History Taking

in
Orthopaedics

Orthopaedics:
Ortho straight
Paedics children
Musculoskeletal
systems
Bones, joints, muscles,
tendons,
ligaments, peripheral
nerves,
blood vessels.
special tissue:
meniscus, bursa,

Divisions of Orthopaedics
Trauma Surgery
Spine Surgery
Arthroscopy & Sports Medicine
Hand Surgery
Paediatric Orthopaedics
Joint Replacement (Arthroplasty)
Oncology
Trauma - 80 % (worldwide)
Our setup - 95%

Group of Diseases
Congenital & Developmental
abnormalities
Infection & inflammation
Arthritis & rheumatic disorders
Metabolic & Endocrine disorders
Tumors & Lesions that mimic them
Sensory disturbance & muscle weakness

History Taking
Patient story
Doctor constructs history
history systematic, carefully,
patiently compiled & informative

Points in history taking

General Information
Age
Sex
Occupation
Presenting Complaint

Symptoms
Pain
Stiffness
Swelling
Instability
Deformity
Limp
Altered
Sensation
Loss of function

Specifics to the HPI

Precipitating incident

trauma (macrotrauma)
repetitive stress (microtrauma)
is this a work related injury?
is there a lawsuit ongoing?

Specifics to the HPI

For MVAs

driver/passenger
belted/non-belted
location of impact and severity of crash
(required jaws of life, if anyone died in the
crash, thrown from the car, etc)
speed at impact
position of the patient and the limb in
question at impact

Specifics of the HPI

for pain or presenting problem

Onset
Duration
Character
Course
Aggravating and relieving factors
Location
Radition
Associated symptoms

Associated Symptoms

In addition to pain do they have:

Clicking
Snapping
Catching
Locking
Sensation of giving way (including
prior falls or dislocations)
Swelling
Weakness

Temporality or Timing

Is it worse when they wake up in

the morning?
Does it gradually get worse over
the course of the day?
Does the pain ever wake them up
at night?

Red flags

Pain at night or rest

Associated weight loss and loss of
appetite
Hx. Of cancer
Steroids use
Hx. Of trauma
Extreme age
Bowel or bladder symptoms

Pain
Most Common complain
Grading of pain
I
II
III
IV
V

No pain
Mild, can be ignored
Moderate, requires treatment
Severe, intrusive despite analgesics
Very severe, inhibits virtually all activities

 At the site of the

pathology:
Location, duration, progression,
nature, intensity

Specific Characters of pain

Sharp shooting pain of back - PIVD
Chronic pain,
Changes

activities

Constant boring pain

- Degenerative

- Infective, neoplastic

 Referred pain:
From
Neck
Shoulder
Shoulder
Elbow
Forearm, hand
Lumbar Spine
LS Spine
Region
Hip
leg
Thigh

To
Arm
Groin
Gluteal
Thigh, knee,
Knee

Autonomic pain:
from autonomic nerves
& accompany peripheral blood
vessels
e.g. after operation
Poorly understood, often doubted

Stiffness
Symptom of joint involvement
Protective mechanism, spasm around joint

Generalized:

Systemic disorder like RA, AS

Localized:

to particular joint

Swelling
Soft tissue, joint, bone
After trauma, injury or reactive
Rapidly or slowly
Painful or not
Constant or comes and goes
Same size or

Instability
C/O Joint giving way

Muscle weakness, ligamentous deficiency & disruptio

Deformity
Associated with pain & stiffness
c/o knock knees, bowlegs,
Important: Progressive or not
Impaired function or not

Limp
Abnormal pattern of ambulation
Involved joint, dysfunctional muscle,
Due to deformity
Progressive or not

Altered
Sensation

C/O tingling, numbness, burning pain

Nerve involvement
Note progressive
Eg. diabetic neuropathy, radiculopathy, laceration

Loss of function

Depends on individual needs

Judged on social, professional,
domestic & recreational
demands

 Personal history & background

work, travel, recreation, home

circumstances,
support from family & friend
Family history
genetic disease RA. Communicable
disease TB

Past Medical History

previous trauma, injury,
sprain, strain
Systemic Review
LBP : Acute UTI
PID

Trauma Patient
General History
ABC
LOC
Spine, Joints, limbs
Previous history of injury