MSK assessment

Question 1

MSK: Presenting condition

Answer 1

Recorded on body chart

• Type and site of pain (descriptors)
• Quality of pain (nerve/bone/joint etc)
• Intensity of pain (numerical/ descriptive scales/VAS)
• Altered sensation (anaesthesia/parasthesia/hyperalgesia)
• 24 hour cycle ?
• Worse in am/pm ? time to ease stiffness
• Link symptoms ? Referred pain ?
• What aggravates pain + time frames
• What eases pain + time frames

Question 2

MSK: Special questions

Answer 2

Normal 
- pins + needles
- numbness 
- swelling/ colour/ temperature
For lower back + legs
- Bladder/bowel function
- Altered sensation around genitalia
- Effect cough/sneeze have on symptoms (may indicate pressure in spinal column)

Question 3

MSK: History of Presenting Condition

Answer 3

Also on body chart:

• Beliefs about what’s wrong
• When & how did it start (gradual vs sudden)
• Mechanism of injury
• Progression since (worse/better)
• Any previous treatments/investigations
• Any previous similar episodes

Question 4

MSK: Red & Yellow flags

Answer 4

Red - indicate serious pathology
Yellow - indicate likelihood of developing persistent problem
ie. attitudes/beliefs/behaviours/compensations/work/ family/diagnosis or treatment problems

Psychological pain measures

• Fear avoidance beliefs questionnaire
• Coping strategies questionnaire
• Self efficacy questionnaire
• OREBRO questionnaire

Question 5

Past medical history

Answer 5

• THREADS (thyroid/heart + bp/respiratory/epilepsy/arthritis/diabetes/steroids)
• Cancer
• TB
• Skin disorders
• growth disorders if relevant
• previous fractures/surgeries

Question 6

Drug History

Answer 6

• Painkillers - dose + type
• NSAIDS - dose + type
• steroids (osteoporosis risk)
• anti-coagulants (precaution for manual therapy/exercise)

Question 7

Social/Family History

Answer 7

• Age
• Work + activities
• home situation
• dependants/carers
• drive ?
• hobbies/exercise/sports/leisure

Question 8

SIN Factor

Answer 8

S - severity (mild/moderate/severe)
    - pain score
    - impact on life
I - irritability (mild/moderate/severe)
  - aggs + eases
N - Nature (acute/sub-acute/chronic)
    - Cause ? mechanical/ inflammatory/ sensitisation ?

Question 9

After subjective

Answer 9

• Discuss goals + expectations (SMART)
• Subjective markers (how progress will be measured)
• Objective assessment

Question 10

Objective assessment

Answer 10

- Observation - informal + formal
(posture/gait/muscle form/soft tissue)
- Palpation (heat/redness/swelling)
- Active + Passive RoM
(quality, resistance/ range/ pain/ tone)
- Muscle testing - isometric + dynamic
- Functional activity (what are they able to do)
- Special tests - test actual structure

Question 11

After objective

Answer 11

• Problem list (most severe + active to least severe +inactive)
• SMART goals (agreed with patient)
• Treatment plan (specifics)
• Objective measures: how progress will be measured
• Outcome measures - designed to test if specific treatment is working

All recorded clearly & systematically for ease of others - at time of assessment