Przejdź do treściThe place where pain is felt is not always where it originates. That is why a good orthopaedic examination may include an adjacent joint, the spine, the course of a nerve and the way the whole limb functions — even when the patient points to one very specific painful spot.
Pain can be referred
A hip problem may be felt mainly in the groin or even at the knee. A cervical-spine disorder can cause shoulder and arm pain, while irritation of a lumbar nerve root may be experienced in the buttock or leg. Pressing on the painful area therefore does not by itself identify the structure responsible for the symptoms.
A nerve may need to be assessed along its course
Hand numbness can result from nerve compression at the wrist, elbow or higher up. Similarly, radiating pain into the leg may originate in the spine, pelvis or deep tissues of the buttock. The site of the strongest tingling does not always correspond to the level of nerve compression.
This is why the examination may include sensation, strength in selected muscle groups, reflexes and provocative tests at several levels. Ultrasound of one short segment of a nerve can be useful, but it does not replace a broader neurological examination of the limb.
An adjacent joint can change loading elsewhere
Restricted ankle motion can change how the knee works during a squat. Hip stiffness can alter knee loading, while limited shoulder motion may force compensation through the scapula and spine. In such cases, the painful area may be a genuine problem but not necessarily the only factor that needs to be addressed.
After an injury, more than one point must be checked
The force of an injury does not stop at the boundary of a single joint. With a fracture or dislocation, the examination may also include the skin, circulation, sensation, finger or toe movement and the joints above and below the injured area. This helps avoid missing a second injury, nerve compression or impaired blood supply.
Why should imaging follow the clinical examination?
If the source of pain is assumed too early, it is possible to perform a very detailed scan of the wrong region. A knee MRI will not identify referred pain arising from the hip, and a shoulder ultrasound will not answer a question about cervical nerve-root compression. The clinical question should come first; X-ray, ultrasound, MRI, CT or nerve-conduction testing can then be selected to answer it.
For a broader explanation of how different investigations are selected, see Diagnostic Tests.
What is useful to tell the orthopaedic surgeon?
- where the pain starts and where it travels;
- whether there is numbness, tingling or weakness;
- which movement or position reproduces the symptoms;
- whether the spine or a neighbouring joint also hurts;
- how the injury happened;
- whether symptoms change with coughing, sitting, walking or neck movement;
- which everyday activities have become difficult or impossible.
The key point
Examining beyond the painful spot does not mean ignoring the main complaint. It is a way of determining whether that point is the true source of the problem, the site of referred pain or one part of a broader chain of dysfunction. That distinction often determines which test and which treatment actually make sense.
More patient information: For Patients.
Content prepared by: Tomasz Poboży - orthopaedic surgeon.