It is very important to understand a patient’s history prior to performing a clinical exam. In fact, it is generally felt approximately 85% of the time that one can arrive at a working diagnosis for a knee pathology based on the history alone. The physical exam can then be more focused to confirm or supplement this based on the patient examination.
DATE OF INJURY
One of the first things that should be questioned is to determine when the injury occurred. This helps to determine if this is a recent onset, acute injury, or a chronic injury. In some instances, it may be an acute injury with a previous chronic problem.
MECHANISM OF INJURY
The mechanism of injury, or “how”, is also very important to determine for each patient. It helps to distinguish between whether there was a contact or non-contact mechanism, whether the patient had a twisting or giving-way episode or other means of injury.
LOCATION OF INJURY
It is also very important to determine the “where” for an injury. Did this occur at a sporting event, work, or during recreational activities? This also helps to hone down the questions to be asked including weather conditions, shoe wear, uneven terrain or other factors which may have lead to the injury.
PREVIOUS INJURIES OR SURGERIES
It is not that uncommon for patients to present with an acute exacerbation of a previous chronic injury, and sometimes the patient does not remember the previous injury. Thus, it is important to determine if they did have a previous injury or if this is a new onset injury. This is important because it could affect their ultimate treatment recommendations.
In addition, it is important to know a patient’s previous surgeries, the type of surgery performed and the patient’s response to their symptoms before and after surgery. It also very helpful for the patient to bring all medical records including operative notes and operative photographs the day of their clinic visit to help supplement their understandings of what happened during surgery.
It is very important to determine a patient’s actual limitations due to an injury. For example, do they have problems with giving way, going up or down stairs, going up or down inclines, twisting, turning or pivoting? It is also helps to determine if they have difficulty with squatting, arising from a chair, or other activities.
In addition, it is important to try and determine what the patient’s desires are for increasing their activity level. This can vary greatly based on the age of the patient, sporting activities, recreation activities, work, and their overall expectations. While some patients may wish to desire to get back to functioning like their knee once was, in some instances with significant scar tissue or arthritis (for example), these may be unrealistic expectations and it is important to review this with the patient early on so they can work to get to their highest level of post-injury functioning.