Orthopedic and Rheumatological Symptoms: Common Presentations Flashcards
Key questions to ask in back pain
Pain SOCRATES
Osteoporosis risk factors
-older females, smoking, CS
Neurological review
- shooting pain down legs => cauda equina vs sciatica questions
- dermatomal rash => shingles?
Systemic review
- signs of cancer
- signs of systemic inflammation - AS (night pain improved with mv, gradual onset)
- spinal infection
- spinal trauma, fracture - tenderness/non specific pain
Non specific lower back pain
-varies with posture, time, worse on mv
GI review - peptic ulcer, pancreatitis
GU - renal colic, URTI/LRTI, PID
Joint pain, stiffness, swelling
Identify joints
-painful, red, hot swollen? - septic arthritis
Speed of onset
- acute - gout, pseudogout, septic, reactive
- subacute - inflammatory
- insidious - degenerative, neoplastic
Morning stiffness and duration
- long = inflammatory
- short = OA
Effect of mv
- better = inflammatory
- worse = OA
Sleep disturbance
- no = OA
- yes = inflammatory
Impacts on daily tasks
- shopping
- dressing
- cooking
- work
Rheumatological review
Rheumatological review
Skin - rashes, ulcers, Raynauds -PSA, SLE, Hair loss Eye - dry (Sjogren), red (uveitis?) Mouth - dry (Sjogrens) Chest - SOB (AI pneumonitis) GI - IBD symptoms GU - dryness (Sjogrens), haematuria (SLE) Psych - mood Systemic unwell -inflammatory -malignancy Recent infections? - reactive
Orthopedic review
Joints, bones, tissue
- pain, stiffness, swelling
- restricted mv
- inability to weight bear
Mechanical
- locking
- giving way
Neurological
-weakness, numbness
Key questions to ask in bone, tissue, joint injuries
Pain SOCRATES Bone pain - dull and worse on rest Tissue pain - sharp and worse on mv -MOI - strain, sprains -ability to weight bear? bony tenderness?
Neurological review
Rheumatological review
Systemic review
Past medical history
Any medical conditions
-how is it managed
Any medications
Past surgeries, procedures, hospital visits?
Allergies and reaction
Other rheumatological, AI disease
Past GI bleeds? - NSAIDs CI
Recent infections - septic, reactive arthritis
Analgesia
CS
Biologics, antiTNF
Family history
Joint problems in parents or siblings
Social history
Home -type of accommodation -stairs, lifts, Social support -who they live with, who helps them? -shopping, cooking, self care, housework -carer input
Smoking, alcohol
Recreational drugs
-IVDU => septic
Work
-impact on ability to work
