What Is an Orthopaedic Assessment?

What Is an Orthopaedic Assessment?

An orthopaedic assessment is a structured, systematic clinical examination designed to identify the anatomical structures contributing to a client's presenting symptoms, characterise the nature and severity of their dysfunction, and generate a working clinical diagnosis that guides the selection and sequencing of treatment interventions. It is the clinical foundation upon which all subsequent treatment decisions rest. In the context of musculoskeletal myotherapy, the orthopaedic assessment draws on principles established by James Cyriax, Robin McKenzie, and subsequent generations of manual therapy clinicians and researchers — integrated with contemporary pain science and neurophysiological assessment frameworks. The assessment is an active, hypothesis-driven clinical process in which each finding either confirms or challenges the emerging clinical picture.

The Subjective History

Every orthopaedic assessment begins with a thorough subjective history — a structured conversation in which the client's story is listened to carefully as the primary diagnostic tool. This encompasses the primary complaint (location, quality, intensity, behaviour over the day), onset and mechanism (sudden or gradual, specific incident or accumulated load), aggravating and relieving factors (which activities, postures, or movements worsen or improve symptoms), the 24-hour pattern (worse in the morning suggesting inflammatory component, with sustained postures suggesting mechanical cause, with activity suggesting load-dependence, or constant suggesting possible systemic pathology requiring medical referral), and medical history including medications, previous injuries, imaging reports, systemic conditions, and red flag screening for conditions requiring medical management rather than manual therapy.

Observation and Postural Analysis

Before a single test is performed, systematic observation provides significant diagnostic information. Postural analysis examines spinal curvatures, pelvic alignment, shoulder girdle symmetry, limb alignment in standing and walking, and skin characteristics including bruising, swelling, muscle wasting, and protective splinting. The way a client moves matters as much as the position in which they rest — observation of gait, how they rise from a chair, or the way they guarded a limb during greeting can reveal protective motor patterns that would not be apparent from static assessment alone.

Range of Motion Testing

Range of motion assessment distinguishes between impairment originating in contractile tissue (muscles and tendons) and non-contractile tissue (joint capsules, ligaments, bursae, cartilage) — the foundation of Cyriax's selective tissue tension approach. Active ROM tests movement performed by the client using their own muscle contraction, implicating both contractile and non-contractile elements. Passive ROM tests movement produced by the examiner — pain or restriction found only at end-range passive motion implicates non-contractile tissue. The quality of resistance at end-range (the "end-feel") provides additional information about tissue involvement. Resisted isometric testing tests muscle and tendon integrity under load without movement — pain during a resisted contraction without joint movement implicates the contractile element.

Special Orthopaedic Tests

Special orthopaedic tests are specific examination manoeuvres with documented sensitivity and specificity for identifying particular pathologies. They are interpreted in the context of the full clinical picture — a positive test adds weight to a hypothesis already supported by other findings, rather than confirming a diagnosis alone. Examples include the Spurling's compression test for cervical radiculopathy, Hawkins-Kennedy and empty can tests for shoulder impingement and rotator cuff pathology, the SLR and slump test for lumbar disc and sciatic nerve involvement, FABER and FADIR tests for hip joint pathology, and the Thessaly test for meniscal integrity. Each test carries a known likelihood ratio that statistically adjusts the probability of the working diagnosis — a principle underpinning evidence-based clinical reasoning.

Neurological Screening

When a client presents with radiating pain, paraesthesia, numbness, or weakness in a limb, neurological screening determines whether nerve root compression, peripheral nerve entrapment, or upper motor neurone pathology is present. This includes dermatomal sensation testing, myotomal strength testing (assessing key muscles innervated by specific spinal segments), deep tendon reflex testing, and upper limb tension tests or straight leg raise to assess neural mechanosensitivity — the degree to which the nerve's capacity to lengthen and glide freely within its canal is compromised.

Clinical Reasoning and Differential Diagnosis

The endpoint of the orthopaedic assessment is a coherent clinical hypothesis that accounts for all findings, identifies the most probable tissue sources and contributing factors, ranks differential diagnoses in order of likelihood, flags any findings requiring medical referral, and generates a treatment plan with clear, measurable short and long-term goals. This process of clinical reasoning — weighing evidence, testing hypotheses, updating beliefs in response to new findings — is what distinguishes a thorough clinical assessment from a superficial symptom checklist. It is the foundation of the evidence-based, root-cause approach to musculoskeletal care that informs every session at this clinic.