MSK History Taking Flashcards
What are our core questions for site in an MSK history?
Site-What is the pattern of joint involvement? i.e. 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?
PMH of MSK: Key questions?
• Has the patient had anything similar previously? What tests, diagnoses and treatments
have they had and how did they respond to those treatments? Previous medication.
Did it work? Any side effects? Why was it changed?
• Is there a history of trauma?
• Has the patient had any recent infective episodes? Including dental or pharyngeal
infection (risk of joint sepsis)
• Does the patient have diabetes (predisposing them to infection e.g. septic arthritis)?
• Does the patient have psoriasis, inflammatory bowel disease or coeliac disease?
• Have they had tuberculosis?
• Do they have any auto-immune conditions (e.g. thyroid disease)? (This increases their
risk of developing an additional auto-immune disease such as RA/ SLE).
• Do they have risk factors for gout (alcohol intake, renal disease, low dose aspirin,
diuretics, metabolic syndrome [hypertension / obesity / diabetes / vascular disease])?
What do we want to know with the drug history and allergies in an MSK history?
Current medication for the presenting condition
• Other current medication
• Over the counter medications? Do they work?
What are our social history questions for an MSK history?
• 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 are our family history questions for an MSK history?
Is there a family history of RA, OA, psoriasis, gout, Ulcerative Colitis, Crohn’s disease, connective tissue disease or any other autoimmune disease?
What are core questions for onset in MSK?
Onset-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 are core questions for character in MSK?
Character-e.g. ache, sharp pain, throbbing
What are core questions for radiation in MSK?
Radiation-e.g. neck pain to upper limb; lower back pain (LBP) to buttocks/ lower limb; hip pain to knee
What are core questions for associated symptoms in MSK?
Associated Symptoms: 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 are core questions for timing in MSK?
Timing-Is there a relationship with the time of day? Ask: ‘What do your joints feel like on rising; How do you feel at the end of the day? How do you sleep?’ e.g. RA – significant early morning stiffness (>60 mins usually)
& joints stiffen up again after period of rest/ in evening
OA – minimal to moderate early morning stiffness (<30 mins usually) & joints made worse by activity. Also stiffen up in evening.
What are core questions for exacerbating/alleviating factors in MSK?
exacerbating and alleviating factors-Exercise in mechanical/ degenerative conditions; Rest in
inflammatory conditions.
Alleviating: NSAIDs.
Exercise / Rest as above
What are core questions for severity in MSK?
Severity-Very severe – acute gout +/- sepsis
Slightly less severe – RA/ OA (usually)
Any movements that are particularly painful? Is function
limited by pain?
