MSK History

Trying to visualise the content and data involved in an MSK history can be difficult and an assessment form cannot be all things in all cases.  It would need to be pages and pages long. When thinking about an MSK history and what areas need to be covered with your patient you quite quickly realise that there are some key areas, but thereafter multi-layers that sit beneath these areas. 

My personal perspective from years of working in MSK both in the NHS and private is that taking a good history from your patient not only helps to drive your clinical examinations but often, the patient will give you the majority of the information you need to form a diagnosis.

While it’s clear that clinical pathways and treatment algorithms are excellent for passing exams and attaining qualifications, it is still apparent that there is a fear of MSK or biomechanics in podiatry.  Putting aside the theoretical teaching of the topic of biomechanics, the subject does not lend itself well to pathways and black and white algorithms.

I believe this to be because when students are learning, while we implement acronyms to help to ensure we’ve covered all aspects of taking a history there’s always one fly in that soup – the patient.  Every patent is different and therefore every clinical history is different.

The subjective history taking process is an interview, a conversation with the patient which should also help to establish aims and objectives, and potential barriers to any potential interventions.  

Perhaps, a problem based approach to history taking is what is required than ticking off a list of letters of an acronym. A different approach…like Jigsaw Puzzle Thinking!

So, I wanted to try to find a way to challenge this and make is easier for students and clinicians to be able to take facilitate clinical history taking in podiatry.  I’ve been developing this thinking further to come up with an accessible way of checking what info is needed or what questions you might need.  I’ve come up with a sunburst answer.