2. Taking a musculoskeletal history

Demonstrate taking a musculoskeletal history

What is a history

it’s when you first talk to a patient, getting most of the info required to give a diagnoses and making a management plan.

STRUCTRE- 8 bits

• introduce yourself

• present complaint

• history of presenting complain

• systems review

• past medical and surgical history

• drug history

• social history

• family history

what does introducing yourself include

• full name, role

• explain what you wanna do and gain consent

• get name, date of birth, preffered term of addressing

present complaint. what’s that include

Ask what’s brought them here today

history of presenting complaint

explore the background of the complaint (did anything trigger it, how long, where are they (are they symmetrical), has it happened before)

what’s SOCRATES for

an acronym for asking questions about pain.

What’s socrates stand for

• Site- where’s the pain, multiple sites

• Onset- when’d it start? sudden/gradual

• Character- describe the pain

• Radiation- does the pain go anywhere

• Associated symptoms

• Timing- better/worse/stayed the same over what time?

• Exacerbating and relieving- anything makes it better/worse?

• Severity- scale of 1 to 10

systems review: what to ask about

seronegative features

connective tissue disease

red flag symptoms

what are seronegative features

psoriasis; IBD; uveitis; dactylitis… just words :)

what are connective tissue disease features

mouth ulcers, photosensitivity, Raynaud’s, alopecia, miscarriage, sicca, VTE

What are red flag symptoms

unintentional weight loss, night sweats, loss of appetite

questions for past medial and surgical history

underlying medical conditions?

previous operations?

significant hospital admissions?

Drug history questions

regular prescribed meds?

OTC medications or herbal remedies (anything off the internet- they can interfere or make this worse)

drug allergies?

social history questions

smoke?

alcohol?

recreational drugs? and route of administration?

employment?

living w anyone?

need assistance w anything in daily life

Family history

Anything significant running in the family

autoimmune conditions?

ICE

ideas, concerns, expectations

trauma/fracture specific questions

consider non-accidental injury if it’s a kid

Other injuries that may be more important (e.g. head injury)

regional joint pain specific questions

type of pain: mechanical, inflammatory, night/bone

joint stiffness- duration and severity

swelling?

deformity?

non-specific symptoms of systemic illnesses- fever, weight loss, fatigue

Inflam & non inflam

worse in the morning, worse towards end of the day

significant early morning stiffness-hours, minor early morning stiffness- minutes

good responds to NSAIDs, bad responce

Activity improves it, activity worsens it

how long does inflam vs non imflam last in widespread musculoskeletal pain

week to months, months to years

acute, hot, swollen joint specifc notes/questions

patient’s age and gender maters more

stuff like chemo, immunosuppression and bleeding disorders can be a cause for the pain

aswell as high levels of alcohol

swelling specific questions

what tissue? skin/subcutaneous, joint, bone, muscle/deep soft tissue

increased in size? over how long?