MSK History Flashcards
What mnemonic can be used for an MSK history?
● SOCRATES
● Site
● Onset
● Character
● Radiation
● Associated symptoms
● Timing
● Exacerbating factors
● Alleviating factors
● Severity
What sort of questions could be asked regarding ‘site’ during history of presenting MSK complaint?
● What is the pattern of joint involvement?
● Which joints are affected?
● Small or large joints?
● One or more than one joint?
● What was the speed of onset like?
● Is the condition bilateral?
● If so, is it symmetrical or asymmetrical?
What sort of questions could be asked regarding ‘onset’ during history of presenting MSK complaint?
● When did it start?
● What was the onset like? (Acute e.g. gout; Subacute e.g. septic arthritis, rheumatoid arthritis (RA); Chronic e.g. osteoarthritis (OA))
● Has it been constant since the onset?
● If episodic, what are the frequency, regularity and duration of the episodes?
What sort of questions could be asked regarding ‘character’ during history of presenting MSK complaint?
● e.g. ache, sharp pain, throbbing
What sort of questions could be asked regarding ‘radiation’ during history of presenting MSK complaint?
● e.g. Neck pain to upper limb
● e.g. Lower back pain (LBP) to buttocks/ lower limb
● Hip pain to knee
What sort of questions could be asked regarding ‘associated symptoms’ during history of presenting MSK complaint?
● Stiffness and/or swelling, crepitus (grating of surfaces against each other)
● Erythema, increased local temperature
● Fatigue, malaise, depression
● Systemic temperature (e.g. gout, sepsis)
● Rashes/skin conditions (e.g. psoriasis, erythema nodosum)
● Nodules (e.g. rheumatoid nodules, gouty tophi)
● Fever, abdominal pain, weight loss (e.g. systemic symptoms of vasculitis/connective tissue disease or symptoms suggestive of associated inflammatory bowel disease)
● Dry mouth and gritty eyes
What sort of questions could be asked regarding ‘timing’ during history of presenting MSK complaint?
● Is there a relationship with the time of day?
● What do your joints feel like on rising
● How do you feel at the end of the day
● How do you sleep?’
What sort of questions could be asked regarding ‘exacerbating factors’ during history of presenting MSK complaint?
● Exercise in mechanical/ degenerative conditions.
● Rest in inflammatory conditions.
What sort of questions could be asked regarding ‘alleviating factors’ during history of presenting MSK complaint?
● NSAIDs.
● Exercise?
● Rest?
What sort of questions could be asked regarding ‘severity’ during history of presenting MSK complaint?
● Very severe – acute gout +/- sepsis
● Slightly less severe – RA/ OA (usually)
● Any movements that are particularly painful?
● Is function limited by pain?
What questions could be asked about drug history and allergies during an MSK history?
● Current medication for the presenting condition
● Other current medication
● Over the counter medications? Do they work?
What questions could be asked about social history during an MSK exam?
● Occupation. Does the problem affect their employment?
● Sports and hobbies
● Home circumstances (type of dwelling e.g. house, bungalow; dependents, carers, social support)
● Ability to carry out activities of daily living – a detailed history is likely to be needed here. For example, a patient with osteoarthritis of the hip may have difficulty getting in and out of a car or bath, picking up objects from the floor, putting on their shoes and socks, cutting their toenails etc.
● Smoking
● Alcohol consumption
What questions could be asked about family history during an MSK exam?
● Is there a family history of RA, OA, psoriasis, gout, Ulcerative Colitis, Crohn’s disease, connective tissue disease or any other autoimmune disease?
In relation to an MSK exam, what risk factors would predispose a patient to a diagnosis of gout?
● Alcohol intake
● Renal disease
● Low dose aspirin
● Diuretics, metabolic syndrome [hypertension / obesity / diabetes / vascular disease])?
In relation to an MSK exam, what risk factors would predispose a patient to a diagnosis of septic arthritis?
● Diabetes
