MSK Subjective Assessment Masterclass Flashcards
Why is it important to ask about fractures in past medical history?
Fracture history can indicate conditions like osteoporosis, affecting healing and the risk of future fractures. Pain at previous fracture sites might also suggest avascular necrosis or mal-union.
How can hypothyroidism impacts MSK conditions?
Without enough of it, issues like poor bone development, cartilage wear, and different types of joint problems can arise.
Common symptoms include:
- Joint pain and stiffness
- Muscle weakness and aches
- Carpal tunnel syndrome
- Swelling in the joints, especially in the knees, wrists, and hands, often with thick, jelly-like fluid that isn’t usually inflamed
- Osteoporosis
- Arthritis
What does the acronym #THREADSOCS stand for in assessing past medical history?
THREADSOCS stands for Fractures, Thyroid, Heart, Rheumatology, Epilepsy, Asthma, Diabetes, Steroid use, Osteoporosis, Cancer, and Surgical history.
What social factors might influence a patient’s pain and ability to manage symptoms?
Factors include standard of living, family and support networks, employment status, mental health, and lifestyle. Social factors can significantly impact pain perception and recovery.
What are “Yellow Flags” in social history?
Yellow flags refer to social or psychological barriers to recovery, such as low mood, anxiety, lack of support, or employment issues.
How can the 24-hour pattern of pain provide diagnostic clues?
Different patterns, like pain worsening at night or in the morning, can indicate mechanical or inflammatory issues and help differentiate between conditions like osteoarthritis or inflammatory arthritis.
What specific questions should be asked about night pain?
Ask about the ability to fall asleep, wakefulness due to pain, time to return to sleep, and differences based on sleep positions or use of painkillers.
What is a red flag symptom progression for Cauda Equina Syndrome?
Symptoms often start with back pain, progressing to leg pain, leg weakness, and eventually issues with urination or bowel function.
Why is it crucial to start with Past Medical History (PMH) in a subjective assessment?
Starting with PMH helps to quickly identify any serious or relevant conditions (e.g., history of cancer or fracture) that could affect the clinical picture, influencing the rest of the assessment and management plan.
Why is it important to identify aggravating factors, and what conclusions might these factors support?
Aggravating factors, like specific movements or postures that worsen pain, help identify if the pain source is mechanical or non-mechanical. For instance, pain worsened by loading or activity may indicate a musculoskeletal origin.
How can easing factors guide hypothesis formulation?
Easing factors suggest which treatments or postures might help alleviate symptoms, helping refine whether the pain is likely due to a specific joint, tendon, or non-musculoskeletal cause.
What might indicate constant symptoms that do not change with any activity?
Constant, unchanging symptoms could suggest a non-mechanical cause, such as inflammatory or systemic pathology, which may need further investigation or referral.
What helps differentiate between osteoarthritis (OA) and rheumatoid arthritis (RA)?
OA:
-Pain worsens with activity and improves with rest.
-Stiffness, particularly after periods of inactivity (like in the morning, but usually resolving within 30 minutes).
RA:
-Pain and stiffness are worse in the morning (lasting longer than 30 minutes) and improve as the day goes on.
-Symmetrical joint involvement (both sides of the body).
-Systemic symptoms such as fatigue, fever, and weight loss may be present.
-Joint swelling, tenderness, and deformities can occur over time if left untreated.
What typical symptom pattern might you expect in a patient with hip osteoarthritis?
Hip OA patients often report pain with activities involving hip flexion and rotation (e.g., putting on socks), and the pain typically worsens with prolonged weight-bearing.
What aggravating factors are classic for patellofemoral pain?
Activities involving knee flexion, like squatting, stair climbing, and prolonged sitting, are often aggravating for patellofemoral pain.
