MSK History Flashcards
Osteoarthritis
Mechanical wear and tear
Gout
Hot and swollen
RA
Worse in the morning
Septic arthritis
Hot and swollen
Fever
Osteoporosis
SHATTERED
Psoriatic arthritis
HPC: Site
What is the pattern of joint involvement?
- Which joints are affected?
- Small or large joints?
- One or more than one joint?
- Bilateral? Symmetrical or asymmetrical?
HPC: Onset
When did it start?
Speed of onset?
Acute: gout
Subacute: septic arthritis, RA
Chronic: osteoarthritis
Constant since onset?
If episodic: frequency, regularity and duration?
HPC: Character
Ache
Sharp pain
Throbbing
HPC: Radiation
Examples:
Neck pain to upper limb
Lower back pain to buttocks
Hip pain to knee
HPC: Associated symptoms
Stiffness and/or swelling
Crepitus (grating of surfaces against each other)
Erythema, increased local temperature
Fatigue, malaise, depression
Systemic temperature (gout, sepsis)
Rashes/skin conditions (psoriasis, erythema nodosum)
Nodules (RA, gouty tophi)
Fever, abdominal pain, weight loss (systemic symptoms of vasculitis or associated IBD)
Dry mouth, gritty eyes (sjogrens)
HPC: Timing
What do your joints feel like when you get out of bed in the morning?
How do you feel at the end of the day?
How do you sleep?
RA: significant early morning stiffness (>60 mins usually) and joints stiffen up again after REST/in evening
OA: minimal to moderate early morning stiffness (<30 mins) and joints made worse after ACTIVITY and also stiffen up in the evening again
HPC: Exacerbating factors
Exercise in mechanical/degenerative conditions
Rest in inflammatory conditions
HPC: Alleviating factors
NSAIDs
Exercise/Rest
HPC: Severity
Very severe - acute gout/sepsis
Slightly less severe - RA/OA
Any movements that are particularly painful?
Is function limited by pain?
Completing questions
ASK ABOUT TRAUMA
Recent infective episodes?
Have you had anything similar previously? What tests, diagnoses and treatments have you had? How did you respond to those treatments?
Diabetes? (Predisposition to infection)
Psoriasis, IBD, Coeliac?
TB?
Autoimmune conditions (e.g. thyroid) increases other autoimmune e.g. RA/SLE
Risk factors for gout (alcohol intake, renal disease, low dose aspirin, diuretics, metabolic syndrome (HT, obesity, diabetes, vascular disease)
Drug history
Current medication for presenting condition
Other current medication
Over the counter medication? Do they work?
Previous medication - did it work? Any side effects? Why was it changed?
Social history
Occupation - does the problem affect their employment?
Sports and hobbies
Home circumstances - type (house, bungalow, dependents, carers, social support)
Ability to carry out ADLs - detailed history likely needed
Smoking
Alcohol
Family history
RA
OA
Psoriasis
Gout
UC
Crohn’s
Connective tissue disease
Other autoimmune
