Week 1 Flashcards
(24 cards)
What is the subjective assessment
The initial assessment where we talk to our patients and gather information
Discussions with other clinicians, family or carers
Reading referrals or notes to gather initial information
What are the aims of the subjective assessment
Build rapport with your patient
Gather information to enable us to plan our objective assessment
Establish differential diagnoses
Establish the main problems and patient’s goals / expectations.
Evaluate patient awareness, knowledge and insight.
Establish baseline subjective markers
What is included in an MSK subjective assessment
History of present condition
Past medical history
Drug history
Social history
Patient goals / aims / expectations
Differential diagnoses
What is involved in HPC
Timeline, Mechanism of injury, treatment/ investigations to date
How might an improving Vs worsening presentation change your potential diagnosis or further assessment?
How might a clear mechanism help your diagnosis?
What might a major mechanism suggest vs a minor mechanism?
What information or mechanism would make you stop and think?
How might previous intervention information help your assessment? How might it hinder it?
what are non-verbal pain cues
- Facial expressions, grit teeth, frown, grimace, bite lip, blink, tears, tightly close eyes
- Making a fist, extending legs or fingers, curl toes
- Talking a lot or Quiet
- Deep breathing or Measured breathing
- Colour changes – pale or flushed
- Withdraw from touch
other words to describe pain
Sharp, aching, shooting, dull, prickling, tight, cramping, hot, burning, heavy, gnawing sickening, splitting, stabbing, throbbing, sore, tiring, exhausting, gripping, angry, stinging….
What is involved in PMH
Previous operations, accidents or significant illnesses
(THREADS)
Relevant current medical conditions
Specific ‘red flag conditions’
What is involved in Drug history
Current medication
Significant past medication
Specific ‘red flag’ medication
what is involved in social history
Occupation.
Relevant social or family situation
Hobbies and interests
HPC - Signs and symptoms
What are the main symptoms
Are there any other symptoms that the patient might report?
How can we record these in a clear, detailed way?
How are signs and symptoms recorded
Symptoms are recorded on a body chart.
Symptoms should be numbered if there is more than one eg P1, P2 for different areas of pain.
The relationship of these to each other should be established as well as the exact location and behaviour of the symptoms.
what is pain defined as
'’An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” (IASP definition)
how can pain location be recorded
body chart, is it dull or a sharp pain, are there more than one pain locations, is it deep or superficial, are the different pains linked together
what things do we need to know surrounding the pain tendancies
aggravating factors, Easing factors, 24hr pattern, night pain
what are special questions
Questions which help diagnosis eg
Any P&N/numbness?
Any swelling?
Any feelings of instability / locking / giving way?
Any audible pops / clicking?
what are red flags questions
Questions which indicate more serious pathology eg
Cauda equina symptoms
PMH THREADS questions
what is SIN
Severity - L/M/H
Irritability - L/M/H
Nature - Nociceptive, Neuropathic or neurogenic
what is irritabaility
Irritability = a disorder’s susceptibility to become painful, how painful it becomes and the length of time this pain takes to subside.
It is usually rated as low, moderate or high.
what is Nociceptive pain
Pain derived from tissues by mechanical or chemical processes.
Most likely to be associated with an acute injury, with damaged and healing tissues and postural pain.
what is neuropathic/genic pain
Pain derived from the nerve itself or its connective tissue by mechanical or chemical stimulation.
Has characteristic qualities typical of nerve irritation and involvement including the sensation and behaviour of the pain.
What is Nociplastic pain
Pain derived from a hyperactive and hypersensitised nervous system where the stimulus would not normally trigger a pain response and can be strongly linked to stress and emotion.
Can exist a feedforward response where thoughts and feelings can elicit a pain response.
what are examples of Nociceptive pain
Dull, aching, sharp pain, mechanical inflammatory pattern, clear stimulus: response (aggs+eases), pain localised to area of injury
what are examples of neuropathic pain
burning/ electric shocks, tingling/prickling/cold, allodynia/prolonged hyeranalgesic state, dermatomal/peripheral innovation field, random, spot pain along a nerve, paraesthesia
what are examples of nociplastic pain
diffuse pain location, non-mechanical patter, increased emotional response and triggers, history of failed treatments, unclear stimulus: response, non-anatomical palpation pain
