TOPIC 1: HISTORY TAKING

BASIC INFO MEDICAL HISTORY / PAST HEALTH HISTORY

- Name - Surgeries / hospitaliza�on

- Gender o Childhood
- Age o Adulthood
- Occupa�on - Trauma / accident / falls
- Major or Chronic illness (eg: diabetes, HT, heart
Chief complaint: (presen�ng problem, if pa�ent had more than disease, asthma, cancer)
one, re-take for another clinical session, focus on one condi�on - Medica�on (prescrip�on)
at current session.) What
brings u here
today ? o How many pills per day
LODCTRAPPA FAMILY HISTORY
LOCATION: which part of body, point it out - Siblings, parents, grandparents
- Paternal vs maternal
ONSET:
HOW
PSYCHOSOCIAL HISTORY
- When did the pain start
-

- Does the pain happen suddenly? Gradually? Follow by - Diet

an accident? - Water
- Describe the accident - Coffee, tea
- Smoking / recrea�onal drugs
DURATION
- Sleep
- How long have u experienced this pain - Exercise
- Acute, sub-acute, chronic - Hobbies
- Work
=
COURSE

- Hows is the pain felt throughout the dura�on since 1st

experience it SYSTEM REVIEW
o Beter
1. CNS
o Worse
a. Vision
o Stay the same
b. Taste
- Is the pain constant or comes and goes
c. Smell
TYPE d. Hearing
2. CVS
- Can you please describe the pain
a. Chest pain
o Sharp, dull, throbbing, stabbing,
b. Palpita�on
- Can you grade the pain from 0 to 10 (rmb to explain)
c. Fa�gue
o Now
3. RESPI
o At its worst
a. Cough
o At its best
b. Chest pain
o At �me of injury
c. Dyspnea
RADIATION d. Fa�gue
4. GI
- Does pain radiate to other parts of the body a. Appe�te
- How far down does it radiate (ask pa�ent point it out) b. Nausea (felt disgusted)
c. Vomi�ng
d. Diarrhea
e. Abdominal pain
RELIEVING FACTOR 5. GU
a. Frequency
- Anything you did that makes the pain felt beter b. Dysuria (pain during urina�ng)
- Eg: Painkillers, ice, heat 6. MSK
a. Joint pain
AGGRAVATING FACTOR
b. Rashes
- Anything that makes it worse c. Muscle ache
- Eg: Postural changes

PREVIOUS EPISODES
3 DDX with jus�fica�ons
- Have you had anything like this before
2-3 orthopaedic tests for for each ddx
PREVIOUS TREATMENT
Know the +ve findings for each condi�ons
- Have you seen anyone for this problem before
- IF YES
o What the dr said (diagnosis)
o What treatment is given (med, physio)
o Why discon�nue from previous treatment

ASSOCIATED SYMPTOMS

- Is there any other symptoms that comes with this

problem
Thoracic

DDX SIGNS & SYMPTOMS EXAMINATIONS

Thoracic - Pain ↑ by deep repiratory movements, cough, sneeze - ROM
segmental joint - Sta�c palp.
dysfunc�on - Mo�on palp.
Costochondri�s - Ant. chest wall pain (mild-moderate) - Rib movement
- May radiate to back or abdomen - SMR
- Pain exacerbated by cough/sneeze/respiratory movement
- Occur unilaterally / bilaterally
- Tenderness at chondrosternal jxn of affected ribs
- Possible history of URTI
- Caused: costochondral jxn strain caused by persistent cough

Thoracic disc - Lower back pain - ROM

protrusion - Radicular pain (neurological symptoms due to compression of nerve roots) - Sta�c palp.
- Dermatomal numbness / paresthesia - Mo�on palp.
- Limited ROM - SMR to assess for possible
- Valsava’s test +ve myelopathy
~
soto hall

Ankylosis - Pain & s�ffness, worse in morning Chest expansion

Spondyli�s - Improves throughout the day - Normal: 1.5 to 3 inches
- Follow a patern of exacerba�on & remission - Male < 1.5 inch
- Decreased lumbar lordosis - Female <1 inch
- SIJ Tenderness upon palpa�on
Oft's Sign
Schober Test
- < 4cm Flex : 2 to
4 cm
Ext. : 1 To 2 am

Scoliosis - Ribs hump - Forward bending test

- Hyper kyphosis - Adams test

Shoulder

DDX SIGNS & SYMPTOMS (pa�ent’s complaint) EXMAINATIONS

Rotator cuff - pain with overhead ac�vi�es - Drop Arm
tears - night pain - Hornblower
- severe pain at �me of injury - Empty Can
- shoulder s�ffness
- weakness of involved muscles
- tenderness over greater tuberosity
- pain @ant. Shoulder, radiate down the arm
Supraspinatus - pain over lateral shoulder Impingement Test
tendini�s - pain radiate distally - Empty Can Test
(Rotator Cuff - pain may disturb sleep - Neer’s Test
Tendinopathy) - pain gradually ↑ - Hawkin Kenedy Test
- pain in area of tendons of rotator cuff muscles - Painful Arch
Radiate - pain when reaching overhead, reaching back, li�ing & sleeping on
affected side
- unable to reach abduc�on & flexion of 90 deg.
- ADL can cause lot of pain
SLAP lesion - Painful clicking / popping in shoulder - Ant. Apprehension Manoeuvre
(Labral Tear) - Athletes performing overhead movements - Ant. Slide Test
- Fall onto an outstretched arm with shoulder in abduc�on & slight - Jobe Reloca�on
flexion at �me of impact - O’Brien Ac�ve Compression Test
- - Bicep’s load Test

Adhesive - Pain & limited ROM (esp. shoulder abd. & ext. rot.) - Drop Arm
Capsuli�s - Risk factor - Appley’s Scratch
(Frozen o Diabetes - Li� off
Shoulder) o Thyroid disease
o Age 40-65
o Asian
o Female
Calcific - Right shoulder is more common - Impingement Tests
Tendini�s - Night pain, causes loss of sleep - Bicipital tendinopathy tests
(Hydroxyapa�te - Constant dull ache - Appley’s Scratch
Disease) - Pain ↑ with AROM
- Radia�ng pain up into suboccipital region or down into fingers
- Reduce ROM, complaint of s�ffness
Bicipital - Speeds Test
Tendinopathy - Yergason Test
- Biceps Muscle Test
Shoulder - Any shoulder test
bursi�s
Shoulder Impingement Tests
Impingement
Syndrome
Elbow

DDX SIGNS & SYMPTOMS EXAMINATIONS

Lateral - Overused, repeated wrist extension & forearm supina�on / prona�on - Cozen’s test
Epicondyli�s - Jobs affected - Mill’s test
(Tennis Elbow) o Carpenter
o Bricklayer
o Pianist
o Drummer
o Prolonged keyboard / mouse work
o Tailors
o Tennis players (improper biomechanics of backhand or serves)

Medial - Overused, repeated forearm flexion, prona�on - Reverse Cozen’s test

Epicondyli�s - Sports affected - Reverse Mill’s test
(Golfer’s Elbow) o Baseball
o Golf
o Bowling
o Javelin throwing
o Weight li�ing
o Archery

Cubital Tunnel - Paresthesia / pain radiate down from medial epicondyle to 4th & 5th digit - Tinel’s Sign
Syndrome - May radiate to neck / shoulder - Elbow flexion test
(Ulnar nerve - Loss of grip strength & fine motor control
entrapment At - Muscle was�ng
elbow) - Leaning on elbow on hard surface (eg: desk)
- Jobs that needs to maintain elbow flexion like holding a tool, telephone
- Sports affected
o Baseball
o Tennis
o Racquetball

Radial Tunnel Result from - Radial tunnel compression

Syndrome - Overuse test
(radial nerve - Forceful handgrip work - Resisted supina�on test
compression) - Excessive wrist extension, prona�on, supina�on, vibra�on - Resisted long finger
extension
Compression / irrita�on on sensory branch of radial nerve - Tinel’s sign
- Pain, paresthesia along post. forearm
- Radia�ng to hand, 1st web space, back of thumb & index finger
- Night pain

Compression / irrita�on on motor branch of radial nerve (post. interosseous nerve)

- Finger drop
- Weakness of MCP joints, thumb extension

Pronator Teres Result from -

Syndrome - Repe��ve forearm prona�on & supina�on, wrist & finger flexion
- Gripping with palm down

Complaints
- Aching discomfort in ant. forearm
- Paresthesia radiate down to first 3 ½ digits

Olecranon - Pain at post. elbow -

bursi�s - Swelling at olecranon

Wrist & Hand

DDX SIGNS & SYMPTOMS EXAMINATIONS

De Quervain’s Resulted from - Finkelstein’s test
Tenosynovi�s - Li�ing, grasping, pinching movement
- combined with wrist radial & ulnar devia�on

Ac�vi�es affected
- video gaming (gamer’s rhumb)
- frequent tex�ng
- excess mobile phone use
- li�ing infants
- wringing out wet clothes (washer woman’s sprain)

Scapholunate Resulted from rupture of scapholunate ligament - Watson’s test

Dissocia�on - FOOH injury
- Hyperextension
 Complaints
- Swelling at dorsum of wrist
- Tenderness distal to lister’s tubercle, in proximal anatomical snu�ox, at SL jt.
- Limited ROM
- Pain ↑ with loading across the wrist (push up posi�on)
- Clicking in the wrist
- Wrist instability / weakness

Carpal Tunnel’s Resulted from - Wrist flexion

Syndrome - Prolonged, repeated wrist flexion & extension Compression
- Trauma, fracture, disloca�on, OA that may narrow the carpal tunnel - Tinel’s
- Fluid reten�on during pregnancy - Phalen’s
- Inherited a “square shaped wrist” - Reverse Phalen’s
- Aggravated by gripping ac�vi�es - Carpal Compression
- Relived by shaking hands out
crubbing hands

Complaints
- Paresthesia (numbness, �ngling) over 3 ½ fingers
- Night pain leads to awakening from sleep
- “whole hand is numb” (pain is difficult to localized)
- Pain some�mes may radiate up to elbow
- “dropping things” (weak LOAF muscle due to loss of median nerve
innerva�on)
Thumb Ulnar Resulted from - Thumb ulnar
Collateral Lig. Tear - Sprain of UCL of MCP jt. of thumb collateral ligament
(Gamekeeper’s - Thumb fully extended & abduc�on strain to MCP jt. instability test
thumb / Skier’s - Common skiing injury, fall onto handheld the stock firmly clenched by thumb
thumb)

Inferior Radioulnar Resulted from - Press test

Joint Sprain - Tear of triangular fibrocar�lage / disc in inferior radioulnar jt.
- Indirect injury, forearm in sudden forceful prona�on / supina�on
- Clicking / pain in circumduc�on, ulnar / radial devia�on of wrist
- Common in racquet sports

Complaints
- Pain over distal end of ulna
- Tenderness at dorsal ulnar aspect of wrist
- Painful clicking
- Weakness / instability of wrist
- Grip strength reduced

Cervical

DDX SIGNS & SYMPTOMS EXAMINATIONS

Cervical Spondylosis - Neck s�ffness, pain (constant dull ache) - Spurling / Jackson’s /
- Loss of ROM of neck Maximal Foraminal
Def: degenera�on of disc & 4 joints o muscle strain (SCM, Upper Trapezius) Compression
of cervical mo�on segment - pain aggravated by prolonged si�ng - Cervical compression
- pain relieved by hea�ng, movement (changing posture) - Cervical distrac�on
- Disc hernia�on (DDD) - May radiate to interscapular region, shoulder, arms, hands, - Shoulder depression
- Joint degenera�on (DJD) finger, if compression / irrita�on / inflamma�on on nerve roots
- Osteophyte forma�on or nerve itself.
- Loss of cervical lordosis o Nerve compression -> paresthesia
- Ligamentous changes o Nerve inflamma�on -> pain

Leads to
- Cervical radiculopathy
- Cervical myelopathy

Cervical Myelopathy - Neck pain

- Arm & leg dysfunc�on
Def: spinal cord compression o Leg s�ffness
(reduce in spinal cord diameter) o Foot shuffling
o Fear of falling
o Broad-based gait
- Difficulty walking over uneven surfaces
- loss of balance
- Reduc�on in SMR
- Upper motor neurone findings
o Hyperreflexia
o Ankle clonus
o Babinski’s sign
o Hoffman’s sign

Cervical Joint Dysfunc�on - Tightness in the neck

- S�ffness in the cervical joints
- Deep ache in the neck
 - Similar as cervical spondylosis
o Neck pain
o Tor�collis
o Headache
o Face pain
o Ver�go
o Shoulder pain
o Upper interscapular pain
- ↓ ROM

Cervical Radiculopathy Complaints

- Cervical Disc Hernia�on - Dull ache to severe burning pain
- Cervical Spondylosis - Can radiate to scapula, upper / lower arm, hand
- Cervical Stenosis - Muscle weakness
- Sensory changes (�ngling, numbness, loss of sensa�on)
*↓ cervical lordosis, ↑ risk of disc
hernia�on Resulted from
- Repe��ve stressful worksta�on
- Prolonged forward head posture
- Repe��ve cervical flexion
- Improper sleep posture
- Trauma
- Frequent heavy li�ing
- Driving
- Opera�ng vibra�ng equipment

Relieving factor
- Abduct shoulder & place hand on the head