This document outlines how to take a thorough musculoskeletal history. It emphasizes that history taking is the most important part of making a diagnosis. The history should follow a structured format that includes demographic information, chief complaint, history of present illness, functional level, musculoskeletal review, medical history, and social history. The musculoskeletal review focuses on key areas like pain, stiffness, swelling, instability, deformity, limping, loss of function, and altered sensation. For each area, questions are provided to fully characterize location, onset, progression, aggravating/relieving factors, and associated symptoms. Red flags and risk factors should also be considered. The history should conclude by reviewing current and previous treatments.

1. Musculoskeletal History Taking
• Importance
• Structure
• Orthopedic hx
• History of treatment

2. Objective
By end of this session, you should be
able & know how to take a relevant history of
the major musculoskeletal conditions

3. History taking skills
• History taking is the most important step in
making a diagnosis.
• A clinician is:
 60% closer to a diagnosis with a thorough history.
 40% by (examination & investigations).
• History taking can either:
 Traumatic,
 Non-traumatic injury.

4. Structure Of History
• Demographic features
• Chief complaint
• History of presenting
illness
• Functional level
• MSK systemic review
• Systemic enquiry
• PMH
• PSH
• Drug Hx
• Smoking
• Occupational Hx
• Allergy
• Family Hx
• Social Hx

5. MSK systemic review
1. Pain
2. Stiffness.
3. Swelling
4. Instability
5. Deformity
6. Limp
7. Loss of function
8. Altered Sensation.
9. Weakness.

6. 1) Pain
• Location
 Point with a finger to where it is
• Radiation
 Does the pain go anywhere else
• Type
• How long have you had the pain
• How did it start
 Injury:
oMechanism of injury
oHow was it treated ?
 Insidious

7. 1) Pain
• Progression
 Is it better, worse or the same
• When
 Mechanical / Walking
 Rest
 Night
 Constant
• Aggravating & Relieving Factors
 Stairs
 Start up, mechanical
 Pain with twisting & turning
 Up & down hills
 Kneeling
 Squatting

8. 2) Swelling
• Onset
• Duration
• Painful or not
• Local vs. generalized
• Constant vs. comes and goes
• Size progression: same or ↑
• Rapidly or slowly
• Aggravated & relived factors
• Associated with injury or reactive
• From: soft tissue, joint, or bone

9. 3) Instability
• Onset
• How dose it start?
• Any Hx of trauma?
• Frequency
• Trigger/aggravated factors
• Giving way
• Locking
• I can not trust my leg!
• Associated symptoms
 Swelling
 Pain

10. Mechanical symptoms
Locking / clicking
• Due:
 Loose body,
 Meniscal tear
• Locking vs. pseudo-
locking
Giving way
• Due:
 ACL
 Patella

11. 4) Deformity
• When did you notice it?
• Progressive or not?
• Associated with symptoms  pain, stiffness, …
• Impaired function or not?
• Past Hx of trauma or surgery
• PMHx (neuromuscular, polio)

12. 5) Limping
• Onset (acute or chronic)
• Traumatic or non-traumatic ?
• Painful vs. painless
• Progressive or not ?
• Use walking aid ?
• Functional disability ?
• Associated  swelling, deformity, or fever.

13. 6) Loss of function
• How has this affected the patient’s life
• Home (daily living activities DLA)
 Prayer
 Squat or kneel for gardening
 Using toilet
 Getting out of chairs / bed
 Socks
 Stairs
 Walking distance
 Go in & out of car
• Work
• Sport
 Type & intensity
 Run, jump

14. Keep In Mind

15. Red flags
• Weight loss
• Fever
• Loss of sensation
• Loss of motor function
• Sudden difficulties with urination or defecation

16. Risk factors
• Age (the extremes)
• Gender
• Obesity
• Lack of physical activity
• Inadequate dietary
calcium and vitamin D
• Smoking
• Occupation and Sport
• Family History (as: SCA)
• Infections
• Medication (as: steroid)
• Alcohol
• PHx MSK injury/condition
• PHx Cancer

17. Current and Previous History of Treatment
• Non-operative:
 Medications:
o Analgesia
o Antibiotic
o Patient's own
 Physiotherapy
 Orthotics:
o Walking aid
o Splints
• Operative:
 What, where, and when ?
 Peri-operative complications

18. Now
You are able & know how to
take a relevant history of
the major MSK conditions