From the Guidelines
A tertiary orthopedic exam involves a comprehensive evaluation by orthopedic specialists, including a detailed patient history, physical examination, assessment of range of motion, strength, stability, and neurovascular status, as well as advanced imaging studies and laboratory tests to develop a personalized treatment plan. This level of examination is typically reserved for complex musculoskeletal conditions that require advanced expertise, such as those that haven't responded to standard treatments or require subspecialty care 1.
The exam may include:
- A detailed review of the patient's medical history to understand the progression of the condition and previous treatments
- A thorough physical examination focusing on the affected area to assess range of motion, strength, stability, and neurovascular status
- Advanced imaging studies, such as MRIs, CT scans, or specialized X-rays, to provide a detailed understanding of the condition
- Specific provocative tests to evaluate particular conditions and assess how the musculoskeletal issue affects the patient's daily functioning
- Laboratory tests to rule out inflammatory or systemic conditions
- A biomechanical analysis to understand movement patterns and functional limitations
The goal of a tertiary orthopedic exam is to develop a comprehensive treatment plan that may include advanced surgical options, specialized rehabilitation protocols, or cutting-edge interventions not available in primary care settings 1. This level of care is necessary for complex cases requiring subspecialty expertise, such as revision surgeries, rare conditions, or cases that haven't responded to standard treatments. Effective collaboration with other disciplines, such as rheumatology, is also crucial for the management of musculoskeletal conditions, as highlighted in the recommendations for a rheumatology service 1.
From the Research
Orthopedic Tertiary Exam
- The orthopedic tertiary exam is a comprehensive assessment that involves a detailed evaluation of the patient's musculoskeletal system 2.
- This exam is typically performed after the initial and secondary exams, and its purpose is to further localize the problem to a specific limb, region, or joint 2.
- The tertiary exam may involve specialized tests and procedures, such as radiography or arthrocentesis, to confirm the diagnosis and develop a treatment plan 2.
Components of the Tertiary Exam
- A thorough history and physical examination are essential components of the tertiary exam 3, 4.
- The physical examination should include a detailed assessment of the patient's gait, range of motion, and joint stability 2, 4.
- The examiner should also evaluate the patient's neurological function, including sensation, strength, and reflexes 3.
Challenges and Limitations
- Performing an orthopedic tertiary exam can be challenging, especially in patients with complex or multiple musculoskeletal problems 2, 3.
- The examiner must have a strong foundation in orthopedic anatomy, physiology, and pathology to accurately diagnose and manage musculoskeletal disorders 5, 6.
- The use of imaging modalities, such as X-rays or MRI, may be necessary to confirm the diagnosis and guide treatment 5, 6.
Education and Training
- Orthopedic residents and practitioners require ongoing education and training to develop and maintain their skills in performing tertiary exams 3, 5, 6.
- The use of standardized patients, simulations, and other educational tools can help improve the accuracy and completeness of the tertiary exam 3.
- Staying up-to-date with the latest research and advancements in orthopedic medicine is essential for providing high-quality patient care 5, 6.