Receiving/taking subjective history is crucial to make a clinical diagnosis and decision. We can spend time on asking questions as much as we need to while we study at university. I remember one of my classmates spent 50 mins on receiving a patient medical history to fill in the patient history form. Most workplaces set an initial consultation for 30-60minutes. How much do you spend on receiving the subjective history? You may not want to spend too much time on asking questions. However, 75% of diagnosis can be made by adequate information before moving onto objective assessments and tests [1]. Asking questions that rule in and out your diagnoses in your mind will help practitioners save time and get vital information.
For example,
A 60y/o male patient with the type 2 diabetes were to complain of shoulder pain and restricted movement, what would you suspect and what diagnoses would come up to your mind?
From this brief information, rotator cuff tear would be suspected. (You may think about other pathologies, but that is fine as long as you have reasons and know what to rule in and out)
*Age and sex[2, 3, 4], diabetes [5] are risk factors of rotator cuff tears.
Having that diagnosis or differential diagnoses help you determine what questions need to be asked. If you are suspecting rotator cuff tear or related pain, you may ask whether pain affects sleep [6].
If a patient is 50 y/o female with type 2 diabetes were to complain of shoulder pain and restricted movement, would your diagnosis change?
If I only knew this much of information, I would change my provisional diagnosis just based on what research says. Then, keep asking questions to rule in and rule out based on my diagnoses and simultaneously think about what tests I need to perform.
Risk factors of adhesive capsulitis
Primary
Female and diabetes [7],
Thyroid diseases, Parkinson disease, cardiac disease, [9]
Age range 40-60 [10], can be seen age over 60 and rare to see age under 40 [8]
Secondary
Previous injury [8]
Hip OA [11]
Unlike other hip pathologies, subjective history can help diagnose hip OA. Objective tests such as FABER test (+LR 1.8) and resisted hip abduction (+LR 3.5) are not superior to subjective history or even worse [11].
Subjective complaints that can help diagnose hip OA
·Family history of OA (+ve LR, 2.13)
·History of Knee OA (+ve LR, 2.06)
·Groin and anterior thigh pain (+ve LR, 2.51-3.86)
·Self-reported restriction in hip ROM (+ve LR, 2.87)
·Constant lower back and buttock pain (+ve LR, 6.50)
·Groin pain on the same side (+ve LR, 3.63)
· Pain longer than 3 months (OR, 2.49)
·Morning stiffness (OR, 2.6)
·Age>60 years old (OR, 13.06)
·Pain with hip movement (OR, 2.49)
·Worst pain in the groin (OR, 4.1) or medial thigh (OR, 8.7)
*LR (likely Ratio), OR (Odd Ratio)
Conclusion
If you understand well pathologies, you know what information you need to know to rule in and rule out the diagnoses in your mind. Also, patients do not know what information they need to report. Thus, it is practitioners’ responsibility to ask vital information. This is an acquired skill and need sufficient knowledge of pathologies. Understanding pathologies well, having sufficient knowledge and experience helps save time asking questions and allows you to spend more time on interventions/treatments.
References
[1], Ohm, F., Vogel, D., Sehner, S., Wijnen-Meijer, M., & Harendza, S. (2013). Details acquired from medical history and patients’ experience of empathy – two sides of the same coin. BMC Medical Education, 13(1). https://doi.org/10.1186/1472-6920-13-67
[2], Sayampanathan, A. A., & Andrew, T. H. C. (2017). Systematic review on risk factors of rotator cuff tears. Journal of Orthopaedic Surgery, 25(1), 230949901668431. https://doi.org/10.1177/2309499016684318
[3], Plachel, F., Moroder, P., Gehwolf, R., Tempfer, H., Wagner, A., Auffarth, A., Matis, N., Pauly, S., Tauber, M., & Traweger, A. (2019). Risk Factors for Rotator Cuff Disease: An Experimental Study on Intact Human Subscapularis Tendons. Journal of Orthopaedic Research, 38(1), 182–191. https://doi.org/10.1002/jor.24385
[4], Jain, N. B., Fan, R., Higgins, L. D., Kuhn, J. E., & Ayers, G. D. (2018). Does My Patient With Shoulder Pain Have a Rotator Cuff Tear? A Predictive Model From the ROW Cohort. Orthopaedic Journal of Sports Medicine, 6(7), 232596711878489. https://doi.org/10.1177/2325967118784897
[5] Cho, N. S., Moon, S. C., Jeon, J. W., & Rhee, Y. G. (2015). The Influence of Diabetes Mellitus on Clinical and Structural Outcomes After Arthroscopic Rotator Cuff Repair. The American Journal of Sports Medicine, 43(4), 991–997. https://doi.org/10.1177/0363546514565097
[6] Longo, U. G., Facchinetti, G., Marchetti, A., Candela, V., Risi Ambrogioni, L., Faldetta, A., de Marinis, M. G., & Denaro, V. (2019). Sleep Disturbance and Rotator Cuff Tears: A Systematic Review. Medicina, 55(8), 453. https://doi.org/10.3390/medicina55080453
[7] Erickson, B. J., Shishani, Y., Bishop, M. E., Romeo, A. A., & Gobezie, R. (2019). Adhesive Capsulitis: Demographics and Predictive Factors for Success Following Steroid Injections and Surgical Intervention. Arthroscopy, Sports Medicine, and Rehabilitation, 1(1), e35–e40. https://doi.org/10.1016/j.asmr.2019.07.005
[8] Tzeng, C. Y., Chiang, H. Y., Huang, C. C., Lin, W. S., Hsiao, T. H., & Lin, C. H. (2019). The impact of pre-existing shoulder diseases and traumatic injuries of the shoulder on adhesive capsulitis in adult population. Medicine, 98(39), e17204. https://doi.org/10.1097/md.0000000000017204
[9] Itoi, E., Arce, G., Bain, G. I., Diercks, R. L., Guttmann, D., Imhoff, A. B., Mazzocca, A. D., Sugaya, H., & Yoo, Y. S. (2016). Shoulder Stiffness: Current Concepts and Concerns. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 32(7), 1402–1414. https://doi.org/10.1016/j.arthro.2016.03.024
[10] de la Serna, D., Navarro-Ledesma, S., Alayón, F., López, E., & Pruimboom, L. (2021). A Comprehensive View of Frozen Shoulder: A Mystery Syndrome. Frontiers in Medicine, 8. https://doi.org/10.3389/fmed.2021.663703
[11] Wright, A. A., Ness, B. M., & Donaldson, M. (2021). Diagnostic Accuracy of Patient History in the Diagnosis of Hip-Related Pain: A Systematic Review. Archives of Physical Medicine and Rehabilitation, 102(12), 2454–2463.e1. https://doi.org/10.1016/j.apmr.2021.03.029
