A general approach to orthopaedic history and examination

by Stefan van der Walt, Stephanie Roche & Stephen Roche

Learning objectives

  1. Develop an approach to assessing a joint, history and examination.
  2. Understand the terminology used to describe alignment.

General approach to assessment of any joint

Steps include taking a history, examining the joint, examining other systems if indicated (for example, general or respiratory examination), and investigations after that. This chapter will not focus on any of the investigations.


Common presenting complaints in orthopaedics include:


Using the approach taught in other disciplines can also be used to assess pain in a joint, for example, ‘SOCRATES’

S: Site

Where is the pain?

Always consider referred pain when dealing with a joint, especially from the joint above or below.

O: Onset

When did it start?

Did it begin suddenly, or has it slowly been getting worse? (For example, acute onset in trauma or septic arthritis, or more chronic history in osteoarthritis).

C: Character

Is it a sharp, throbbing, dull or burning pain?

(For example, burning pain could suggest a neuropathic cause unrelated to the joint).

R: Radiate

Does the pain move anywhere?

Look for dermatomal or nerve root patterns.

A: Associated features

Do you have a fever?

(For example, fever in septic arthritis).

T: Time course

Is the pain worse in the mornings?

Does it get worse with activity? (This can help distinguish mechanical as opposed to non-mechanical or inflammatory joint pain).

E: Exacerbating or relieving factors.

Does the pain improve with analgesics?

(Often pain from a non-benign lesion is not relieved with analgesics). Is the pain worse in a specific position or with certain movements?

S: Severity.

A scale from 0-10 often helps.





Joint noises


Functional limitations

Besides the primary presenting complaint, the following questions should also be asked:

Systemic enquiry (see the chapter on Red Flags for more detail).

Orthopaedic history

General medical and surgical history

Family history

Social history


The examination begins from the moment the patient is seen. Observe the level of consciousness (particularly in trauma), and assess for any syndromic features, obvious deformities or gait abnormalities. You should immediately see if a patient is generally unwell (for example, septic arthritis, osteomyelitis) and the degree to which they can bear weight. Next, you must look, feel and move the joint.


Ensure that your patient is adequately exposed; you must be able to see the entire limb and compare left to right. If possible, look at the joint from the front, back and side. If examining the lower limb, look at the joints while the patient is standing, seated or recumbent.



Deformity and posture







Try and determine where the swelling is (intra- vs extra-articular) and what it consists of:


Active movement

The patient should move the joint/s themselves first; this is known as active movement.

Passive movement