Case history Flashcards
SOCRATES
S - Site. where is it, what anatomy
O - Onset. When did it start. gradual/sudden. continuous/constant.
C - Character. Type of pain, shart, throbbing, stabbing, ache, dull
R - Radiating. Does the pain travel. pins and needles
A - Alleviating. / associating symptoms =. What does it better/relief. cold/heat. painkillers, exercise, rest. headache, dizzy..
T - Timing. When do symptoms start. morning, night. daily pattern
E - Exacerbating. what makes it worse, bending, sitting, sneezing, driving
S - Severity. VAS, scores, yellow flags.
Presenting the complaint
where is the pain
does it radiate
what does the pain feel like
is it constant or intermittent
neurological symptoms - pins and needles, weakness, numbness
bowel/bladder changes - cauda equina
if neck pain - consider headaches and asks:
5Ds 3Ns 1A;
Dizziness
Diplopia - blurred vision
Dysarthria - issues swallowing
Dysphagia - issues speaking
Drop attacks - fainting
Neusea
Numbness
Nystagmus - irregular eye movement
Ataxia - bad balance, walking, speaking
5Ds
3Ns
1A
if neck pain - consider headaches and asks:
5Ds 3Ns 1A;
Dizziness
Diplopia - blurred vision
Dysarthria - issues swallowing
Dysphagia - issues speaking
Drop attacks - fainting
Neusea
Numbness
Nystagmus - irregular eye movement
Ataxia - bad balance, walking, speaking
Red flags
Unexplained weight gain/loss
Unexplained pain
Night pain
Previous cancer
Prolonged corticosteroids
Unexplained fever
Dizziness, bad balance and vision
low BP in under 50
Hight BP
Orange flags
eating disorders
mental health
Blue flags
Work related
Black
Legal claims
PIP
When to screen for Cauda Equina
+ symptoms and questions to screen
Lower back and leg pain
Normally - unilat back pain with bilat leg pain
Altered bladder function - difficulty starting/stopping/leaking/not aware when bladder is full
loss of anal tone - inability to stop bowel movements
Sexual dysfunction - erection/ejacalation inability
loss of sensation when wiping/sexual intercourse
VINDICATE
V - Vascular. vessels (bleeds, inflamed, blocked. DVT, stroke
I - Inflammation/Infection. IBS, RA, TB
N - Neoplastic. Cancer
D - Degenerative. Age related, repetition, OA
I - Iatrogenic/Intoxication. caused from meds, surgery. Withdrawals
C - Congenital. Born with it
A - Autoimmune/allergic. Diabetes, RA, crohn’s disease
T - Trauma. Fractures, tears
E - Endocrine/environment. hyper/hypothyroidism. Pollution/poverty
Areas with conditions
Neck - whiplash, facet irritation, cervical artery dysfunction
Shoulder - impingement, bursitis, frozen shoulder, rotator cuff tear
Elbow/wrist - epicondylitis, carpal tunnel syndrome
Spine - TOS, scoliosis, spinal stenosis, spondylosis
Pelvis - piriformis syndrome, SIJ pain
Hip - RA, OA, bursitis, snapping hip syndrome
Knee - bursitis, torn meniscus, patellofemoral
Ankle/feet - achilles torn, bunion, gout, RA, OA
Tests
ortho tests
peripheral tests:
Myotomes = muscle power. 0 (absent) - 5 (full power). Corticospinal tract
Reflex = 0 (absent), 1, 2 (normal), 3, 4 (clonus).
Dermatomes = sensation, soft/sharp
Doral column test = vibration test. common with TD1/2
Muscle tests
MET test
