Taking a musculoskeletal history
LO: Demonstrate taking a musculoskeletal history
History
- The talk with the patient before moving on to other aspects of your overall assessment
- Good clinical history will give you most of the answers you need to formulate a differential diagnosis and make a management plan
Structure
- Introduce yourself, gain consent, check patient ID
- Presenting complaint
- History of presenting complaint
- Systems review
- Past medical and surgical history
- Drug history
- Social history
- Family history
Consultation
- Taking an accurate and concise history is an important skill and essential in medicine
- Start with open questions, then close in on specifics
- Check yours and the patient's understanding
- Summarise
- Ask about 'ICE' (Ideas, Concerns and Expectations)
- Be aware of the context
- Listen
Presenting complaint
- What is it that the patient has sought help for?
History of presenting complaint
- Background of the presenting complaint
- "What can we do to help you today?" - unambiguous and open
- Chronicity - when did the symptoms start?
- Where are the symptoms? Which joints or limbs? Are things symmetrical?
- Did anything seem to trigger the symptoms?
- Has this happened before?
SOCRATES
| Abbreviation | Meaning |
|---|---|
| Site | Where, are there multiple sites? |
| Onset | When, sudden/gradual? |
| Character | Describe pain, dull/aching/sharp/shooting, intermittent/persistent? |
| Radiation | Does the pain go anywhere? |
| Associated symptoms | Any other symptoms? |
| Timing | Better/worse/same? |
| Exacerbating and relieving factors | Does anything make it better or worse? |
| Severity | 1-10 how severe? 1 - minor, 10 - worst pain ever |
Systems review/specialist questions
Rheumatology
- Seronegative features: Psoriasis, IBD, uveitis
- Connective tissue disease: Mouth ulcers, photosensitivity, alopecia
- Red flag symptoms: Unintentional weight loss, night sweats, loss of appetite
Past medical and surgical history
- Any other underlying medical conditions?
- Any previous operations?
- Any significant hospital admissions?
Drug history and allergies
- Any regular prescribed medications?
- Any over the counter medications or herbal remedies?
- Any drug allergies?
Social history
- Smoke?
- Alcohol?
- Drugs?
- Employment?
- Living with anyone?
- Need assistance in day to day life?
Family history
- Anything significant run in the family?
- Anyone in the family have an autoimmune condition?