MSK OSCE

If a patient has pain and swelling after a recent injury what modality might you use and why

Ice because it calms pain and swelling

What effects does ice have on tissue

It slows nerves and lowers blood flow and swelling

What are the contraindications for ice

Poor sensation poor circulation cold intolerance open wounds

How does reduced sensation change your plan with ice

I avoid it because they cannot feel danger

What else can the patient do to manage swelling

Elevation and gentle pain free movement

When would you avoid modalities

When movement and exercise help more

How do you decide between heat and ice

Ice for swelling heat for stiffness

What healing stage guides heat or ice

Acute stage needs ice later stages may need heat

How to explain heat and ice to a patient

Ice calms things down heat loosens tight areas

What should a patient feel with ice or heat

Ice feels cold then burning then aching then numb heat feels warm not hot

If the patient is two weeks post sprain would the choice change

Yes use heat if stiff unless swelling is still present

What exercises do you give in the acute stage of a sprained ankle

Pain free movement gentle isometrics easy balance

Why are these exercises right in the acute stage

They prevent stiffness and keep muscles active without stress

What do you add two to three weeks after a sprain

Band strengthening single leg balance and light loading

Explain the difference between mobility strength and proprioception work

Mobility improves range strength supports the joint proprioception improves control

If movement hurts what do you say

Use a smaller pain free range or switch to isometrics

One more exercise tip for this patient

Walk short easy distances if pain stays low

What exercise groups help a shoulder with pain during overhead lifting

Mobility rotator cuff work and scapular control

Why choose these for shoulder pain

They reduce irritation and improve control for overhead tasks

What should you avoid early with shoulder pain

Heavy overhead lifting

How does pain change the exercise plan

High pain start easy low pain allow more strength work

How do you know when to progress shoulder exercises

When pain is calm movement looks smooth and tasks feel easy

What red flags do you screen for with musculoskeletal pain

• Fever

• weight loss

• cancer history

• bladder or bowel issues

• numbness

• weakness

Which red flags need urgent referral 9

1. Any bladder or bowel problems
2. Any numbness in the saddle area
3. Any fast or new weakness in the legs
4. Fever or chills with back or joint pain
• Severe night pain that does not change with position
• Unexplained weight loss that is fast and not linked to diet
• History of cancer with new strong pain
• Trauma with concern for fracture
• Worsening widespread numbness or tingling

Which red flags may be explainable

Weight loss from diet changes

How do you phrase red flag questions to a patient

Any fever any trouble wiping any trouble holding pee any new falls

If a patient has night pain what is your follow up

Ask if changing position helps

If a patient lost weight how do you explore concern

Ask if they changed diet appetite or activity

If a patient has new numbness or tingling what do you ask next

• Where it is

• when it began

• if it is worsening and any weakness or bladder issues

How does severity or location of numbness affect concern

A nerve area pattern suggests root irritation wide numbness is more serious

What makes numbness a red flag instead of routine

If it is new worsening or paired with weakness

When do you keep doing physio and when do you refer

• Keep if mild and stable

• refer if weakness or bladder issues appear

Take a brief pain history using SOCRATES

• Site

• onset

• character

• radiation

• associated symptoms

• time

• Exacerbating

• Severity

What did you learn from SOCRATES

Pain pattern stage of healing and likely structure

Which SOCRATES part guides your plan most

Severity and irritability

How does pain pattern show the healing stage

Intermittent pain is mechanical constant pain is inflammation

What extra question do you ask outside SOCRATES

Ask how pain limits daily life and goals

A patient says their pain is sharp and radiating what does this tell you

Possible nerve irritation

What differentials come from sharp radiating pain

Nerve root irritation or joint or muscle referral

How does radiating pain change exercise choice

Use gentle mobility and calm positions not heavy strength

How do you explain radiating pain to a patient

The nerve might be irritated so pain travels

How do you integrate red flags SOCRATES exercises and modalities in a first assessment

Check red flags then take pain history then pick safe exercises and add a modality only for comfort

What do you prioritize first and why

Safety because serious signs change the plan

If the patient has severe pain how do you adapt

Use gentle movement and maybe a comfort modality

If the patient fears movement what do you do

Give reassurance education and small graded steps

One more thing to teach the patient

Use pacing not full rest

If symptoms improved since the first visit how does your plan change

Increase load and reduce passive treatments

Why is progression important

It helps tissue adapt and return to function

How do you know when to load tissue

Pain is stable swelling down and control looks good

What stops you from progressing

Pain flare swelling or poor form

One more safe way to progress

Add balance before adding weight