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Hx Taking + Physical Exam Cheat Sheet (DRAFT) by

Features of the Hx Taking and Physical Exam

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Hx Taking

Site - Where the pain is? Different site or local? Note their gestures
Onset - Sponta­neo­us/­gra­dua­l/s­udd­en/­tra­umatic?
Aggrav­ati­ng/­rel­ieving factors - Rest? Moveme­nt?­pos­ture? Have patient demons­trate moveme­nts­/po­sture
Quality of pain - Character of pain in patient's own words as much as possible, if they can't, give them a list - Burning, deep, dull, aching, sharp,­thr­obbing, stabbing
Radiation - Where the pain goes and what character it is? Different from local pain?
Severity - 1-10 scale, functional disability (outcome measure)
Time - length of time pain has been present - constant? interm­ittent? variable? 24 hr period?
Associated symptoms - Stiffness, Swelling, crepitus, locking, instab­ility, weakness and neurol­ogical signs - did you notice any other symptoms come on at the time of your pain?
General Hx
Systems review - Is the pain coming from a certain system? Check organs
Previous Health - previous trauma, operat­ions, medical illnesses, invest­iga­tions + treatment - similar past episod­es/­pre­vious MSK disorders " Have you seen any other profes­sionals about this? What did they do? Did it help?"
Other Potential precip­itating factors - infect­ions, illnesses, surgery + stress
Family Hx - Any joint/­sys­temic diseases - ask about grandp­are­nts­/pa­rents + siblings
Social Hx - Work + Home life - how does this pain/s­ymptom affect them at work/home? Hobbies affected? - Outcome measur­e/goals for the patient
Functional assessment - Loss of function?
Red Flags
Clinical features - serious, uncommon condit­ion­s/d­iseases - requires URGENT evaluation - Tumours, infection, f#, neurol­ogical damage
Yellow Flags
Psycho­social + Occupa­tional factors that could increased the risk of chronicity - Bourne­mouth Questi­onnaire (BQ)
Attitudes + Beliefs about pain
Compen­sation issues
Diagnostic + Treatment Issues
Family life
Work Life

Physical Exam

Bony + Soft Tissue - Look for - Deformity, Warmth, Crepitus, Muscle Tone, shape + Size, Swellings, Tenderness
AROM, PROM, RROM - End Feel, stiffness, Pain, Crepitus, locking.
AROM + RROM - Muscul­ar/­con­tra­ctile Tissue.
PROM = Non-co­ntr­actile tissue

Mechanical Sensit­ivity

- Neurom­uscular Condition can be aggravated by various provoking factors
- Classed as Low/Mo­der­ate­/High
- Effective Management Plan
What Activity brings on the pain?
How long can the pt perform the activity before the onset of pain?
After onset - can they keep working, if so, how long for?
After stopping - How long does the pain take to settle?
Assessment Factors
Nature of activity that provokes symptoms
Intensity of the pain provoked
Time Span between onset + Offset

High Sensit­ivity (Strong Reactor)

Severe Pain - Provoked Easily
- Rapid Onset of Pain during activity
- Patient Ceases activity and pain occurs hours afterwards
- Radiation of Pain is Common
Rx: NOT RECOMM­ENDED FOR: Manipu­lation, Mobili­sation, deep myofascial therapy
Recomm­ended: Drug Therapy, PIR + Gentle Massage

Moderate Sensit­ivity (Mild Reactor)

- Definite Pain free period
- Pain unusually Gradual Onset - Slow then builds up during activity
- Patient ceases Activity
- Pain stops after 1 or 2 hours after stopping activity
Rx: Mobili­sation + Moderate Myofascial therapy + less intense forms of manual therapy

Low Sensit­ivity (Weak Reactor)

- Long delay in onset of pain
- Strenuous activity provokes it
- Pain level rises slowly, patient can continues with the activity
- When the patient stops activity - pain settles rapidly - within 15-30 minutes
Rx: Any form of manual therapy - low chance of reaction