musculoskeletal history taking.ppt
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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.
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This document provides guidance on taking a thorough musculoskeletal history. It emphasizes that history taking is the most important part of making a diagnosis, as a clinician is 60% closer to a diagnosis with a thorough history compared to 40% from physical examination and investigations alone. It outlines the key components of a musculoskeletal history, including chief complaint, history of present illness, functional assessment, review of systems, past medical and surgical history, medications, social history, and specific questions for common conditions like pain, swelling, instability, and loss of function. Examination techniques like inspection, palpation, and active and passive range of motion testing are also summarized. The goal is to educate clinicians on how to take a comprehensive history for the major musculoskeletal
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2014 Ovarian Cancer National Conference: Sexual Health
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2014 Ovarian Cancer National Conference: Sexual Health
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- 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