History

On questioning the patient, the clinician must determine:

• Exact symptoms, particularly the nature of any pain, their duration and particular precipitating, aggravating and alleviating events.

•If a single or multiple joints are involved.

• Exact site of injury and side dominance of a patient (right or left handed).

• If the symptoms occur at rest or are purely mechanical in nature, such as pain on weight bearing, history of giving way or locking (Fig. 22.9).

• If there are any system symptoms, particularly those involving the genitourinary and gastrointestinal symptoms, and also pertaining to the eyes and skin, namely rashes and conjunctivitis. A history of urethral diseases may be significant.

• If there is a history of recent infections, either viral or bacterial, or recent overseas travel, particularly to third world countries. Of particular relevance, is whether the patient may have been exposed to tuberculosis.

• If there is a recent or more distant past history of trauma to the joint and whether this was a single event or recurrent trauma (see below).

• If there is any family history of diseases involving the joints, particularly at a young age.

Figure 22.9. Patellofemoral osteoarthritis.

• The nature of any treatment, conservative or operative, instituted in the past: standard pain killers, anti-inflammatory agents, steroids, immunosuppressive agents or antibiotics; bracing of the joint for stability or pain relief, physiotherapy, walking aid, surgical procedure, etc.

• If past treatment has been successful and if there has been a recurrence of symptoms.

• Most importantly, the degree to which the symptoms have interfered with the patient's quality of life and his ability to remain in gainful employment. Have they just prevented the patient from taking part in sporting activities or hobbies or are symptoms of such a severe nature that the patient has difficulty with personal hygiene, dressing or feeding, thereby resulting in loss of independence?

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