chapter 3: History and Physical Examination

Other Medical History

A complete history should include a review of pertinent medical history including any history of other joint pain or associated systemic diseases. The clinician must be aware of signs and symptoms associated with inflammatory arthritides such as gout, pseudogout, rheumatoid arthritis, psoriatic arthritis, Reiter's syndrome, and Lyme disease. Metabolic disorders, infections and neoplasms can also be important causes of myalgias and arthralgias and must not be overlooked.

Patient Goals and Expectations

No history is complete without understanding patient needs and expectations. History taking should include current and desired activity levels and work requirements. An important part of treatment of many patients with patellofemoral disorders is developing realistic goals. Ask the patient to define and discuss specific treatment goals.

Pain Diagrams

Patient‑drawn pain diagrams have correlated well with tenderness (Fig. 3.1). In a population of patients with anterior knee pain, 86% of negative patient zones on standardized diagrams correctly predicted a negative examination (7). It has been the author's experience that these diagrams can often correctly direct attention to the heart of the problem in very complex presentations. In addition to predicting areas of tenderness, patient drawings can be useful diagnostically because patients will occasionally draw patterns suggesting radiculopathy. Exaggerations such as stars, arrows, and exclamation points suggest a propensity to symptom magnification, although such correlation has not been clinically proven. Because they accurately predict areas of tenderness, pain diagrams link the history to physical examination of patients with anterior knee pain.






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