MSK Subjective Ax

Question 1

What are the core components

Answer 1

History of PC
PC
PMH
Drug History
Social History
SIN Factor
Patient expectations and goals
Yellow Flags

Question 2

Components of History of PC

Answer 2

Mechanism of injury
Length of symptoms
Previous injuries
Previous interventions/ investigations

Question 3

Mechanism of Injury

Answer 3

How the pain started - specific injury or trauma
When the pain started
Force and positions during injury

Question 4

Length of Symptoms

Answer 4

How long
Is it new or chronic
changes around time of injury

Question 5

Previous Injuries & Interventions

Answer 5

Anything similar in the past
What interventions have been done before, did they help
Active/ passive interventions
Xrays scans seen a gp etc

Question 6

Components of PC
specific about site of symptoms and current behaviour of symptoms

Answer 6

Location of pain
Nature of Pain
Aggs and Eases
Diurnal Pattern

Question 7

Location of Pain

Answer 7

Use of body chart
Where it started
Where it is now/ developed to
Has it spread
Referred pattern of pain
Localised pain

Question 8

Nature of Pain

Answer 8

VAS scale
Quality - dull aching burning
When is it there - constant or occasional
Look out for neuro symptoms

Question 9

Aggs and Eases

Answer 9

What makes pain worse
Activities and postures
What makes it better

Question 10

Diurnal Pattern

Answer 10

24-hour symptom pattern
When is it worse
Night pain - keep them awake or just when turn

Question 11

PMH (THREADSS/ THREADSOCS)

Answer 11

Thyroid - can cause MSK symptoms
Heart - chest pain, pain in arm, etc
Rheumatoid arthritis - management and exacerbations, worse with rest
Epilepsy - regularity, predictability
Asthma - management
Diabetes - what type management, tendon problems
Steroid Use - osteoporosis, tendinopathies
Osteoporosis - predispose to fractures, back pain
Cancer - weight loss
Surgery - in area of problem and general

Question 12

Other PMH

Answer 12

respiratory diseases
allergies
fatigue

Question 13

Drug History

Answer 13

What medication are they on and for what

Question 14

Social History

Answer 14

Jobs
Hobbies
Physical activity
Who they live with
Drinking, smoking

Question 15

SIN Factor

Answer 15

Severity
Irritability - once irritated how easy to go, how easily is it irritated
Nature of Pain
gives an indication of what order to do ax in which positions to do last, what tests to do

Question 16

Patient Expectations

Answer 16

What they want to achieve
What do they want out of physio
Realistic outcomes

Question 17

Yellow Flags

Answer 17

Feelings around pain
Poor experiences
Understanding how the person feels/ works with their pain
Factors which may feed into their pain
Has anything changed - sleep, lifestyle, stress, eating

Question 18

5 Ds and 3 Ns

Answer 18

Dysarthria
Diplopia
Drop attacks
Dysphagia
Dizziness

Numbness
Nystagmus
Nausea