History - Musculo Skeletal

Musculo-Skeletal *

History

·        HPC:

o   When it started: gradual, injury (nature of injury, did it swell straight away, after a day etc)

§  Arthralgia: joint pain without swelling

§  Arthritis: pain and swelling

o   What‟s happened till now: gradual, fluctuating, etc

o   Now:

§  Site, character, radiation, aggravating and relieving factors

§  Include:

·        Morning stiffness, and how long it lasts (classically inflammatory arthritis)

·        Effect of rest and exercise

·        Sequence of joint involvement

§  Severity: 

·        Activities of daily living – what can‟t they do that they would normally do, use of aids and appliances

·        How far can you walk

·        Night pain: is it keeping them awake (always consider neoplasia and infection)

o   What treatment have they tried: NSAIDS, orthotics, physio, etc

o   Other features if inflammatory arthritis:

§  Systemic: Raynaud‟s phenomenon, rash, fever, fatigue, weight loss,

§  Eyes: 

·        Dry eyes and mouth (Þ ?Sjogren‟s syndrome)

·        Red, painful eyes (Þ ?iritis in seronegative arthritis), conjunctivitis in Reiter‟s

§  GI: diarrhoea (eg inflammatory bowel disease, scleroderma), mucosal ulcers (eg SLE)

§  Skin: psoriasis, nodules (rheumatoid), ulcers

§  Genito-urinary: dysuria, genital ulcers (Þ ?Reiter‟s)

§  Lungs: eg Pulmonary fibrosis in systemic sclerosis, ankylosing spondylosis

§  Kidney: eg Gout

§  Heart: Rheumatic fever,

·        PMH

o   Surgery: any operations

o   Medical: any medical problems, especially diabetes, asthma, heart and lung disease

o   Also childhood arthritis

o   Sexually transmitted diseases, especially non-specific urethritis and gonorrhoea

·        Drugs, side-effects and allergies (including what the allergy does to them)

·        Family history: 

o   Especially rheumatoid arthritis, gout, primary osteoarthritis, sero-negative spondyloarthropathies and inflammatory bowel disease. Note age of onset and outcome 

o   Also Developmental Dysplasia of the Hip

·        Social:

o   Always ask about occupation: any potential causes or implications of impaired function

o   Living situation: who else at home, any family living nearby, steps, etc 

·        Systems review: mainly cardiovascular, respiratory and GI. Also urinary stream in a male with a hip problem (fix the prostate first, otherwise operation ® urinary retention ® catheter ® infection ® dynamite to a recent hip replacement)