen- cing treatment of fracture. (10) Bed sore: In the patients with severe traumatic coma or spinal fracture complicated by paraplegia who need to keep in bed for a long time, compression of some PPE AT BEAL FT SE EE RURAL, TTS BH OPE TILA FER. i 2) ABBR SAH Arar ay ES 52 HE ir 3 PEMA BUR. AAT FAS Le Ae 38 Pa GB HK TE ER. MAR Jes» STS AG HA HE 2 AE PRG I BH JI a AER. (8) Re R fab HL WBN BT St AE UAE AHI. RAAT BE FEAL OLAP SK LK eA HE RS EA it JAB Wi He F 3H FE a FF PT LAL Es i FE a SR i.» PLT FB AE At. (9) AR AR RP IE AUS HE A AT. DK SD PR BC iy BE BL BS. BE BE BR, FALE, 1 LIF WR A BE ARE VA CERES, AM eR Ac dit. CR A Ze BS ARS Ta] Bie ZANE TRUE A » BE Bh $e HA OK FEBDTEDE s EAS GO TB IT HY BW aE F.1D EO BE SBR. (0) He PH PER THE RUE SG ASAIN ACH. He te FE 9S BB CaN+1 General Introduction 227° parts with projecting bone may lead to necrosis of the tissue because of disturbance of local blood circulation, hence forming ulcer. So, the patient should be given strict nursing care for an early prevention. The parts subject to bed sore should be kept clean and dry, the patient’s position should be changed frequently, and the patient should be given massage, or cotton or air pad in the local region in order to reduce compression. (11) Urinary infection and calculus: A long period of treatment of indwelling catheter for urinary dysfunction of a patient with spinal fracture complicated by paraplegia may cause retrograde urinary infection, giving rise to cys- titis, pyelitis, etc.. So, the catheter should be regularly changed, and the bladder be irrigated regularly. The bone of a patient long living in bed is decalcified, the kidney se- cretes a great deal of calcium salt. If the patient does little exercise and drinks less, he may get urinary calculus due to hypouresis. So, the patient should be encouraged to drink a lot in order to keep normal urination. (12) Traumatic ossification: It is also called ossifying myositis. In the case of intracapsular fracture or fracture around the joint. the trauma. poor emergency fixation, repeated rude reduction and passive exercise may make hematoma spread or bleeding repeat. The blood diffuses into the broken muscle fibers. After the organization of hematoma. it may gradually change into cartilage through induction of periosteal ossification nearby, and it may undergo calcification and ossification. There is ossification shadow in X-ray film. Clinically, it is a complication often seen in trauma of cubital articulation and may greatly influence the movement of the joint. (13) Traumatic arthritis: Malposition healing of HO JS LARP EAL) SET. iif BC Je BB 0 BG, 2H Ke TERR GBA BD. MH LEONG PE BEG. PERE IE BAB LE RS I We Pet PE BE Jey BS DAG Bs Bi A ak as ST 48, DoD FRG, CD RBRRH BG PEAT A Ht RES. AFER WRK SRA Ab BRASS OY | LET ER RR, ABR. A RRE. BUTTE TG BA A FF ES RAE APH ER Be. SA AES. GERM PAE HE th FB BI OD th TAD TUE DR AB HH A TB PRESSE Al. WL BR BR OK 7k RES VO. C12) HH TRB “HACHEM” KT RK PHA A. BREE SRMEDR, RA HTAR WM SP A oT oH BE LAPT PCa J BB FM a, PB ABBR 6 ULF AE ZT LI PUGS ME ARI BS BMEWKA. Rie tt. Ab. HE X RR ET WRB HC BA. ih PR EDT SAA IE HT PP ms NAL. (13) ARR FH+ 2B PRBHAR: RR intracapsular fracture due to improper reduction or angulation healing of diaphysial fracture may make the articular surface uneven, or lead to unbalanced force acting on the articular surface. A long period of abrasion with articular movement may cause damage and degeneration to the articular cartilage surface, hence traumatic arthritis. (14) Ankylosis: It may occur in the severe cases of intracapsular fracture. A long term of wide extra-articular arthrodesis may cause adhesion of soft tissues and con- traction of muscle tendon around the joint, and then lead to disturbance of joint movement. Therefore, for the case of intracapsular fracture complicated with hemato- cele, the blood needs to be drawn out as thoroughly as possible. The time and range for the arthrodesis should be proper, and an early functional exercise of the joint is beneficial. (15) Ischemic osteonecrosis: Disturbance of blood supply for fractured segment may cause ischemic osteonecrosis. The common cases are fracture of neck of femur complicated by necrosis of femur head, and fracture of middle part of scaphoid bone complicated by necrosis of the proximal segment. (16) Delayed deformity: Fracture of epiphysis in children may impair the growth and development of the joint, gradually (usually in several years) lead to deformity of the limb. For example, lateral condylar fracture of humerus may result in deformity of cubitus valgus or claw hand. In the treatment of fracture, the prevention should be employed first for all these complications. If a complication has already occurred, it should be promptly diag- nosed and properly treated. Then, most of the complications may be avoided or cured. PAAR A RS RAP HT kA A RKPOARP ERK GS TIE BE RSA SR AE HE TUE KW KA BBE, TAA: BI TERR 4) RFR MW RAB SK HE (HE. KA 22 BSP Ae 9 aS 5 A BK A HE AL BOSS SR th A] S BK hE fh. Al, MRA A aTH A Pus RS. BEEN 3S EEL Ay Fa) Bs BAF hE SAETT ICT HY EAB. (15) sia PRI AP hr BY at EY A OR TERRI. UR SE BAEK AI EH A RB TH REMRMH AS A (16) RR aE JURE A iti a6. A my Be RPE BE HS BLM. AL JBM Cit Teas FAP) tH BBR MATE. OH Sh Re SUIS Sh BH WIE. PRR aE Hy i NIE EE CEMATE ATT IT M EE EMU HAE. MRE tH SL nie Be a HD A EG IF DRE KB RSE HE eB AT DA BIA AAD 5+1) General Introduction + 29° 2.1.2.2 Pathology of dislocation (=) Bi 2.1.2.2.1 Classification of dislocation 1, BEAL ANSE (1) According to the cause of dislocation, it may be (CL) RRR A OH classified into traumatic dislocation, pathologic dislocation 497 HENBL AZ ra FALE AB AL A and habitual dislocation. RE RBLA. (2) According to the degree of dislocation, it may be (2) Be Ride ABBE FF classified into partial dislocation (or semiluxation) and = 92884} EBERLE CIR BR “EB complete dislocation. (3) According to the direction of dislocation, it may be classified into anterior dislocation, posterior dislocation, superior dislocation, inferior dislocation and central dislocation. (4) According to the time of dislocation, it may be classified into fresh dislocation whose duration is within 2 to 3 weeks and old dislocation that has not been set yet for more than 2 to 3 weeks. The articular dislocation that re- lapses repeatedly is called habitual dislocation. (5) According to whether there is wound opening to the outside in the dislocated joint, it may be classified into closed dislocation and open dislocation. 2.1.2.2.2 Complications of dislocation (1) Fracture: It often occurs in epiphysis near the articular surface or glenoid lip. For example, anterior dislocation of shoulder is usually complicated by the fracture of greater tuberosity of humerus. This kind of fracture mostly takes place when the fracture is set, and the fracture segments are reduced with the correction of dislocation. (2) Injury of blood vessel: Because of great violence, the epiphysis of dislocation makes blood vessels injured, leading to disturbance of blood flow in distal limbs. For example, anteroinferior dislocation of shoulder joint and posterior dislocation of elbow joint may respectively fic") FTE E BEAT (3) RL ey FF Aaa BEAN Fs ABA EBB AEF ARAL AE BEA (A) AR REAL 4 A I £2~3 FTEMUA RAH SR at 2~3 +B RAM AM IAEBL. & WE RA RA BE HE REAL. (5) RBA REA ala bsp Ra DAA PERE AL FFE HE A 2, BUCA FE a HE C) BR BRAEB WRT HW FM AY MR. WO a BL BE A IE MAKE EE RRA KEEBLE ZI. BH oN FEZ BE (2) mea Till SERA ART» BEAL Sd PL BY SP BCG A ae Mi a 38 BE BE. MUSCAT ATP BEAL PU BAL} BI AT 5 | sis HK+ 30° PREDAS +R cause injury of arteria axillaris and arteria brachialis, resulting in disturbance of blood circulation of the sick limbs. (3) Injury of nerve; It is often caused by compression or traction of the dislocated epiphysis. For example, in anterior dislocation of shoulder joint, the circumflex nerve may be injured by traction of end of humerus. Most of this kind of injuries of nerve may gradually recover in three months or so after removal of compression and traction factors through reduction. (4) Ischemic osteonecrosis: A disturbance of blood supply of bone due to laceration of joint capsule and ligament may result in ischemic osteonecrosis. For example, dislocation of hip joint may be complicated by ischemic necrosis of head of femur. (5) Traumatic ossification: It is often seen in the dislocation of elbow joint. (6) Traumatic arthritis; It generally occurs when the articular surface becomes uneven because of injury of articular cartilage surface in the dislocation, and there develop retrograde changes and hyperosteogeny of edge of epiphysis due to continuous friction and compression of the articular surface caused by weight bearing and movement. It is often seen in the lower limbs with load bearing. 2.1.2.3 Pathology of injury of muscle and tendon 2.1.2.3.1 and tendon (1) According to the nature of injury, it is classified into; 1) Sprain: Traction and torsion by the indirect vio- Classification of injury of muscle lence make the soft tissues around the joint go out of their normal range of physiological activity, hence giving rise to MG 2h Bk aA A») A WER. (3) FAR BAB AA Si FE 8 aR AE HB. Je BT BE A SA SB, BAER. RAMA i AF SLADE RR T Fea WAR KSSH 3 AAG HEAR (4) hie PRR HK WHEE BA. OLIRT ASM BEG a» AT Be AEP PETRIE. NBR SG 5 WBE BE BY HE BIAS MEAG, ) REP Bi FRAT BL. (6) UHRA R 4 HEIL 2 Wt eS RT EH G5 HEARSE RF #8 th RR. LA HS SBE, 5) RRA ES Sah A SAE PA: A RTA, HAE FR AH RB. (=) Btw 1. BRI SE (DREGE RDA Dit RRR A FE DUEAGG ( JA AR A SUR AC TE A Ae BG+1 General Introduction - 316 laceration, fragmentation, malposition and joint transposition. The feature is that the injury is far from the force- acting part, mostly around the joint. 2) Contusion; Attack or crush of direct violence on a local part of the body causes a closed trauma of the part. The feature is that the injury occurs at the force-acting area, mainly in soft tissues. (2) According to the severity of injury. it is classified into: 1) Laceration: There is injury of muscle and tendon or partial fragmentation of tendon because of indirect violence, usually no severe functional disturbance appears. 2) Fragmentation: The pathology is the same as that of laceration, but because of greater force, there is complete fragmentation of tendon, and there often occurs functional disturbance in different degrees, or even deformity. 3) Transposition of bone: There is a little dislocation of a movable or minutely moveable joint because of the action of an external force, it is often a complication of sprain or contusion. (3) According to the duration of injury, it is classified into: 1) Acute injury of muscle and tendon: Acute injury, also called fresh injury, refers to the injury caused by sud- den attack of external force on muscles and tendons of the body, and the duration of injury is not more then two weeks. 2) Chronic injury of muscle and tendon; Chronic injury. also called old injury, refers to the condition in which Hi. 5/2 WR RK SOSERE HORE i AE sk Db Fate ABBA Be Be Ae FEET JANE. 2) eh ARR $0 abe BR HA Es I AB HRA AAEM. H 5 A i RE ESD HR EFL BB A» DA Jaa BB SH 2 5 BL AX. (2) REGMERDA: DPA Ria TA BEAR VE FAH AL i 2 Hh HG AEH A i. BAS] BPE TANT AE BRAS. 2) wR ASH AGH, RASA KDA Sl TT 3 BY ee WS ‘is is iA Td FE BE 8 EB FE BEATE 3) AM FET ATK i AA a a EA HED 8 EF PRA AH Oh i a» BAL Hii. (3) BAGH MBDA: 1) AEM HR Oi". AR ARE ZI KR A BBG Fila AE 24 GG. 2) TEM RR BR Oi”. AAA AE ie+326 PRAAAY + SB it delayed treatment or incomplete treatment for an acute injury may lead to the chronic injury, generally the duration is more than two weeks. (4) According to whether there is mucocutane- ous rupture, it is classified into; 1) Open injury; There occurs breaking of skin when the muscle and tendon is injured, subcutaneous or deep tissues are open to the outside. This kind of trauma is subject to infection. 2) Closed injury: There is no breaking of skin in the injury of muscle and tendon. 2.1.2.3.2 Complications of injury of muscle and tendon; As an injury of muscle and tendon occurs because of violent forces, there may come various complications in either early or late stage. Therefore, it should be given a careful examination, and the complication should be treated simultaneously. Otherwise, the recovery of articular function will be affected. (1) Avulsed fracture: It is usually caused by indirect violence. The muscle tendon attaching to apophysis of joint suddenly and greatly contracts, resulting in avulsion fracture. (2) Nervous injury; Based on movement of the limb, the range of anesthesia and whether there is atrophy of muscle, the site and extent of nervous injury may be by and large judged. (3) Ossifying myositis: See the section of complications of fracture. (4) Intracapsular corpus liberum: It is also called “joint mouse”. There is injury of articular cartilage in the case of tendon injury. The injured cartilage gradually develops into a small bone, then the bone exfoliates and becomes a corpus liberum, which often changes its position RGR IT A UG » TPE BAY HE Miia Bt 2+ EMU LARHF. 4) BEE BAR AS HR AREA: LD FRE RTE BaTALOT Ay Be ARBOR BE BR BBL SNF ABH. BEE EADS BARR, 2) ATE ALE MARR BAS 2. GAMHRE ZR FG HE JG BR RAE AG BSD HE A BC BRE FRE IN FETE. HA A AY A VER aT At — Fp ah, HEAD EEL QL) awa AZ ela ERA MEET RES ULB DRA SB Wi TT BE AMR AT. (2) APRA HLTA Riz oh RE TH AB EE, WLS A Fc BA SB Be AT AH EH A Bh A #E. (3) FLEMK BR AMSA, DAFAHEA YW RP”. BGM RAK RCH. TE a HAE FESR WBE YE TB EB SRA 1) (BT ah WR AE ie+1. General Introduction +3. following the joint movement. This commonly occurs in the knee joint. (5) Bony arthritis: Injury of tendon in joint, if not properly treated in the early stage, may cause retrograde degeneration of articular cartilage surface in the late stage, then the weight-bearing will become unbalanced, and there may occur arthralgia, functional disturbance, etc. . 2.1.2.4 Pathology of qi and blood in trauma 2.1.2.4.1 Damage of qi (1) Stagnation of qi; This means that in some parts or viscera, because of trauma, there occurs the disturbance of qi activity, the flow of qi is stagnated. Damage of qi exhibits distention, distress and pain, but distension more remarkable than pain and the pain is characterized by migration. Stagnation of qi may occur everywhere in the body. (2) Blockage of qi: It is often caused by the failure of qi to go outside due to the obstruction of the stagnant blood in the case of severe trauma. The main manifestations are transient faint, coma, dysphoria or lethargy, even syncope. Blockage of qi is most closely related to the heart and brain in pathology. (3) Deficiency of qi: It is a pathological state caused by insufficiencies of some or all viscera of the body. Development of qi deficiency concerns hypo-production or excessive consumption of qi. It is often seen in the chronic trauma, or convalescent stage of a serious trauma, or in the old and weak patients. The main symptoms arc lassitude, lower voice, shortness of breath, reluctance to talk, spontaneous sweating, poor appetite. loose stools, etc. . BE, SRETIRRG. G) FRAP R RW BAIT BY AGG» PE Ah AN, Ja A RA HR BATHE BE TRB OG HBL TE 58 DREGE AK (Q) MAM 1. C1) %ae HARE PB fiz BY SE BT a BLA A. ABN Bi HH AE BGI UH EB Re BW He FS) FEF (LARS I BH KENDA BR. THES RADHA AE 5 (2) 2A BAP RR Gi UML GAL U9 LE. UA KERR. TAEBRAA IS HER AR, UR ARE BR KER SEA A A BIE. AAPL Sb ANI RRAEY. (3) AR REAR FEC IE WS OH RE AS A AE ERS. MRED 4AM SRD REA K. BAF BEM Hh wit GRAMME EABA. A HAY ERI HERE A PR >. PL ABE GER.We PRBGNE- Rit (4) Loss of qi; It is a syndrome in which qi fails to preserve inside and is then followed by massive bleeding. It is seen in the rupture of internal organs in thoracic or abdominal cavities with massive hemorrhage. The main symptoms are unconsciousness, closed eye, open mouth, tachypnea, pale complexion, sweating. cold limbs, urinary and fecal incontinence, etc.. This is a critical syndrome. 2.1.2.4.2 Damage of blood (1) Blood stasis; This is a pathological state in which circulation of blood is obstructed and stagnated or blood escapes from the vessel and accumulates subcutaneously or in internal organs. Blood is substantial. If the es- caped blood stays among muscles, it will lead to swelling; if it stays subcutaneously, it will result in ecchymoses. Stagnated blood gives rise to pain. So there is local pain, which is of stabbing nature and fixed in focus. There are also dark complexion, dry and squamous skin, dry hair, cyanosis of lips, purple tongue, thready or uneven pulse. (2) Blood deficiency: It is a pathological condition in which the blood fails to nourish skin, muscle, tendon, bone, meridians and viscera due to shortage of blood in the body. It is often caused by massive bleeding; or dy- shematopoiesis with asthenia of the heart and spleen due to consumption of healthy qi in either general weakness or a long period of trauma; or deficiency of liver-blood and kidney-essence due to serious trauma of tendon and bone involving the liver and kidney; or no production of fresh blood because of existence of stagnant blood. The main manifestations are dizziness, vertigo, pale or sallow complexion, palpitation, insomnia, amnesia, tendon flaccidity, numbness of limbs, impaired movement of joints, pale (4) 2B BHAAA SF CBE BR TEE. WL Fa HE ML FG» TBE EE FH tH SE. BEE BE Ae HAG. AA ARR ETAT Hh, OARS. TRAEG FRE. 2. fit CD) eae HGH BIE FIA FR AA BE. BK at Wat BK Sh, BS 2S i HE BRE BEF DL ARBRE hs AF AR FY. mA FE ZH fh Bat FL PAIR SU Ks Bat FAL Fa) SLABS. ARR OL BEL HAF 5 AS SL TUR 5 AAC JS ees HR EL AE A MU EE] IAS AD BB SH OY IA Ti Wg LR ERAR SER AW SEERA AR. (2) fo REA WA AAT RAT 2 Hey AE BY Tt A) Hs BB KE, SAMA MTS. RH Pe ne 53 TS. BRA A. TERE ES, Boy BE AN RGA Bi. RRA, BOAP oi FEAR AS 3 BE an 7B MAN EBC, tA BN) SRAALE BR MASA SAE SE ARDEP UR RE. FE AL LR AR KA AB Al PAA EIR AN+1 General Introduction +35. nail, pale tongue, thready pulse, etc. . (3) Blood heat: This means that there is heat in the blood. It is often caused by production of heat from stasis after trauma. or infection of pathogen-poison from incised wound. The main manifestations are fever, bitter taste in the mouth, thirst, restlessness, red tongue with yellow coating and rapid pulse. In the severe cases, there may be high fever and coma or mania; if pathogen-poison infection produces heat because of stagnation, it may cause pu- trefaction of muscle leading to purulent sore. If blood is forced by heat and the vessel is obstructed, there may occur bleeding of various types, such as epistaxis, he- matemesis, hemoptysis. hemafecia, hematuria and hema- tohidrosis. 2.2 Etiology and Pathology of Osteopathy The etiology and pathology of osteopathy is in many respects the same as those of trauma, but there are also some differences. 2.2.1 Etiology of osteopathy 2.2.1.1 Endogenous pathogenic factors 2.2.1.1.1 Congenital aplasia Many congenital deformities in children are caused by congenital aplasia. Some of these deformities may be found at birth, such as congenital talipes equino varus. Some appear later in youth, such as congenital scoliosis. Some bone tumors, such as multiple exostosis are related to genetic factors in pathology. 2.2.1.1.2 Age There are different morbidities of (3) doth eB AR Ph eh Ait 5 AR EA, TION Bi AB HE BR BC. JAN ERMA RAO. FB bE ALR SF PERL A 4 a HA 2k BRC ATE s 25 A BE RR BB HGH A PAY Ss 2 BE 3» 2A SE BEL af AS a» SL ee a (Eat BR AUK HH th Br FRR a ARASH ARS MZ, A ATA Zio —. RaHaA (—) AB 1. KHRARARA ILA STE AGA TE A TO PRG Br S| ie Be eH BY ERLE A A BY eR, OG Atk BA AR. 77 AY FRR ERT, AMER HEAPRE OS. Roe AE bE Can SBUIWE ADE) 1 Sea SI ARBK. 2. FR ia.36° bone and tendon diseases in different age periods. For example, poliomyelitis often occurs in infants and young children, osteochondrosis in young people. osteoarticular retrograde degeneration in middle-aged or old people. 2.2.1.1.3 Constitution people with sound kidney qi and strong tendons and bones Young and vigorous are not subject to tendon and bone diseases. If the constitution is weak, the liver and kidney are insufficient and the healthy qi is impaired, pathogens will take advantage of deficiency and invade the body, resulting in bone tuberculosis or bone carbuncle. 2.2.1.1.4 Nutritive condition Dystrophy may cause such metabolic osteopathies as rickets, osteomalacia, and osteoporosis. 2.2.1.1.5 Visceral dysfunction Tendon and bone are the external matches of the liver and the kidney. When visceral functions get disordered, the tendon and bone will lose their nourishment, hence disease, such as renal osteopathy, dysparathyroidism, hormonal bone necrosis, cerebral palsy, and neurogenic myophagism. 2.2.1.2 Exogenous pathogenic factors 2.2.1.2.1 Invasion of six exogenous pathogenic factors Invasion of such six exogenous pathogenic factors as wind, cold and dampness may cause Bi-syn- dromes of tendon and bone. 2.2.1.2.2 Infection of pathogen various pathogens such as bacteria and viruses may cause Invasion of infectious diseases of tendon and bone and poliomyelitis. 2.2.1.2.3 Chronic strain diseases of tendon and bone, such as retrograde articular It may cause various degeneration and some occupational diseases. 2.2.1.2.4 Geographic factors In different regions, the geographic conditions, climatic factors and PROGR: BR ABR A ATA SURE BF BH IL aK ARE RT ROE PAB TERME RT PER. 3. RR PRE AL FEI: » AAR AE, AR Sn BE AR. BSS FES PEC A, WER ETA, DRA ABR TIE 4LBRKR ARTE YS | ee tty a aE RLS SUE AA. 5. AERA REA Ja AF PEA Db ES 5 Ae BEB 2 BE A A A 2 FF 2H MOE LE BR» FEARS BRD BE: FAL WRB RETA I. h ESE BE RHE WL SS HS (=) 58 1. SMB SPRUE WEAR BA Sa HE. 2, BRR Me ABBE CANE BEE) BY S| tz 805 rR Me tHe BE RS I) JL TR We 3. BEB BSH SOG APG MK BAT ER i SLMS. 4. MA AIK FEBRERO+1. General Introduction -37- dietary habits are different, and there are different common diseases. For example, some osteophathies like os- teoarthrosis deformans endemica and fluorosis of bone are related to these factors. 2.2.1.2.5 Poison and radioactive rays Con- stant exposure to harmful substances like inorganic poisons (lead, zinc, phosphorus and chromium) and organic poisons (benzene, chlorine and ethylene) , and radioactive rays may cause injury of bone. 2.2.2 Pathology of osteopathy 2.2.2.1 Pathology of exogenous pathogens 2.2.2.1.1 Pathogenic wind changing Many diseases are caused by pathogenic wind. Fight between healthy qi and pathogenic factors around the joint leads to flaccidity of tendon and migratory pain. 2.2.2.1.2 Pathogenic cold resulting in pain Affection by pathogenic cold makes yang qi damage. thus, yang qi fails to warm the tendons, which then contract, resulting in pain. 2.2.2.1.3 Pathogenic fire damaging yin Fire and heat can damage yin and consume blood, leading to malnutrition of tendon and bone with resultant atrophy and blockage syndrome. Or if the muscle is putrefied by rampant heat, it will cause purulent sore. Or if the rampant heat stagnates, it will lead to formation of tumor. 2.2.2.2 Pathology of qi and blood 2.2.2.2.1 Qi stagnation blocked, it will result in pain, which is characteristic of If the flow of qi is migratory and distending nature. 2.2.2.2.2 Blood stasis If meridians are blocked by stagnant blood, it will result in pain, which is fixed in certain focus and is of stabbing or cutting nature. ABA FRADE FR, DUCA RHE SR SHAR RUM. 5. BMSRMHR A Heh A DR, We LE CHEE) AED CR ZEAE VA BRIT ER Ss RawE. =. BRB (—) SB 1, RRB SRR HAUS. BATE. REF A, He HK AH FEM 2, RASH BSL FB WU LK BS 6» HB AAI EGP. 3. ABBA RAAB AE EY BA 5 HT SCAG BK PFET Ae Ae BASIE 5 BAC HR TAY TR a RE (=) SDH, LR PLT BAL ASI SUI «| SURI AE HB AE JER DANKA E 2, MR HRM ik. ANSE WU 5 MLR PE IA AB A Ble Je wNET RIAL.+ 38° TEBGNS- Se 2.2.2.2.3 Qideficiency Because of congenital- ly inadequate essence qi in the kidney and insufficient grain qi derived from food and water after birth by the spleen and stomach, as a result, viscera, tendons and bones become asthenic. Then there may occur shortness of breath, reluctance to talk, lassitude. hyperpnea, spontaneous sweating, thready, weak and forceless pulse. 2.2.2.2.4 Blood deficiency by the failure of the spleen and stomach to produce enough It may be caused blood or by massive bleeding. Besides the symptoms of pale complexion, palpitation, shortness of breath, numbness of the limbs, vexation, insomnia, and thready and forceless pulse, there may occur contracture of tendon and ankylosis. 2.2.2.3 Pathology of meridians Meridians are passages. through which qi and blood circulate and by which viscera are interrelated. The upper and the lower, the interior and the exterior parts of the body are communicated, and functions of every part of the body are regulated. Life activity of the human body, occurrence of diseases and effect of treatment are all dependent upon meridians. So, if the disease of tendon and bone involves a meridian, it will affect the function of organs through which the meridian runs, resulting in symptoms in the corresponding parts of the body. For example, myelopathy or diseases of peripheral nerve may cause paralysis. 2.2.2.4 Pathology of viscera Osteopathy is most closely related to the kidney, liver and spleen. 2.2.2.4.1 The kidney dominates bones. produces marrow and stores essence The growth. development and repair of bone are all dependent upon the nourishment of the kidney essence. So, maldevelopment 3, Sm FR FERGAL” AL 6 te A “ORAS AR AU" AB AE BT (8 AEE RE SG tH DU EB A ES. BT HBL ACRES «BEE TEA 5 Mit ECKL. PPK AB FE I Se CRETE. 4. MR my BR EAE tb ARR MHL SH TB BRE RHA EA OE. FURR AR SU BR BK AN FE Fa Ph » HB PY HH Bh Ae AG BS WHEE. (=) 28a ee iS TT AML RANE ARE Pasa Ze EB a AB SHE BS HR 2a SB A EH AE BB HS BEE AB IF 3 FRB Fe 3H BL 2K SLAY. FT AR FL Beam BB He Bt SC EAT BS 8 OG «FT AREAL BB ie AY EAR. GFF BARTEL 2 gE TB TERS. (2) REM EAL BRS AP Ae SAE WRARA BH 1. BES. AMER RR PORTADHE FE BOL ME Hs Be FF HF a FE BABA AL BF+1 General Introduction + 39+ of bone in children is often caused by congenital deficiency of kidney essence. As a person is in his old age, his kidney essence is also declined and fails to nourish bone, then there may occur hyperosteogeny and osteoporosis. Deve- lopment of bone tumor is closely related to the kidney. 2.2.2.4.2 The liver dominates tendons and stores blood The liver has the function of storing blood and regulating blood volume. If the liver is short of blood and fails to nourish tendons, it will give rise to contracture of tendons, numbness and impaired movement of the limbs. 2.2.2.4.3 The spleen dominates muscles and The spleen transforms the foodstuffs into essential substances and transports the nutritive es- four extremities sence to nourish the four extremities and bones. If the spleen fails in transformation and transportation, the essential substances will be short, then there may occur atrophy of muscle with no strength in movement. In addi- tion, the diseases of tendon and bone are also difficult to be cured. Bo SAREM. PAAR, AVA FEA FT th BL AE ABLES EAE. ABE AY BAS AWKARA EY. 2, ERB HM APA SE AE at He A at at 9 DE. ARF OLAS AB 5 AS ee 2G» HH BE BAAR AR J AA AR Pik. 3. BEMA. OR I AYRE AT IE ALKA «HA SPE FA, DUAR BE FE. MERGE (RA A, WH AULA 88 BU AC BE A PE TE J) SE BFBIEAKE3 Diagnosis 3.1. Inquiry In inquiry diagnosis in orthopedic and traumatological department, besides collecting the data of general condition of age. occupation, type of work, and the past ill- ness, the stress should be also put on the following aspects. 3.1.1. Chief complaint Inquire the main symptoms of the patient and their duration. Chief complaint should reveal the nature of disease and the reason that makes the patient go to seek medical service. The chief symptoms of orthopedic and traumatological patients are pain. swelling. numbness, functional disturbance, deformity, contracture. and paralysis, etc. . 3.1.2 Time of onset Inquiring the time of trauma or onset is beneficial to determining what the trauma is, new or old, acute or chronic. or some other osteopathy. 3.1.3 Process of onset The doctor should inquire in detail about the following: The cause and condition of onset, the nature and strength of violent force, position of trauma; whether there was coma and the duration of coma; whether there s-* BB A FD RE Bee lb, Tee TAL ABE Ea SEE BELL ERAT ILtA HH. awe —. ER Va] AB 2 AE BEE AR AF BE FETA]. EDR EH a mE AY HE SRB AE AE AB AT OR BS ADR A. RAW EDERKERA PEI AP AK PR AR 0 BE BRE HTE BEYE BEBE =, 2a (FL A et HI ae Be RO, DA J BR i BHU AB EL BG FWA. =. Ra FD BEA HF] BASE GD SARE BATRA HH He J BR BE Be 5S PT YO A, FRY Ay TC BK 2 BE PR ANT] A,+1 General Introduction 2416 occurred coma again after resuscitation; whether there was bleeding and the volume of bleeding; whether emergency treatment was given on the spot and what was the result; and what are the present symptoms and the severity. Generally, trauma in everyday life is mild; but indus- trial, agricultural and traffic accident traumas are serious, they are often compound or serious crush traumas. If the patient was falling from high place with heel first touching the ground, then he may get trauma in spine, heel or base of skull. Inquiring the cause and the position of trauma is helpful for judging the condition of trauma. 3.1.4 Traumatic condition This aims to inquire the region of trauma and the local symptoms. 3.1.4.1 Pain Inquire the region, time, range, severity and nature of the pain, i.e. . is it sharp, or distending, or aching. or stabbing pain, persistent or episodic? What are the factors aggravating the pain? Whether there is referred pain, radiating pain and numbness. 3.1.4.2 Swelling Inquire about the time. region, extent and range of the swelling. In traumatic disorders, usually pain goes before swelling; and in infectious disorders, swelling usually goes before pain or with local fever. If there is local mass, whether the mass is growing and how fast it grows should be inquired. 3.1.4.3 Functions of the limb Inquire whether there is functional disturbance. If VAR a TOE PRE si Be tes hn Be >, HL RRR OT, ATR AEE BEE MRT BE, TW. RH LEP GR ARR BRA BALA GR BNR. or A SA, RG a Af WU $B a FE Be AE TE HF AE. ALB URE. DALY AB 2S BBR PR AL A i BA RATER. A. atitt BT fe BR HS BY BB AN BBR. (—) BR (5) ARP AE HA BB i, Ff Ti) 9), RE EG ABU AG RO BJ J. PER RAR WME StARRAK. AS 7 AO BOT RASS (=) BK (ak ob He He LA oF] ML EE. BER BE RICM ats BORER B ESE AIM, TA BB BR PL. WAM AR AOR, oT BSE BAIA BORK EE ay. (=) RR BBHES A DAE.+ 42+ PREGAS > RB it there is, did it appear immediately after the trauma or gradually? Generally, at the time dislocation or fracture occurs, the function is immediately lost in most cases. In the case of soft tissue injury, it takes a period of time for a hematoma to develop gradually to affect the function of the limb. 3.1.4.4 Deformity Inquire about the time of occurrence of the deformity and its developing process. After trauma, there may appear deformity immediately, or several years later. If there is no trauma, congenital or developmental factors or other osteopathies should be considered for a deformity. 3.1.4.5 Open wound Inquire the time the opening of wound develops, the environment where the trauma occurs, the condition of bleeding, the process of treatment and whether antitetan- ic serum is used. 3.2 Examination 3.2.1 General examination 3.2.1.1 Inspection 3.2.1.1.1 Inspection of the whole body (1) Inspection of spirit and complexion: Inspec- tion of spirit and complexion can judge the strength of the healthy qi and changes during the course of trauma. Gen- erally, 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, platy- coria or miosis. it indicates a critical condition. ASA OBE SE BR A) FS SGOT BN Ae AE 5 AB Fe i J NR 4A, AUBURN BT a HEI BEATS TE TEA ALAR eA MMH MH. A — BUY Ta), AANA BAAD AE. (BD) He Dis) AB WSF, Se AB tT] ABATE. Sb fila Hl or BD TE BRL mF NT 8 LE Fae SL. BCS Bh WT A BGG Kitt BAER HAS (4H) #0 Tf RO) HG ae BN Tal, SEO SE te a HARI be PRLS EDA Be Re To EF i TS MBS. BrP MEDS —. TS (-) BB 1. B25 CQ) BE RATT Hy WB LE 0) A EH OFLA DL. ARBOR. HE THEE GBB HA EAE BME, GPRM, REECE. HARE. HH RA Met SA ce SL 45 FTES PR FD GA Ss Bi SE 1S DUBRS FF aH a0 a RAEFL BOK SRE) WU FEAR.+1 General Introduction +435 (2) 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. 3.2.1.1.2 Inspection of local areas (1) 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. (2) 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 col- or of the skin usually indicates an old trauma. (3) Inspection of wound: If there is wound. the wound should be investigated about its size and depth, the (2) BES BARK FE ASH AR, & 9 HH BE BE BUY PAD. AN A AUN SAB ETE A. AS RBH OG» & EMM PR AS TA Phe 2 A A BB Sd i» BEB AR HT 3 HAFLER S EH, 2. Bes CD 2a% Be RA eH BL AA BI SK fee. MA. RRR S. WS FES GP TE FF 4E. FMS TE A RE HEN ID WE AB i fe TARA TES (2) aR ee RE JBUACE Hi He BE A FCB RIE BHR BEN EE A BTA GI HE. Ah A HEE GRALA A TT BRE: HARRAH R ARAB PBA ABI SRE IK EB Br aR BE Ts BK ™ BE RRERE Ww: RAR IK REE EA REA. 25 ™ A or ths hb KB BE RAE A TE BER # ABATE. (3) Bho Heat 1 BORE 5 I PRI-44+ PREGA BR 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. (4) Inspection of the functions of limbs: Inspec- tion 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. 3.2.1.2 Auscultation and olfaction Besides listening to the sound of, 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. 3.2.1.2.1 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 col- lide and give rise to sound, which is called bony crepitus. So, when there is bony crepitus. it indicates fracture. Af- ter 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. 3.2.1.2.2 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 DBE B BF. PE EE BRE El , TP Ly Bk BD BAM MF. WF RR HHA, AAFRAABR HRA RRO Rs GA wee SU Do BADR . (A) BRAD HE WE BD) fe Wb A BE aE PARE BES BL PURER AU FER a HY YE FB ASRORE. (=) ae BRTE RED AO OF WK Bk mh Ok nt By Be BCE A AE ML i 09 OR ED TT Sh AE BOE ME LE Susi. LARS SRE AVN RRAEZ—. Em HRM TEL ETT 4 a fk EY, BT rE AA REG, KA PRE”. POPU OB aE a Bt TL) WAAR. 4a a PRE WK RHA CER. (AM EBRALALG RARE, DRA A HS 20 ARR KBE FEM ROHL. A ET BA SF RAR”. FH SL Ai fF Be PS BB CA. OA Ee A. A SIR HG+1) General Introduction +456 harm. 3.2.1.2.3 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. (1) 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. (2) 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. (3) 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. 3.2.1.2.4 Listening to cry When examining a 3. A 15 HR EB EN BY AAR AD FEE a ALF A LAA LL PILE. DAPRRE RE —FRCER ERB A FPL I IF HK i BH) AY OF BK sh BH) THE BE RAV A KT EE AT HE — HEN HE BR UD, Se HE AB. FH HA EL AR EE BT TEER A RN FB ; HORA WB — AE TA RAF MRA RT AA BELT A BLUE BS. (2) REM RAMU A RAR BRET Spay HY Ay BES On TS Wee AB eB Et TE TE Fa A BEN BY wy 3 HE ey FS, AL JA FEAR ERE AEA BY LL TB BMS RA NE RW “BRE”. STEN BA RE HB SL BEF RATE 65 fe LA AC BB 9 BBE POS AULA} A PRE (3) RB Hem TEE FETE A Ht i eS Ry. Te BL 3G A Pa, UA HE {HIRES TE Bh RAE AY BY BAe BE Te TS 4. RR MAIL+ 46° PREGRS SR 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. 3.2.1.2.5 Listening to sound of traumatic subcutaneous emphysema After trauma, if there is a large area of diffuse swelling that is not coincident with the extent of trauma, it should be examined whether there is subcutaneous emphysema. When examining, one should part his fingers as a fan and gently knead the sick part. if there is special crepitant rales or crepitation, then, there is gas subcutaneously. For example. in the case of fracture of rib. if the end of fracture pricks the lung, it may result in subcutaneous emphysema due to endosmosis of gas into subcutaneous tissues. 3.2.1.3 Palpation 3.2.1.3.1 Clinical action (1) Palpation of tenderness: According to the site, range and extent of tenderness, the nature and type of trauma may be differentiated. A direct tenderness re- veals a local fracture or injury of tendon; and an indirect tenderness such as longitudinal percussion pain usually indicates existence of fracture. In the complete fracture of diaphysis of a long bone, there is often a circular tenderness in the part of fracture. (2) Palpation of deformity: Touching and palpating the change of protruding bone can judge the nature of fracture and direction of displacement, and superposition, angulation or rotation of deformity. (3) Palpation of skin temperature: From the AEE ANY TE RE RP BB A AULA BE HN 5S Bi Z AB A. HAN JLAR RE ETE DE EB HE OL RR RAI 7S BEBE EFT HEIR AG DA eR BT 5 YA BE ABA. AS JL SEB SRS FAL, SU Be me ah BS ie. 5. Urata MNiaee SUBBED BoA AH Fe CEM AKL» REAADR EAU. BH BYE FAS DFE BATE REET HABA 24 Be LR FREES RA — APA RAS FRBAR. WMA AA OST St HL BE HE 4 28 BAR PALA ATI BE PU (=) ae 1. FB CD RRA BURA EAR (79 BB A YE EB, PR EO BA OS HE AAS, ABER TRE RMA A i RH fi: Ti Vn) $e FI AA A a) Kaa ee. KAT SEAM EAT BSA SNE AGE. (2) Bem fh BB RR EAC. AT aT FURR IE IR AB ALT Ta UB BE UE SA (3) BRE WES+1. General Introduction temperature of local skin, heat or cold syndrome can be differentiated, and the condition of blood circulation of the sick limb can be known. A hot swelling generally indicates a new trauma or heat stasis or infection of local part; and a clod swelling indicates a cold disease. If the distal part of the traumatic limb is cold and numb, and pulsation of the artery declines or disappears, this means a disturbance of blood circulation. Generally, it is advisable for a person to feel the skin temperature with his dorsum of hand. (4) Palpation of abnormal movement: In a part of the limb where there is no joint, if there occurs movement similar to the movement of the joint, or a joint can move to a direction to which the joint can not originally move, this is called abnormal movement. This is a sign peculiar to fracture, and it is also seen in rupture of ligaments. However, one should not actively seek for abnormal movement when examining the patient, lest it increase the patient’s sufferings and make the trauma severe. (5) Palpation of elastic fixation: If the dislocated joint is kept in a special position of deformity, there will exist an elastic sensation on palpation. This is one of special signs of dislocation of joint. (6) Palpation of mass: The mass should be, first, differentiated in anatomy, i. e., is it bony or cystic. in skeleton or in muscle or tendon? Then, the size, shape. hardness and clearness of the boundary, mobility and evenness of the surface of the mass should be palpated. 3.2.1.3.2 Commonly-used methods (1) Touching and palpating method: Put the thumb or the thumb and index and middle fingers on the traumatic site, gently press and carefully touch and +47 ABCA YS HAE RE BT LAA JE RUE RE i fT BA JEAN OL. BVP — RR RH BG BURY AUER 5 29 Hb Be a8 AR Bh BR HE Bh BOT AR JY PEAR IE RMR EN — RAF AMR EL. CD BAR GA EK TBE AL A Mh BLT AS LK FATE OD. RS BOR A BE TE HAH HRT GH. BRA “SA SN”. a A aT FAKE — CF A Bt R.A Ta RE EDS LH i WM BA AU EB () RHR AL BRA BRAT AS SES RAE ES HY at FEAL EE, EAR I AH PEAY BULA EZ —. (6) BPR AMR SB AR A HR A EK EA a A EE EN) EE REVAMBRSHAP, & BRR KN TE AS BEBE RAB ELAS AB MRAM. 2. BRAK C1) wea DH aK BAPSRET RSG, Pama FE AF A Ha BE. EL IC+48 + palpate it. starting from the distal part, gradually to the traumatic site. The strength of force used should be decided upon the site injured. In palpitation, one should carefully learn the condition from the sensation of fingers, just like an old saying goes: “Palpation with the hand and sensation by the heart”. The definite site of trauma and disorder, deformity and crepitus of traumatic region, changes of skin temperature and hardness, and fluctuation sensation may be known through touching and palpating. So, the method is commonly used first of all in examination. (2) Squeezing and pressing method: Use the palm or fingers to squeeze and press the upper arid lower, the left and right, the anterior and posterior parts of the focus, according to transmitting action of force to judge whether there is fracture. For example, pressing test of thorax in examination of fracture of rib is to press the sternum and the relative vertebra with the palms anterior- ly and posteriorly, if there is pressing pain, it usually indicates fracture. (3) Percussing method; This is a method to inves- tigate whether there is fracture by impulsive force resulting from lengthwise percussion of the limb by the root of palm or fist. For example, in examination of fracture of femur or tibia and fibula, the method of percussing the heel is generally used. If there is a percussing pain. it often means there is fracture. (4) Rotating method: Hold the distal part of traumatic limb with hands and gently rotate the limb to see whether there is pain of traumatic part, impairment of movemient er special sound. This method is often used in combination with flexing-extending method. (5) Flexing-extending method; Hold the traumatic joint with one hand and hold the distal part of the traumat- TRBAAY +R i HELSUG SF fs, 2 A TP GL. FADIA AN LB (00 TT FE 5 fh BE EY AFAR IG IS FRE HAA “FROS’ WEG. WN fh HRY Tih Ht i BATT AB WAT AL A FETE BEGET » Be HR ta BE OR EA KEN ERAS. Hi CECE RE Fe BU. (2) Hk AF RR FRA RRA BRET A Ai TID es » ARB fe SHE A KROME E A A Ht. WOR A Fs Pa Aer i 8 FT « B FEE i Sea BF A BH AUTHE APES om AAT. (32) PA AUER BRE RP CAA SA 1 A ab BT Pe A Woh 1) RAE BT AY ATT, RAE BUT MR FH OD ay ABR AY i. AH ON die HB te A HoT. (D) REA APE AL a ROE at «HE OR BE HE BBD WE 5 Mb i TE TB BURR AG BE OK Hm FT We He SE AERA A (5) Bethe FF BARD BFR Ba+1 General Introduction ic limb with the other hand, and make the limb flex and extend slowly. If there is an acute pain, it indicates there is trauma of bone or joint. (6) Swaying method: Hold the traumatic part with one hand, and hold the distal part of the traumatic limb with the other hand, and make the limb slightly sway. Ac- cording to the nature, abnormal movement and rub of the affected part, and in combination with inquiry and inspection, it can be determined whether there is trauma of bone and joint. 3.2.1.4 Measurement 3.2.1.4.1 Measuring the length and thickness of limb A tape ruler is usually used for measuring the length and thickness of limb, which is then compared with those of the healthy side. ()) Significance 1) The affected limb is longer than the healthy one: This is usually a sign of dislocation. It is commonly seen in anterior or inferior dislocation of shoulder or hip joint; and also seen in length-wise separation and displacement of fracture. 2) The affected limb is shorter than the healthy one: This is often seen in overlapped displacement of fracture or in posterior dislocation of hip and elbow joints. 3) The affected limb is thicker than the healthy one: This is commonly seen in the serious case of fracture or dislocation, or in the case of swelling caused by injury of tendons and muscles if there is no fracture and dislocation. 4) The affected limb is thinner than the healthy one: This is often caused by atrophy of muscles in the ald trauma, or paralysis of limb with injury. (2) Points for attention in measurement 1) Before measurement, make sure whether there -49- Se PR BK TES SLB BLA BSR Hi. (6) HRA AFR {ERS ML FB RE Sit PEERS IN AE SEN a) BLD HR AB BB PA EL AE TG EB SF WAAR SRV. (Bo) mie LEK KE SA WS AE IR aA AK PEAKS A ES BE HWE. () €& 1) BRK AO HA BE KA. BOW BH i B18 LP OR MS EB BRT] Py BEL OS BT LPT IAI BALE. 2) RB He BSL FREABUM AT RAF ABT JECT 1 BAL. 3) RUG LF ed SL FR RBZ AE. BI SRA a A I 2) BNP AEM 2H RIEL Hea (5 TB AG SS A 5 BH AA MARAE (2) EP MEEER D HOHE RR aA50+ are congenital deformation and .old trauma, which should be differentiated from new trauma. 2) Both sick and healthy limbs should be put in a completely symmetric position in measurement for avoid- ing error. 3) The point for measurement must be right. Marks may be made on both starting and ending parts, and the tape ruler should be well stretched. 4) Commonly used methods for measuring the length of limbs: @ Length of the upper limb — from the acromion to styloid process of the radius (or to the tip of the middle finger). @ Length of the upper arm — from the acromion to the external epicondyle of humerus. @® Length of the forearm — from the external epicondyle of the humerus to the styloid process of radius. @ Length of the lower limb — from the anterior superior iliac spine (or the umbilicus) to the inferior border of medial malleolus. @ Length of the thigh — from the anterior superior iliac spine to the medial border of knee joint. © Length of the leg — from the medial border of knee joint to the inferior border of medial malleolus. 5) Commonly used methods for measuring the thickness of limbs: The two limbs are measured on the parts at the same level. The most swollen part should be taken for measuring swelling, and the belly of muscle should be taken for measuring muscle atrophy. For example, the place 10 to 15 cm above the patella should be taken for measuring thickness of the thigh. and the thickest part should be taken for measuring thickness of the leg. 3.2.1.4.2 Measuring the range of movement of joint This is done by a special protractor, or estimated by one’s eyes. The degrees that the affected joint can flex, extend and rotate are recorded, and then compared with those of the healthy joint. If the degrees are smaller PRESS R FER FE 5 We IA HE BS A Bt Sa BH SI. 2) RRA Sy GBA AHF 5 SOARS (ie VETTE LAB RE. 3) WU Bite RSE HE AT ZE BNE SK bm BOP PRI HER 4) WRIA KG w OLERKE AME BER RHEL). © LF KE KiB AS ER. QHEKE MAKERS MAZE. OFRKE HERR ARR ER, RBA BREA. © KMK MAT ERE AR. © BB KE RRDPARSAR TR. 5) UDC JA 48 Te PURCR Ta] — 2k BB ER UE A ke NZ BH Ih EE UL 2 CLAS a BLK BB Jal 4 26 46 fe 10 ~ 15 crm. $N tak 71. 5B Jl 428 5 RULE . 2. MEX PSHE H FEES EE AA a A a EWUGhit Fic RE OP Hee BY BE, SRE BE FT He. an NF A SU RAT TE Bh OH HE+1. General Introduction -516 than those of the healthy joint, it is a functional disturbance of joint movement. The method of neutral position as 0° is used for recording the movement degree of joint. For these parts whose angles are difficult to measure accurate- ly, the range of relative movement of joint is recorded by measuring the length. For example, for anterior flexion of cervical spine, the distance between the chin and the manubrium sterni is measured; for anterior flexion of lumbar spine, the distance from the top of middle finger hanging down to the ground is measured. The ranges of functional movement of various joints are as follows. (1) Neck; The neutral position is to keep the face forward with the eyes looking straight ahead. The angle for anteflexion is 35° to 45°; for retroextension it is 35° to 45°; for left or right sideflexion it is 45°; and for left or right turn it is 60° to 80°. (2) Waist: The neutral positron is to stand erectly with the waist stretched naturally. The angle for anteflexion is 90°; for retroextension it is 30°; for left or right sideflexion it is 30°; and for left or right turn it is 30°. (3) Shoulder joint: The neutral position is to keep the upper limbs dropping. The angle for anteflexion is 90°; for retroextension it is 45°; for abduction it is 90°; for adduction it is 20° to 40° (the tip of elbow reaches the ventral median line); for intorsion it is 80°; for extorsion it is 30°; and for lifting up it is 90°. (4) Elbow joint: The neutral position is to keep the elbow straightened. The angle for flexion is 140°; for hyperextension it is 0° to 10°; for pronation (with the palm downward) it is 90° ;and for supination (with the palm upward) it is 90°. (5) Wrist joint; The neutral position is to keep the hand and the forearm in a straight line with the palm downward. The angle for dorsoflexion is 35° to 60°; for BR. Ae FPP a7 fie O" Be ic a KP HEA. WADA Ue Fs BE 09 BT PU KBE HIRI HAT BOE. ‘An SUE i JT BU 2 28 AP «BE J Pe BS 4 fe Se 5b A Ba BADE SG Ban F D RR PUA FORT RPL. HiVaE 35°~45°, Jef 35° ~ 45°, Ze 4a OE 45° FEAT WERE R 60° ~80", (2) AR a WR TL AR HEL AR E.R 90°, FTE 30°. ZEA MM 30°, ZEB TRIES 30°. (3) ARB Phin ERG FE a. BR 90°. 5 45°, Sb RE 90°, Py We 20° ~ 40° CHRIS ER). AE 80° 5b Be 30°, £2 90°, () MARR Parsi SSL. Jab 140°. eh fh O° ~10" ERT CED TAL F) 90°, Rea Cy E)90°~ () RAB Hah FHWA MAR, SbF. Eff 35°~60° AH 50°~60""2526 PRERAA: BR it palmoflexion it is 50° to 60°; for radial deviation it is 25° to 30°; and for ulnar deviation it is 30° to 40°. (6) Hip joint: The neutral position is to keep the hip straightened with the patella upward. The angle for flexion is 145°, for retroextension it is 40°; for abduction it is 30° to 45°; for adduction it is 20° to 30°; for extorsion it is 40°; and for intorsion it is 40°. (7) Knee joint; The neutral position is to keep the knee straightened. The angle for flexion is 145° and for hyperextension it is 10°. (8) Ankle joint: The*neutral position is to keep the foot and the leg at the angle of 90°. The angle for dorsoflexion is 20° to 30° and for plantar flexion it is 40° to 50°. 3.2.2 Commonly-used special examinations 3.2.2.1 Special examinations for the neck 3.2.2.1.1 Percussion test of the vertex The patient sits erectly. The doctor puts one hand on the patient’s vertex with the palm downward. and uses the fist of the other hand to strike his dorsum of the hand on the vertex. If the patient feels pain in his neck, or the pain is radiating to the upper limb, it is positive. This is often seen in cervical spondylopathy. 3.2.2.1.2 Compression test of intervertebral foramen The patient sits erectly with his head inclined slightly to the posterior aspect of the diseased side. The doctor stands behind the patient, puts his two hands crossly on the patient’s vertex and presses downward, making the intervertebral foramen smaller. If there occurs pain in the neck and the pain is radiating to the upper limb, it is positive. This is often seen in cervical spondy- Jopathy. 3.2.2.1.3 Traction test of brachial plexus The patient sits erectly with his head deviated to the BEM 25°~30°, RAF 30°~40". 6) BAP PUMA MOST A eR ab. ie dh 145° Jat 40° Sb 30°~45°, Py 20° ~ 30°, Sh BE 40°. PY WE 40°, CD MRRP PUA RY tt J ah 145°, at fi 10°, (8) RAP HAH BARE 90°, HH 20°~ 30°. BA 40°~50°, =, BRAS (—) RB PROE 1, ARMM BA TEA BEML P PRE BRS KG DRE. F tee OD Se TB 8 FP eR SE SAB PER . BOAR A TL Bo St, WW Ay BA HE. a WLP BH En. 2. HAA ERRR B BEA, AB BO a BRATS RS. OF BEM A STH re He on RAD » (SCE TD FL 8 HH BL SSB ER» FF 8 ON EBC Wi. WW AT A HE. AS LP HEA. 3. BABS rite ARETE MB Sk BHAT A. BS+1 General Introduction © 53° normal side. The doctor puts one hand on patient’s diseased side of head, grasps the wrist of the diseased side with the other hand to make the upper limb abducted, then gives opposite pull and traction. If the cervical pain becomes se- verer, and the diseased limb is painful and numb, it is positive. This is often seen in cervical spondylopathy. 3.2.2.1.4 Deep respiratory test called Adson’s syndrome, and used for the examination of It is also scalenus anticus syndrome, that is, whether the subclavian artery is compressed because of the atrophy or spasm of anterior scalene muscle. The patient sits erectly with his two arms on the knees, holds the breath after a deep respiration, then faces upward with the chin turned to the diseased side. The doctor presses the patient’s shoulder of the diseased side with one hand, and feels the radial artery of the diseased side with the other hand. If the pulsation obviously becomes week or disappears, and the pain gets serious, it is positive. 3.2.2.1.5 Test of throwing out chest This is used for the examination of costoclavicular syndrome or whether the subclavian artery and brachial plexus are compressed in the area between the clavicle and the first rib. The patient stands upright with his chest out and two arms extended backward. If the pulsation of the radial artery becomes weak or disappears, and there occurs numbness or stabbing pain in the arm, it is positive. 3.2.2.2 Special examinations of the chest and the waist 3.2.2.2.1 Squeezing and pressing test of tho- tax The patient sits or stands. The doctor, with his two hands putting on the symmetrical parts of front and back aspects of one side of the thorax or on the symmetrical parts of left and right aspects of both sides of the thorax, does gentle squeezing and pressing act on the thorax. If EFI BAR AF SAE AR UBER (BCP Re HAST AEH USAGE FINE BPE RAR WU FALE. 6 LT SHER . 4. RRR VK “Si FECAdson) GE”. FAP AT BY WLR ETE BA AE BOA FOES Bae A WEA USE TSE BEG. ARAB fi» FF HK ERE, ROE JE REMP ER ADS IEE Fe Fy ARR BE Ae — PP FA BB, a — FRA 88 HK HH SABE Bh BK AE A Bae 3S BR TA PE ASB I. BA PAH. 5. BEM APA BH AEA WA Polk BGM BE ES 1 SBR MPR SER. BA IL IE {iH HA AE a Je A, Be BH DB BOB Ae 4 FE BK ARBRE » BDH BATHE. (=) BRBPRRS 1, OER Re ABA ST » BE AE BEB AU HIT SE eB A GB a A SB HARE 5 er Bh A BA AD AIFEAR BN PTE. SEAN7s PERGAS Bi there appears remarkable pain in the traumatic part, it is positive, indicating fracture of rib. 3.2.2.2.2 Flexing test of neck The patient lies on his back. The operator puts one hand on the patient’s occiput, and the other hand on the patient’s chest, then, bends the patient's head forward. If there appears lumba- go or sciatica, it is positive, indicating prolapse of lumbar intervertebral disc. 3.2.2.2.3 Pressure test of jugular veins The patient lies on his back. The doctor presses the patient’s jugular vein of one or two sides with his hands for one to three minutes. Because the jugular vein is pressed, it may cause increase of pressure of subarachnoid cavity, thus influence the tension of nerve root, resulting in sciatica. This is a positive reaction, indicating an intraspinal disorder. 3.2.2.2.4 Raising test of the straightened leg The patient lies on his back with his two legs stretched out. The doctor holds the patient's heel with one hand, keeps the patient’s knee joint straightened with the other hand, and raises the patient’s lower limb. Normally. the lower limb may be raised to more than 70°. If the limb can not be raised to this height, and there occurs radiating pain of sciatic nerve, it is positive, indicating compression of sciatic root. 3.2.2.2.5 Intensive raising test of the straightened leg In doing the raising test of the straightened leg, when the leg is raised to the maximum resulting in pain, lower the leg about 10° for relieving pain. then suddenly make dorsoflexion of the ankle. If there appears radiating pain of the sciatic nerve because of traction, it is positive. This test is used for ruling out false positive reaction caused by some other factors in doing the raising test of the straightened leg. 2 BRR BAM Eh, REE PIAL BEL PRT AA. RG PEA SL PG AI a He ES BASE AZ BI BES SL “FBEE DB) RR AE 3, PRE MED. BEE FAP HE 8 — Oe BM HE BK 1~3 min, HF FR 38 SOU. 51 aE ee AP HE Fis Hy Se Oy HH ZS HT 9K TAA CAE AS FS BD OY BH YE. Be BA fe 3E Ze RE A. 4, BRR he ANUS « 3 AB AH BE 2» Be As — FRA LR A FREE RELA PEP RE IE. TER PRATT 70° DE. KA AE IK BIE HE BE. ABBA HAAN ER FARA PATE. VENI A ARR EWMS 5. HBAS BE BR Oak RM AR ABA hana SNEAK BRE 5 ae Pt «AB {EG 10° Aes 45 DEA PE HG. BR Tea DE SRG BRS (A HAS SIFTS | AEP BO DHE. isk ae FY HE BR PE Pa 3 2 0 i S| 2 UHR PATE.+1 General Introduction -55° 3.2.2.2.6 Traction test of femoral nerve The patient lies in prone position with his lower limbs straightened, the doctor raises the sick limb for hyperextension. If there is radiating pain of femoral nerve, it is positive, indicating prolapse of the disc between the third and the fourth lumbar vertebrae. 3.2.2.2.7 Test of lumbosacral articulation The patient lies in supine position. The doctor bends the patient’s hip and knee joints of both sides to the utmost, making the buttock leave from the bed, and the waist flex forward. If there appears pain in lumbosacral region, it is positive, indicating strain of lumbar region and lumbosacral vertebral diseases. 3.2.2.3 Special examination of the pelvis 3.2.2.3.1 Pressure and separation test of pelvis The patient lies in supine position. The doctor puts his two hands respectively on the patient’s anterior superior iliac spines of both sides and presses oppositely the two sides inward, this is called pressure test. The doctor puts his two hands respectively on the patient’s medial sides of iliac crests of both sides, presses and separates them outward and downward, this is called separation test. If the pain of traumatic part gets serious, it is positive, usually indicating pelvic fracture. 3.2.2.3.2 Separation test of sacro-iliac joint It is also called figure-of-4 test. The patient lies in supine position with the knee and hip of the sick lower limb flexed and his lateral malleolus of the sick lower limb on the knee of the opposite side, being in a cross-legged state. The doctor holds the patient's iliac crest of the healthy limb with one hand, and presses downward the knee of the sick limb with the other hand. If there appears pain of sacro-iliac joint, it is positive, indicating the disease of sacro-iliac joint. 6 RHBBHM B FED. F BCA EL. Ba Ae Be ie ARB SIS A Ae SE PRES BOM HEM. BD Dy BE. TUF WBE v1 REDDER HH AE. 7. BRATRE BF 40 Bi 4» Bis A Bk BE J A ABLES ORR AB AS OK BES BSD AT, Ae BR ARB A BL A AUPE. LT FR BHI (=) SABRE 1, ABHESP RRB ACA MEM, BRA FADE ot Si AE 2B DO BE 1) PAE SF Hs Oh BF ER A 5 PAY SN FR He Ar EB A PYAR» LSD BS Be HEY BS Be HE BR AR ARR”. Ba PREPAID ABE REAR AT. 2. PERE MARA" Fk AD 48» AB TF FF J A AF Sb BR et ORE AE HRBBAR BAe — PBR EO AEB 53 — A A BB FH AR, 2 5] BA BR 9 WU PE. BB RR AIRE.+ 56° PREGAS: B 3.2.2.4 Special examinations of the shoulder 3.2.2.4.1 Test of putting hand over shoulder It is also called Dugas’s Sign. The patient flexes his elbow of the sick side with the hand over his opposite shoulder. Normally the elbow can touch the chest. If the elbow can not touch the chest, or the hand can not put over the shoulder as the elbow touches the chest, or neither can be done, it is positive, indicating dislocation of shoulder joint. 3.2.2.4.2 Straightedge test mion is in the medial side of the line connecting lateral Normally the acro- epicondyle of humerus with greater tuberosity of humerus. Put the straightedge on the lateral side of the upper arm with the lower end of the straightedge near the lateral epicondyle. If the upper end of the straightedge touches the acromion, it is positive, indicating dislocation of shoulder joint. 3.2.2.4.3 Test of pain arc of shoulder Within the range of 60° to 120° in shoulder abduction, if there appears pain in shoulder because of rubbing between supraspinatus tendon and inferior part of acromion, it is positive. This pain in special area is called pain arc. and seen in tendinitis of supraspinatus muscle. 3.2.2.4.4 Rupture test of supraspinatus tendon Within the ranges of 30° to 60° in shoulder abduction, the deltoid muscle contracts strongly, but the upper arm can not abduct, and the more exertion, the more shrug of the shoulder. But above the range through a passive abduction, the patient can actively raise his upper arm. The disturbance of active abduction in the first range is positive reaction, and usually seen in rupture of supraspinatus tendon. 3.2.2.4.5 Test of resistance of tendon of brachial biceps Let the patient bend his elbow and do (Q) ABRRNS 1 BARR eR“ JME& Dugas) fiE”. BAKER AT SEAS AL BPS AE a FSA REE RE IE. ISSA 78 AE I HE, BIT SS 5 FH BT EAS RP RWATEB , BPA S A BE 5 BD PAGE. SLR Bi. 2. BRR TERIA WEF Sb ERAS AVEAW AM. AERO ELAM, Para He Sh ER, ee HO FG J We BE fh BD BA HE. SPR BBL. 3. BRT FB ATEA SME 60° ~ 120° 98 Bl PA st » Bd AUB 4S J We FE BR JB ohh SUA GO BPE. Be EE SBA PE I BD PE FM”, EPIL WUER 4. EAL BEET Ree ARATE INR 30° ~ 60° IA Sf 5 = faa LF 79 WB (A BE SE LE, BORD, FH. (A a Oh BK WER LB aA +E oh AB. HA) SE oh Sb BE BG Oy BA te. LE PEALE. 5. OKA INES (BA ON fe BF Be+1. General Introduction -57 6 supination of forearm against resistance, if there occurs pain of intertubercular groove of humerus, it is positive and often seen in tenosynovitis of long head of biceps brachii. 3.2.2.5 Special examinations of the elbow 3.2.2.5.1 Cubital triangle Normally, incomplete extension of the elbow, external epicondyle of humerus, medial epicondyle of humerus and olecranon are in a straight line. When the elbow flexes by 90°, the three bone processes form an isosceles triangle, which is called cubital triangle. If there is dislocation of the elbow, the shape of triangle will change. 3.2.2.5.2 Tension test of carpal extensors Let the patient straighten his elbow with the forearm in prone position, then make the wrist joint passively flex. If it causes pain of lateral epicondyle of humerus, this is a positive reaction, and often seen in external humeral epi- condylitis. 3.2.2.6 Special examinations of the chest 3.2.2.6.1 fist It is also called Finkeisten’s sign. Let the patient bend his thumb and make a fist with the thumb in the palm, then make the wrist joint passively twist to ulnar Test of ulnar deviation in clenching side. If there is pain in the styloid process of radius, it is positive, indicating tenosynovitis of styloid process of radius. 3.2.2.6.2 Crush test of cartilage in carpal triangle Make the wrist in neutral position, then make the wrist passively twist to ulnar side and squeeze and press the wrist longitudinally. If there appears pain of inferior radioulnar joint, it is positive, and seen in the injury of cartilage in carpal triangle and fracture of styloid process of ulna. Sea BP 5 es 5 |v WC a Ua] 29 BBAEI BN SAE. LP Ae WL ABR (4) NR PRAS 1 RES ERK WE 56H LB Bb BRA LAR ALR I Be HE — BAL. At3e tJ th 90° my, ERERER-TSBSA RAHA”. BY ABLALET 5 Jt = FA Re ABR. 2. BEALE AOE (aE Be AT LL, PEED AT 19 Be oh JH HH | HAE Sb be BRE PH, BL BL te, MEMES ERR. (A) RBRROE 1. BERR LK “GS-92 HrdH (Finkeisten) fi”. AR ie HS FEA GE BIR TRH TRARY 27 5] BEE SEE ALAA PETG. WDA BAKE. DLP MAZRBBR. 2, REARAR ERS WEIR FP ae 10» RR FETE BEB 1A A A IF A TA HE. AMM PRR KDE WH BG PAE. DL Be = fk Ai RAZR.58° 3.2.2.7 Special examinations of the hip 3.2.2.7.1 Test of flexing contracture of hip joint It is also called Thomas’ sign. Let the patient lie in supine position, flex his healthy hip and knee joints as much as he can, keep the thigh near his abdominal wall and the waist touching the bed in order to remove the compensation increased by lordosis of waist. Then let the patient stretch out his sick leg. If the patient can not straighten his leg on the bed and the leg rises, it is positive and indicative of the deformity of flexing contracture of hip joint. 3.2.2.7.2 Test of hyperextension of hip joint It is also called psoas contracture test. Let the patient lie in prone position with the sick leg flexed at the knee to the angle of 90°. The doctor raises the leg by holding the ankle with one hand, making the hip hyperextended. If the pelvis rises at the same time, it is a positive reaction and seen in psoas abscess or early stage of hip tuberculosis. 3.2.2.7.3 Test of standing on single leg It is also called Trendelenburg’s sign. First, let the patient stand on his healthy leg with the sick leg lifted up, the gluteal plicae (pelvis) of the sick side will rise, this is negative. Then, let the patient stand on his sick leg with the healthy leg lifted up. if the pluteal plicae (pelvis) low- ers, it is positive, indicating instability of the lip joint loaded or weakness of middle and least gluteal muscles. This is seen in disease with weakness of middle gluteal muscle. 3.2.2.7.4 Test of shortened leg called Allis’ sign. Let the patient lie in supine position with the joints of hip and knee of both sides flexing, the heel on the bed. Normally the two top points of both knees are at the same height. If one side is lower than the It is also other, it is positive. indicating shortening of femur or PEER (6) Rane ROS 1, RAE AR Re MP “FE 4S Ht (Thomas) QE”. AR BEA BS EN He AR AR A. RB HE AS (05 BE BB 22 fh OK THT. DATA BR FRAT HM REE. FE LUSHAN EE AAR A A Be ike TO AE (EOF PR AIA. HA TE Ea I 2. RAP KL EKER”. BR APF « AEA BE SEY Fa 90°, Be A: — Fi BR EP BH ak (BE HBL EA LAH FS RAZ. BAPE. We KWL BIER AK. 3, SAMBA iROe EK “ji 7% ( & (Trendelenburg ) 4B” FTE AR Ae BAF BC AB 2a ST.» AN a A SCHR) LAUT. Bik FRAT J 2 Vr « A EB 5 WU YF SB EC PRE UPA. 228A aA A HOE TAS fea BRE WILE Fe RAE PMA BR 4. PRS aK “SAH (Allis) E”. AM Ab» SQUARE HE SS 9 J AB SPACE PR TELE.» TE 2 UT RE NB — ME BEE. eB AL A OR ASAE A+1) General Introduction tibia and fibula or hip dislocation. 3.2.2.7.5 Telescope test It is also called invagi- nation sign. Let the patient lie in supine position. The doctor fixes the patient’s pelvis with one hand and holds the popliteal fossa with the other hand, making the joint of hip slightly flexed, then pushes and pulls the thigh longitudinally. If there is up-and-down mobile feeling of the sick leg, it is positive, and indicative of instability or dislocation of hip joint. This is usually seen in infantile congenital dislocation of hip joint. 3.2.2.7.6 Test of frog posture Let the child patient lie in supine position with the both hips and knees bent to the angle of 90°, then do abduction and extorsion of both hips, forming a frog posture. If one or two thighs can not rest horizontally on the bed surface, it is positive and indicative of restriction of hip abduction. This is seen in infantile congenital dislocation of hip joint. 3.2.2.7.7 Measurement of position of greater tuberosity of head of femur (1) Nelaton’s line: Let the patient lie in supine position with the hip flexed to the angle of between 45° and 60°, draw a line from the anterior superior iliac spine to ischial tuberosity. Normally, the line passes through the top of greater tuberosity. If the top is superior or inferior to the line, it indicates a pathological change. (2) Bryant triangle: Let the patient lie in supine position. Draw a perpendicular line from the anterior superior iliac spine to the surface of the bed, a horizontal line from the top of greater tuberosity to the perpendicular line and another line from the anterior superior iliac spine to the top of greater tuberosity, forming a right-angled triangle. Comparing the length of base in two triangles of both sides, if it is shorter in one side, it is indicated that RADIA BEL. 5. BERtM LK “BBE”. BR MEMG, BA —FReR a. AFR ABS BB AE SY AH SH BRAILLE HERD BARC LF Ba Ry HE. 2 BH KVR BRA BL. WILE MN JUPGR AERIS BEE. 6, eee BULA Bh AHS 3 J 90° 432 FE AE BA Sh RS eo HE + SBRESK fr. A HR BL AA BB AB fe EF DR TL, BI Oy BA PE PRP AE TPR SSP. UL FILER EIA BU. 7. RRAKABAE HN ae (1) A438 (Nelaton) & AE (UBM ic AME Se 9 Fat 45°~ 60", ee A BL BRE A FE SHER «TE UKE TM. AKAM MH PREETI ERE It BR Ae tL (2) ARK (Bryant) = A BA MEMi. BRT LR SREB. AAT ASHRAM KFR AE i LR SAME A ZA #- HR. WR-HM= AA FE. TS Ee TG A FF YR KREWE eA AM+ 60° PRAHA: A the greater tuberosity of the side has displaced upward. 3.2.2.8 Special examinations of knee 3.2.2.8.1 Floating patella test Let the patient straighten his sick leg. The doctor presses his palm on the suprapatellar bursa with the part between the thumb and the index finger against the superior aspect of the patella so as to make the liquid flow into the articular cavity, and vertically presses the patella with the index finger of the other hand. If there is a sensation of floating patella and also a feeling of collision between the patella and the con- dyle of femur, it is positive and indicated that there is dropsy in the articular cavity. 3.2.2.8.2 Test of sideways movement of knee joint Let the patient lie on his back with the knee straightened. The doctor holds up the lateral side of lower end of femur with one hand, and holds up the ankle with the other hand and pulls it outward so as to give an abduction tension to the medial accessory ligaments. If there is pain or sideways movement, it is positive and indicative of an injury of medial accessory ligaments. Repeat the process above for examining lateral accessory ligament. 3.2.2.8.3 Drawer test It is also called pushing- pulling test. Let the patient lie on his back with the knee flexed to the angle of 90°, and foot resting horizontally on. the bed. The doctor stands in front of foot of the sick leg, holds the leg with two hands and pushes and pulls the leg forwards and backwards. An enlarged forward mobility indicates an injury of anterior cruciate ligament, and an enlarged backward mobility an injury of posterior cruciate ligament. 3.2.2.8.4 Test of traction of patella Let the patient straighten his sick leg. The doctor pushes and presses the patella towards distal direction with his thumb and index finger, and asks the patient to contract his quadriceps muscle of thigh. If there appears pain of the KARE EB. OV RBS 1. PRR ARK (EL. BBA — FO a LG FREER ER, ER PRAR HE, BFR HEP ARERA. ABH RAPS HAM RS RB FAR » By FE HE» 2 BH RS WAAR. 2, RAP w AMES, ER A BL, Be AE FER PM. Fs FERRAAT NL BEA OD WERNER A PER WUT YH Bh BD Oy BARE. Ze BA EDR. RZ UAE BOTT AE MT 3. ARBRE Re HE BGR Be”. AA a AAS J 90°, EPI RE BEE fF AUBCQBTDT E HE BR E Aa HERE SHE. fe) BT TE oH BE KR A AGG FA Jat oh BER ARAN D i. 4. BRR BAA FAH EL BEE FH BH eA EE cA Ok AL | RE Ae PB PEG BDA BATE. 8 WLP A AE+1 General Introduction +616 patella, it is positive and usually seen in strain of patella. 3.2.2.8.5 Rotating and squeezing test It is also called Mc. Murray’s sign. Let the patient lie on his back with his sick leg flexed. The doctor puts one hand on the superior part of the knee, holds the heel with the other hand, makes the knee flexed maximally, then makes abduction and intorsion of the leg, and makes the knee joint straightened simultaneously. If there is flicking sound or pain, it is positive and indicative of the injury of lateral semilunar plate. Contrarily, if the adduction and extorsion with the leg straightened cause flicking sound or pain, it indicates the injury of medial semilunar plate. 3.2.2.8.6 Triturating and pulling test It is also called Apler’s sign. Let the patient lie in prone position with the knee flexed to the angle of 90°. The doctor puts his leg on the posterior aspects of lower end of the patient's thigh for fixation. While holding the heel with his two hands and pressing down along direction of the longitudinal axis of the leg, the doctor makes abduction and extorsion or adduction and intorsion of the leg. If there appears pain or flicking sound, it is positive and indicative of the injury of lateral or medial semilunar plate. Lifting the leg up, the doctor makes abduction and extorsion or adduction and intorsion of the leg, if there appears pain, it indicates the injury of lateral or medial accessory ligaments. 3.2.2.9 Special examination of ankle Test of twisting ankle inward and outward = If there appears pain in the lateral aspect of the ankle while the ankle is twisting inward, it indicates the injury of lateral accessory ligament. If there appears pain in the medial aspect of the ankle while the ankle is twisting outward, it indicates the injury of medial accessory ligaments. Fi. 5. BURR aK “Se 96 D5 (Mc. Murray) 4E”. ARCA Gib A Ba, BS A — FRE LM, AFR BB ER GF A BE SR Pe AAS Yb Fae Ae» Dt fe BEST eA BA APS RG OW J TE, RUMP A a th. BZ Zo HE A) HIE PAL SC Se SE ELBE SR 45 He SL GAO A SH Be BP UE A A HH. 6. ABR LAK “BAPE IK (Apler) GE”, AREA Bib, RRS Ta ht 90°, Be AE FA — 7) iB FR ZEB CBRE HI A (EE AER AE ARMA D1 it Jn EBA Tes fe A Bi BY Sb FR Sb He BR A Ra. AAR RRA A, By BA tee » eB Mi PA EA BAG 5s BES A BLL TE SHR Ph Hie BR A CP BEI BT |S PERG » BAR YP UB AF BN BMH. (Ay) RED R BA SBIR BRK PN BB S| aE MA PC IRS» Be a AA AAS 5 BRK Sh AS | HEP UAE IAG » Be a PA BD iii.+ 62° PRBS +S it 3.2.3 Imaging examinations 3.2.3.1 X-ray examination X-ray examination is one of the important means for clinical examination and diagnosis of disease in orthopedic and traumatological department. Fracture and dislocation as well as their site, type, extent and treatment effect of the fracture and dislocation may be determined. Paren- chymatous lesion of bone and joint as well as the nature, site, range and extent of the lesion and the relation of the lesion to the soft tissues around it may be investigated and determined. Bone age may be decided and the condition of skeleton in growth and development may be inferred. In- fluence of some nutritional and metabolic diseases on the bone and its severity may be observed. And also some diseases can be ruled out. and some similar diseases can be differentiated. 3.2.3.1.1 Ordinary X-ray examination (1) Roentgenoscopy; There are two kinds of flu- ororoentgenography and X-ray television diagnosis. Fluo- roscopy is mainly used for the examination of fire injury, scanning, localization and extraction of foreign body, reduction and check of traumatic fracture and dislocation. (2) Plain radiography: It is suitable for all bones and joints. Generally eutopic and lateral radiography is used for long bones of limbs. joints and vertebrae; for some special parts, oblique. or tangential. or axial radiography is needed. 3.2.3.1.2 Special X-ray examination (1) Tomography: It is also called laminagraphy. This can make any one layer of internal tissues of the body develop in an X-ray film, and with the images of the other =. HEFRS (—) x Sie X RB OB FRA CMH RRE RS —. WARE X Ae AT a BHATT BE BOR aT (LAUER fir 38 AY EE AL PTE ORs FL LA WRR B A FSR IE « A BE NY TERR EAE BAAR HAs FT LL A HEMT KR A ARAS WE ARE Bea Y Ay BN Bm. VA BO FARE KA] Wish X AE HE BRAK HE mL BS BY SACS 1, RX RS CQ) X RBM ABE GMA XA. BL ERUPT RA ABH RD BP ER aE 2 Hs SP BE ADT LN SALA. (2) + HRY AF BOR A AB A. AY OA KARMA RH ABARTH PR BB AT IMB BE he, WR BS BA A He. 2, FSR X Bebe CD) KERB ERT ROBBY”. EAT LME APR ALRBAUEE fl — RATE X+1. General Introduction + 63° layers of the tissues being indistinct. Therefore, it can reveal a small focus, and determine the depth of the focus for the purpose of diagnosis. It is commonly used for diag- nostic examination of osteoarticular tuberculosis, osteo- myelitis and tumor of bone. (2) Stereoroentgenography: It can show a spatial relationship of a local tissue or structure to the tissues or structures in front of, or behind, or near, or far away from it, giving a stereoscopic conception. And it can also reveal the depth and range of focus in the thick part. It is mainly used for examination of a complex structure or a thicker part such as the skull, thorax, pelvis, and vertebrae, etc. . 3.2.3.2 CT scan Computerized tomography (CT) can give a cross-sec- tional image of the examined part. It is commonly applied in examination of diseases of the vertebrae. pelvis, and bone and joint of limbs. 3.2.3.3 MRI examination Magnetic resonance imaging (MRI) has the advantage of multiple parameters, high resolving power of the soft tissues, and no harmful radiation. It can give a sec- tional image of any cross section, coronal section or sagit- tal plane. It is commonly used for the examination of diseases of the vertebrae. pelvis and limb joints. 3.3 Methods of Syndrome Differentiation There are in orthopedics and traumatology mainly eight-principle syndrome differentiation, visceral syn- RH LBS HAs Bw BORA BAU BT LA ib aR ty SAHA AL» TE Th St FE 95S BTS EMMIS rH AA. APFRKPAR. AMR Aba SAD TE (2) ERY WUE AERA RAR RH 7s HA Wi He A 2s Ta) KAR HK 3 SEBS HED BB iL a EBA DR BE AE EB. dE Bd FAY 28 Hs 2 Ae wk AK ABE PLB (VL) BE 3k A HS BE AR BES, (=) Cras CT (Computerized Tomo- graphy) e334 th i BB ic 1 PRAHA. SAT AH. Aa. OR AK HEIN hie. (=) MRI MRI( Magnetic Resonance Imaging) HKRAA ERS. SAL EG IF AT FE FRE RT TAL EAR OK TB WOT PAR a St at EE Ko SAP RHE. A. BK ART ENE. BLP PIED AP PEAK ER BA SAREE WE AA PEE A

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