OA knee Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
HPC
Takes a focused history including features of the pain:
Onset - “when did it start?”, “was this sudden or gradual?”
Duration - “when you get the pain how long does it lasts?”
Severity - “how would you rate the pain on a scale of 1-10?”
Aggravating & relieving factors - “does anything make the pain better?”, “is it better when your resting/moving around?”, “does anything make the pain worse?”, “is it worse when your resting/moving around?”
Weight bearing, Locking or Giving Way - “are you able to weight bear?”, “do you sometimes feel the joint locking?”, “does it ever feel like it will give way?”
Other joint aches/pains (esp Hip and Low Back) - “do have pain in any other joints in your body?”, “have you got any hip pain?”, “any lower back pain?”
History of trauma - “have you ever had trauma to the knee/injured it?”
Fever/weight loss/Night Pain - “have you had a recent fever?”, “have you had unintended weight loss?”, “do you get the pain at night?”
Explores what patient has already tried for problem - “what have you already tried for the pain?”
ICE
Ideas - “what do you think could have caused your knee pain?”
Concerns - “is there anything that your worried about regarding your knee pain?”
Expectations - “what were you hoping we would do for you today?”
Ask why the patient decides to present now and not earlier - “did anything influence your decision to come now and not earlier?”
Elicits that attended at wife’s behest
PMH
“Do you have any medical conditions like cancer or any joint conditions?”
Establishes previous stomach ulcer.
DH
- “Are you on any medications that have been prescribed by your doctor?”, “do you take any over the counter medications?”*
- “Do you have any allergies to any medications? What happens when you take the medication?”*
SH
Alcohol, smoking, recreational drugs (including IVDU) - “do you smoke?”, “how much do you smoke each day?”, “how long have you smoked for?”, “have you ever smoked? How much did you smoke and for how long?”(if the patient said they don’t smoke),”do you drink?”, “how much/what do you drink each day?”, “do you use recreational drugs?”, “have you ever injected drugs or shared needles with other people?”
Occupation - “do you work?”, “what do you do for work?”
Home situation - “what’s your home situation like?”, “do you need help with things like cooking, washing/cleaning yourself?”
FH
“Do you have any FHx of joint conditions like rheumatoid or osteoarthritis?”
Establishes Maternal history of OA
Examination
Asks to EXAMINE patient (G if mentions gait, pressing/moving knee)
“I’d like to examine you now by getting you to walk to assess your gait and pressing and moving your knee. Is this ok with you?”
DDx
XR Report: Explains Osteoarthritis to patient
“Osteoarthritis is an inflammatory condition that can cause breakdown of the cartilage and the bone in the affected joint”
Asks patient to complete Oxford Knee Score
“I’d like you to please complete this Oxford Knee Score which will provide an indication of the severity of the knee arthritis and what type of intervention you’ll need”
N.B.
Score 0 to 19 – May indicate severe knee arthritis. It is highly likely that you may well require some form of surgical intervention, contact your family physician for a consult with an Orthopaedic Surgeon.
Score 20 to 29 – May indicate moderate to severe knee arthritis. See your family physician for an assessment and x-ray. Consider a consult with an Orthopaedic Surgeon.
Score 30 to 39 – May indicate mild to moderate knee arthritis. Consider seeing your family physician for an assessment and possible x-ray. You may benefit from non-surgical treatment, such as exercise, weight loss, and /or anti-inflammatory medication
Score 40 to 48 – May indicate satisfactory joint function. May not require any formal treatment.
Counselling
Works towards a ‘Shared Management’ plan
Simple Measures: Hot Water Bottle/ Cold Pack/ Rest/ Knee Support during Harvest Time/ Extra Staff during harvest time/ Advises Wt Loss
Offers referral to physiotherapy/exercise sheet for strengthening
Avoids Prescribing Oral NSAID (G if mentions risk of stomach ulcer)
Suggests topical NSAID or Capsaicin cream for pain
Mentions codeine or Cocodamol (G if mentions SE, e.g. constipation)
Mentions a steroid injection
Mentions referral for knee replacement if no improvement
Advises Conflicting/Poor evidence for Glucosamine). G if says cannot prescribe. Advises, if uses to get from proper retailer
Safety-netting
To come back if symptoms not tolerated/concerned - “If your symptoms aren’t improving within the next week, or you become worried about anything regarding your knee, then please come back to the surgery”
Offers physio exercise sheet for knee - “Here’s a physio exercise sheet showing the exercises you can do for your knee”
Follow up appointment in 2- 3 weeks - “To wrap up, I’d like to book a follow-up appointment to see you in 2-3 weeks. Are there any days that works best for you?”
Close consultation
“Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is arthritis research UK, which I’ll write on a piece of paper for you to take home with you.”
