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MSK0029.txt

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+D: What brings you in?
+
+P: Hi, yesterday I was grocery shopping and, yeah, just in the parking lot somebody bumped into my car and this morning I woke up and my neck is just really painful. It hurt yesterday a little bit, but I mean it was so mild I didn't think much of it. But today it's it's quite a bit worse.
+
+D: OK, so can you tell me how this accident happened? Were you sitting in the passenger seat and the driver? And was the impact from like behind at the back of your car or at the front?
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+P: It was at the back so I was the driver and was just going over a speed bump in the parking lot so slowed down quite a bit and the person behind me must not have, and they bumped into me. There's just some scratches on the bumper. They didn't hit too hard, but I, I guess maybe hard enough.
+
+D: OK, and did the neck pain start immediately after? 
+
+P: Uh no it's I, like not immediately, yeah, I think it started a bit later on and then worse a bit, a bit today.
+
+D: OK. Alright, and is there pain anywhere else on your body? 
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+P: Uh really like my. No, just just really, my neck. 
+
+D: OK. OK, and does anything feel broken? Do, are there bruises anywhere? Any obvious signs of trauma?
+
+P: No, I can’t, I didn't notice anything like that and I can move my neck around so I don't think any I don’t, I don't think anything is broken. Just hurts a lot.
+
+D: Alright, and is a pain constantly there or does it come and go?
+
+P: It kind of comes and goes, it just it's worse with movement. If I just kinda sit still, I don't notice much pain, but if I'm betting my head forward or. Mostly backwards, so I'll get, I'll get pain.
+
+D: OK, and you said this happened yesterday, right? 
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+P: Yeah yeah, this happened yesterday afternoon.
+
+D: OK. Um and does anything make this better? Like have you tried ice, say any topicals any positions that that helps with the pain?
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+P: I did try some like Advil last night, but like when I when the pain was coming on and it must've helped me sleep I guess, but I haven't tried any ice or anything like that, just mostly I guess resting. 
+
+D: OK so you said the pain is at the back of the neck does it radiate anywhere up into your head or down into your shoulders or lower or upper back? 
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+P: Uhm. Maybe a little bit to the upper back, like when I like trap, trapezius, muscle area, or the traps like it if I push on those muscles around that area, I do get a little bit of tenderness.
+
+D: OK, OK, and if you were to describe the quality of this pain, would you say it's sharp, dull, achy, throbbing? Uhm, how would you describe it?
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+P: I would say it's sharp. Yeah, especially if I do any movements like it'll be feels like I mean, it stabbed in the neck.
+
+D: OK, alright, and have you ever had it had pain like this in the past?
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+P: No, this is the first time. 
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+D: OK. And do you feel like it's getting worse, the pain since it started yesterday?
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+P: Yeah, it could be that at first I didn't even have any pain at all. Maybe it was just the adrenaline pumping or whatever, but now I can notice the pain. 
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+D: OK. OK, and 1 to 10, 10 being the worst pain you've ever felt how bad is this pain?
+
+P: It would be. I would say probably a 6 or a 7. 
+
+D: OK, OK and. Have you had any tingling or numbness?
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+P: No, I haven't had anything like that.
+
+D: OK, any dizziness or fainting spells?
+
+P: No. 
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+D: Confusion or memory loss?
+
+P: No. 
+
+D: Any headaches? 
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+P: Um I. No. 
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+D: No OK. And. Is this affecting your sleep at all?
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+P: Oh no, I guess like last night it was a little bit more difficult because I was just I slept I just on my back so that I wasn't moving around as much, so that was a little bit awkward, but I was able to sleep though.
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+D: OK, I know you said you have some pain with certain movements, but do you find it's hard to move your neck at all?
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+P: Oh, it feels a bit stiff, but like I'm able to move it. But yeah, I feel stiff.
+
+D: OK. Any issues with vision like is it blurry?
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+P: No. 
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+D: No, how about ringing in your ears?
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+P: No. 
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+D: No, any sorry yes that, any issues concentrating on on tasks?
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+P: Um. Yeah, this morning I I guess it's been a little bit more difficult to focus on things, but maybe I was just worried like focusing on the pain in my neck. 
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+D: Yeah, for sure. Any fevers or chills? 
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+P: No.
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+D: Any changes in your weight?
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+P: No, my weight it's been been the same.
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+D: Any changes to your hearing?
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+P: No, that's been been normal. 
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+D: Smell or taste?
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+P: That's been normal. 
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+D: Um chest pain or heart palpitations?
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+P: No, nothing like that.
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+D: OK. No cough, shortness or breath, shortness of breath or wheezing?
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+P: No, none of that.
+
+D: How about Issues with their bowel movements?
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+P: No, I haven't had any diarrhea or any any any constipation nothing like that.
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+D: OK, any nausea vomiting?
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+P: No nausea or vomiting.
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+D: Changes in your appetite?
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+P: Uh, no that my appetite's been good.
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+D: OK how about changes in urine?
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+P: No, I haven't had any any changes to or any urinary symptoms at all.
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+D: OK, OK, that's good. And are you otherwise healthy? Do you have any longstanding medical conditions?
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+P: Uhm. No, I am otherwise healthy, I just I'd take birth control, and I am a multi vitamin but that's it. So no medical conditions.
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+D: OK, alright that's good um. And have you had any hospitalizations or surgeries in the past? 
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+P: Uhm, no, I haven’t. 
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+D: No OK. How about medications? Are you on any?
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+P: Just the the the birth control that I'm I'm taking. I've been taking that for about five years now.
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+D: Five years OK, any side effects or any issues with that?
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+P: No, it's been good day I, I've been really happy with it overall too. They help regulate my cycles.
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+D: OK, OK, good. And then are you up to date with your immunizations?
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+P: I am yes, I'll get the flu shot every year.
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+D: OK, that's good. Do you have any allergies? 
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+P: I do, yeah, but it's I think they're just all environmental, 'cause I'll typically get issues with seasonal changes and then then it goes away.
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+D: Oh I see. OK, any family history of lung or heart conditions?
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+P: I think my dad has high blood pressure, and diabetes. Yeah, but no heart or or lung conditions.
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+D: OK, how about a musculoskeletal issues?
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+P: I think maybe osteoarthritis and my grandpa, grandparents, but. 
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+D: OK. 
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+P: But yeah.
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+D: How about an autoimmune conditions?
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+P: No, nothing like that. 
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+D: No? OK how about cancers.?
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+P: Uh, no cancers. 
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+D: OK. And then, do you smoke?
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+P: No, I don't. No I've never smoked before.
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+D: OK, how about marijuana? Do you consume that in any form?
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+P: No, I don't. 
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+D: OK. And then do you drink alcohol?
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+P: Every once in a while I'll have a glass of wine, but it's usually a social thing or or at Christmas. 
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+D: OK. Come have out in terms of sick Contacts. Have you had any recently?
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+P: I don't believe so. Um I've been going to work, I work as a bank teller, um but everybody at work hasn't been sick and we've been using masks and cleaning our hands and all of that sort of thing.
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+D: OK, OK, that's good. And how about travel? Have you had any recently?
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+P: No, I've been put at home, but looking forward to a vacation though.
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+D: Yeah for sure. And then, where do you work and who do you live with and where do you live?
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+P: Yes, I I work at a bank. And I live with my husband and our time and our son, he’s, he's six. 
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+D: OK, OK. OK, um those are all the questions I have for history. We can move on to the physical exam part of this interview. Did you have any questions before we did that? 
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+P: Uh, no, no, that sounds good. 
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+D: OK so if you have someone there with you, or if you have a mirror, or if there's any way you can take a look at the back of your neck as well as the front of your neck um. Do you see any redness or swelling in that area? 
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+P: No, I don’t. 
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+D: No, OK. Do you see any muscle atrophy? Any deformities or skin changes?
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+P: No, nothing like that.
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+D: OK. And then when you kind of just with the back of your hand, place it on your neck in the front as well as the back, does it feel warm at all? 
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+P: No. 
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+D: No OK. And then I'm gonna get you to palpate certain areas so we'll start with the chin. Does that hurt when you press down?
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+P: No. 
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+D: No OK, how about just where the thyroid would be?
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+P: No pain or yeah, no pain there.
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+D: No pain there OK. How about to the sides, kind of where your. Sternocleidomastoid muscles are?
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+P: Yeah, I think like a little bit of tenderness in the the front of the neck muscles there. 
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+D: OK and then how about when you move towards the back and then on your C spine, cervical spine just like at the very back of your neck?
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+P: Yeah, so there's there's no pain when I push on the like bones I can feel like so, actually on that that like C spine itself there's no pain, but like oh off to the side so on the muscles. To the sides or there's a bit of tenderness.
+
+D: OK, so kind of like where, so there's pain on their trapezius and deltoid muscles?
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+P: Uhm. Uh. Yeah, more trapezius not so not so much deltoid and then also, um, like the the perispinal muscles.
+
+D: OK, I see, alright. Uhm. OK, and then let's move on to some range of motion exam so I'm gonna get you to flex your neck. So look down at the ground all the way as much as you can. Does that hurt? 
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+P: It does, yeah.
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+D: It does but you're able to fully flex your neck.
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+P: Yeah, I can touch my chin to my chest all almost uh but yeah, I'll get pain at the back of my neck when I do that and the front.
+
+D: And the front? OK. And then how about when you extend your head all the way back so that you're looking at the ceiling?
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+P: I’m able to do it still is a bit stiff and it's slow to get there, but again I I get pain at the back in the front of my neck when I'm doing this.
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+D: OK, OK, how about when you flex your neck to the side so that your right ear is touching your right shoulder?
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+P: Um yeah, I get there's a little bit of a pain in the muscles on the left side when I'm doing that 
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+D: OK, and then how about when you do the opposite? Touch your left ear to your left shoulder so that you're laterally flexing your neck on the left side?
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+P: A little bit of pain there too, but I'm able to do it though. 
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+D: OK. So you're able to do all of these, it's just that you have some pain when you do that? 
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+P: Yeah, exactly, I could do all of the movements, but yeah, it's pain and stiffness.
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+D: OK, OK. Those are all the questions that I had for you. Did you have any questions of your own?
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+P: Uh no, that I just was wondering if I if you think I I don’t, needed an X Ray or like you think that anything is broken. Kind of like concerned about today, because of this pain.
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+D: Yeah. And for sure, um so right now it just to me it sounds like a whiplash injury and so kind of like low impact. But just to be certain, we can order an X Ray to rule out any fractures or dislocations. And in terms of like the management plan, for pain management you can rest, you can either apply heat or cold packs to your neck for 15 minutes every couple of hours or so. You can try some over the counter pain medications like Ibuprofen or Tylenol. And if it still doesn't get better, we can try like, we can try injections to the area to relieve some of that pain, but something else in conjunction we can try as physiotherapy and they'll basically help you with. Range of motion exercises and try to strengthen the muscles in that area and to improve your posture and normal movement. And that's kind of where we can start for now. And if it doesn't get any better, we can talk about alternative management plans, does that sound OK?
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+P: It does, yeah, that that makes sense. Thank you.
+
+D: OK, yeah, no worries.
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MSK0031.txt

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+D: How can I help you?
+
+P: Hi, I just was brought in here today. I had a fall just waking up coming down the stairs. I fell off the last few stairs and just fell onto the right side and on, right onto my head and now, uh I couldn't even I could barely stand up and put any weight on my hip. It's the right hip.
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+D: OK, Uhm, so what caused you to fall in the 1st place? Did you just lose balance, were you dizzy?
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+P: I think I just I missed, I wasn't dizzy or anything. I just missed one of the steps and just slipped, slipped down the stairs.
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+D: OK.
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+P: But it was just the last few stairs I didn't have like I didn't hit my head or anything like that.
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+D: OK, and when was this?
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+P: This was a so I guess now two hours ago.
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+D: Two hours ago, OK. Has a pain been constant since?
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+P: Yeah, it's, it's really excruciating.
+
+D: OK, does anything make it better or worse?
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+P: No, it's I'm just in extreme pain. Like I I I can't even put any weight on it.
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+D: OK, so you can't, OK so you can't weight bear, and you can't walk on on that leg I guess.
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+P: Mhmm.
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+D: OK. Is it a sharp kind of pain or is it dull and achy?
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+P: It's uh, it's pretty sharp, like if I'm not putting any weight on it right now, it's like really achy. But if I put any weight on, it's really sharp. 
+
+D: OK. And where is this pain exactly? Is it just in your right hip or is it radiating up into your upper anterior lower back or down to your leg?
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+P: It's in the right hip, mostly just on the side, but the pain is kind of like, all over the right side of my groin and I feel like there's some swelling there as well.
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+D: OK. And one to 10, 10 being the worst pain ever. How bad is your pain?
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+P: I would say 10, like I've never experienced pain like this.
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+D: 10, OK. And do you, have you ever had pain like this before? Like have you ever had a fall in the past?
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+P: No, this isn't this is the first time I've had a fall.
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+D: OK, any numbness or tingling?
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+P: Uhm, no, not that I can tell, no.
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+D: Dizziness or fainting spells?
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+P: Uhm, after the fall out like this, I I don't know if it's due to the pain, but even in the ambulance, coming out of the ambulance I was feeling a little bit dizzy, but I don't know if that's just 'cause of the pain. 
+
+D: OK, any headaches?
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+P: No. 
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+D: Confusion or memory loss?
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+P: No 
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+D: Uh, joint pains or muscle aches elsewhere?
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+P: No
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+D: Weight loss recently?
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+P: No.
+
+D: Fevers or chills?
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+P: Nope.
+
+D: Uhm, and rashes?
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+P: Uh no.
+
+D: Any changes to your vision, hearing, smell or taste?
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+P: No.
+
+D: Any, uh, you experiencing any cough, uhm, shortness of breath or wheezing?
+
+P: No. 
+
+D: OK, how about chest pain or heart palpitations?
+
+P: No, not that I have experienced. 
+
+D: OK, and how about changes your bowel movements?
+
+P: Nope.
+
+D: OK, how about changes to urine?
+
+P: No, nothing.
+
+D: OK. And. Are you otherwise healthy? Do you have any longstanding medical conditions?
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+P: Yeah, so I just have a, uhm I do have some osteoarthritis and then I have, I take this medication for blood pressure. It's called uh, Ramipril.
+
+D: OK. OK, and is that the only medication that you're on?
+
+P: Uh, yeah. And then I'm just on vitamins like vitamin D, calcium and just multivitamins.
+
+D: OK. And are you up to date with your immunizations?
+
+P: Yes.
+
+D: Yeah, OK. Any allergies?
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+P: Uh, no, not that I know of.
+
+D: OK. Any family history of lung or heart conditions?
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+P: Uhm, I think, uh my father, he died of a heart attack in his 60s.
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+D: OK, OK, any musculoskeletal issues?
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+P: Uhm, no, I don't think so. 
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+D: No. Uhm, how about autoimmune conditions?
+
+P: No, not that I know of.
+
+D: Any cancers?
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+P: Uh, I think, my, my mother had some skin cancer, but the ones that, she didn't need any surgery, they just zapped them off.
+
+D: OK. Uhm and do you smoke?
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+P: No, I've never smoked?
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+D: OK, uhm, do you drink alcohol?
+
+P: Just maybe like a wine, what every other day, a glass of of wine.
+
+D: OK, and then do you consume marijuana in any form? 
+
+P: No. 
+
+D: OK. And how about in terms of where you live? Who do you live with and where do you live? 
+
+P: I live with uhm, just my husband and and we just live in a small apartment.
+
+D: OK. And have you been in touch with any, anyone sick recently?
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+P: Uh. No, I've I've been like at home with my husband. We haven't really left. 
+
+D: OK. And have you done any travel recently? 
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+P: Uhm, no, I've just stayed at home.
+
+D: OK. Alright, so let's move on to the physical exam part of this interview. So if you can, I'm going to get you to take a look at both your hips as well as your legs. Do you notice any redness or swelling in the area?
+
+P: I do notice some swelling. It's a little bit red. I can't really see too much red.
+
+D: OK. OK. Any muscle atrophy? Any deformities or skin changes like bruises?
+
+P: Uh, maybe some bruising, but I, I don't notice anything else.
+
+D: OK. Alright. And then when you place the back of your hand on both hips, do you notice any temperature changes? Is one side warmer than the other?
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+P: It's a little bit warmer, the right side than the left.
+
+D: OK, and does one like appear to be shorter? Or does does it appear to be misaligned? Or in any sort of like strange positions like outward turning of your leg, one compared to the other?
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+P: I think it's a bit, but look at it a bit, like outward turning. And then yeah, I would say it's more outward turns.
+
+D: OK, and if are you sitting down right now?
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+P: Uh, yeah.
+
+D: OK, are you able to stand up from a sitting position?
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+P: I can try, but it's very painful.
+
+D: OK.
+
+P: Yes, should I go ahead and try?
+
+D: Yes please.
+
+P: Yeah. So I yeah I can barely stand up. I can't, it's kind of just, I'm just supporting myself with my left like.
+
+D: OK and so I, I guess you can't do any of the like hip flexion or hip extension, hip abduction or addduction, correct?
+
+P: No, I can barely move it.
+
+D: OK alright those are all the questions that I had. Did you have any questions of your own?
+
+P: No, I think I I just don't know if I need surgery or something.
+
+D: Yeah, so it sounds like you have a hip fracture from your fall. Uhm, so, the way to treat this is a combination of surgeries and rehab and medication. So we will definitely look into the surgical option first, which is done using some internal repair with screws. Or, you can do a total hip replacement or a partial hip replacement. The orthopaedic surgeon will uh, decide like which option is best for you after we refer you for a consult with them, and then after that surgery they'll likely refer you to some rehab, so physiotherapy will focus on improving your range of motion and strengthening the muscles in that area. Uhm, and for management of pain, you can take ibuprofen or any over the counter pain medications for now. Does that sound OK?
+
+P: Yeah, that sounds good. Thank you so much.
+
+D: OK, great, no problem.

MSK0032.txt

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+D: What brings you in?
+
+P: Um, hi, I'm here with my daughter. Uh, we noticed that uh, since yesterday she's been having this pain just in her elbow. Um, and like today, we've noticed right after she woke up, she's been in pain and also just keeping her elbow like protected, um, kind of like just flexing it and just holding on to it. So I think it's uh, giving her a lot of discomfort and she's been crying as well.
+
+D: Oh yeah, for sure. Um, when did this start?
+
+P: I think it started, uh, after we went for a walk last uh, evening. Um, and we just went to the park and since then like she's been having that pain. 
+
+D: Okay, okay, and did anything happen to trigger this? Did she fall on that arm? Or like, injuries?
+
+P: Um, I think like just uh, she was playing and then um, she was about to fall like right, like right on to the playground pavement. So I remember like, but like I caught her right away, so to protect her, and then since then, I don't know if like there was like a jerk movement as like I kind of pulled her back up, or um, when I was stopping her from falling, like if that caused it. But she didn't hit herself or anything like that.
+
+D: Okay. Alright, um, and in terms of the type of pain she's having right now, did she say if it was a dull, achy kind of pain, or is it sharp?
+
+P: She says it's aching a lot.
+
+D: Okay, and has it been constant since she um, started experiencing this? Or does it come and go?
+
+P: It's, it's been pretty constant since then and yeah, she just kind of keep, keeping, she's kind of keep, just keeping it like, her arms extended um, and then yeah, just holding on to it.
+
+D: Okay. Um, and then, is the pain just in the elbow, or does it radiate down into her hands or up to her shoulders?
+
+P: Um, it kind of goes into her upper arm, like from her elbows to her upper, upper arm.
+
+D: Okay, have you tried anything for this pain?
+
+P: Uh, no, I haven't tried any medications or anything. I just wanted to come in before I tried anything. 
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+D: Yeah, 1 to 10, 10 being the worst type of pain, how bad is this pain for her?
+
+P: I would say it's probably, at least a 7.
+
+D: Okay, and then um, has she ever experienced pain like this in the past? 
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+P: Um, no. This is the first time.
+
+D: Okay. Um, and then does she have any numbness or tingling in the area?
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+P: Um, no, not that I know of.
+
+D: Okay, how about memory loss or confusion?
+
+P: No. 
+
+D: Um, any headaches?
+
+P: Nope. 
+
+D: Um, dizziness or fainting spells?
+
+P: No. 
+
+D: Any weight loss recently?
+
+P: No.
+
+D: Fevers or chills?
+
+P: Nope. 
+
+D: Uh, rashes?
+
+P: Uh, no. 
+
+D: Uh, changes in vision, hearing, smell or taste?
+
+P: No.
+
+D: Uh, any coughing, shortness of breath, or wheezing?
+
+P: Um, no. 
+
+D: Uh, any chest pain or heart palpitations?
+
+P: No.
+
+D: Uh, any changes in bowel movements?
+
+P: Uh, no.
+
+D: Um, how about changes in urine?
+
+P: Um, no. No, no changes.
+
+D: Okay, and is she otherwise healthy? Does she have any longstanding medical conditions?
+
+P: She's been healthy so far, no concerns at all.
+
+D: Okay, and um, with her mother's pregnancy with her, were there any complications at that point?
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+P: Um, no, it was like a normal pregnancy, no complications. She was born at 39 weeks, like with vaginal delivery, didn't have to stay in the hospital or anything like that.
+
+D: Okay, and no issues as a neonate?
+
+P: Uh, no, she, we were able to bring her home pretty quick.
+
+D: Okay, that's good. Um, and then, she hasn't had any hospitalizations or surgery since then?
+
+P: No, no surgeries or hospitalizations.
+
+D: Alright, his she on any medications?
+
+P: No, no medications. 
+
+D: Okay, um, is she up-to-date with her immunizations?
+
+P: Yeah, we've had, we've got all the immunization.
+
+D: Okay, how about allergies? Does she have any?
+
+P: Um, no allergies.
+
+D: Okay, any uh, family history of musculoskeletal issues?
+
+P: Nope.
+
+D: Uh, lung or heart conditions?
+
+P: Nope.
+
+D: Um, autoimmune conditions?
+
+P: No.
+
+D: Cancers?
+
+P: Um, nope.
+
+D: Um, is she like on par with her peers in terms of developments and reaching milestones?
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+P: Uh, no, like she's been meeting, all her milestones have been on par with her siblings and other children. No concerns from the doctor whatsoever.
+
+D: Okay, and who does she live with at home?
+
+P: She lives with me, her, her dad, and um, we, she has two siblings, two older brothers.
+
+D: Okay, um, and does anyone at home smoke?
+
+P: Nope.
+
+D: Any concerns for her safety at home?
+
+P: No, like we're, like, no, I don't think so.
+
+D: No, okay. And how are things at school for her?
+
+P: Schools been well, like it's been difficult with the pandemic, but um, she's doing well.
+
+D: Okay, that's good. Has she come in contact with anyone sick recently?
+
+P: Um, no.
+
+D: Have you done any travel recently?
+
+P: Nope.
+
+D: Okay. Alright, and those are all the questions I had for history taking. Let's move on to the physical exam part of this interview. Um, I'm just going to get you to take a look at both her elbows and arms. Do you see any, um, redness or swelling in the right elbow compared to the left?
+
+P: No, I don't see that. No, I don't see any changes.
+
+D: Okay, how about um, any muscle atrophy, deformities, or skin changes, like bruises?
+
+P: Um, no, I don't see anything like that.
+
+D: Okay. How about, um, when you palpate her elbows, does, is she in pain? 
+
+P: Um, she doesn't really let me, but if I try to, I think that does cause her some pain. 
+
+D: Okay, how about when you palpate her like forearm muscles?
+
+P: Um, no, not as much.
+
+D: Okay, how about her biceps and triceps?
+
+P: Um, no, not really.
+
+D: No, okay. Um, alright, and those are all the questions that I kind of had for you. Did you have any questions of your own for myself?
+
+P: No, I just wanted to find out if she broke something, or like, yeah, I didn't know what was going on.
+
+D: Okay. Yeah, it seems like someone of her age and just the kind of history that you're giving me, it sounds like she has something called a radial head subluxation. Um, and that's usually caused in young children when they're like pulled or lifted by the hand or wrist while their arm is held straight, um, which can kind of pull the bone out of its socket a little bit. Um, so um, in terms of like a management plan, you can try conservative things like ice packs, um, over the counter painkillers. Um, otherwise, we can try to um, put the radius back into its normal position here, which will just take uh, like a few minutes. Um, and, and then after we reduce it back into its place, um, she should have normal function of her arm again. Um, if she's still experiencing pain, we can continue keeping it on a splint, um, but otherwise, I don't think we need any imaging for this at this um, at this time. So did you have any questions or any concerns about that?
+
+P: No, I think that's, um, that's a good plan.
+
+D: Okay, great. Um, thank you.
+
+P: Thank you.

MSK0033.txt

@@ -0,0 +1,151 @@
+D: What brings you in here today?
+
+P: I've been having this pain in my knee and it's been going on now for a few weeks. It's kind of right at the, I could feel it right below my kneecap and at first it it was really only bothering me after activity, but now it's starting to hurt during as well, and so it's, it's trying to limit my ability to play basketball.
+
+D: OK, and so you said this started just two weeks ago?
+
+P: Yeah, about about a few yeah few weeks ago. 
+
+D: OK, and has the pain so it's been getting a bit worse and with activity and it's right below your kneecap, is it the right way or the left leg?
+
+P: Yeah, it's on the right side. It's my right right side. Yeah.
+
+D: OK. And what kind of pain are you experiencing, is it kind of a sharp pain or is it a dull aching pain?
+
+P: It's, uh, it's pretty achy.
+
+D: Yeah, it take you. OK, and does the pain travel anywhere else or does it, it's just right below your kneecap?
+
+P: It's right below my kneecap, yeah I feel like it's just over a kind of a small area it's a pretty specific spot and if I press on that area at all it gives me a pretty, it's a sharp pain if I if I press on it sharp pain.
+
+D: OK. And on a scale of zero to 1010 being the worst pain you felt in your life, how much would you rank the rate this pain?
+
+P: I it's about about a six or seven.
+
+D: Six or seven OK. And is it a constant pain, or like do you get the pain when you're not playing basketball or doing other activities?
+
+P: Um I'll get it if I'm. Like sometimes I'll feel it if I'm going upstairs like walking upstairs or. Like if I'm sitting for a long, long time and I I get up, it'll feel a bit sore. But it's mostly if I'm like doing activities like running or jumping, doing like strenuous stuff like that.
+
+D: OK I see, an has this ever happened before?
+
+P: No, I haven't had any any issues with my knee before. 
+
+D: OK. And otherwise, are you having any other symptoms besides the pain, like any numbness, tingling?
+
+P: No, nothing like that. It's just the pain. 
+
+D: OK, and any weakness in your legs?
+
+P: Um no, no weakness.
+
+D: OK, and uh. Have you tried anything that improves the pain at all or anything that makes it worse? 
+
+P: Um I I have tried taking some like Tylenol and Advil and that or or and NSAIDs that and it has helped with the pain. I've tried icing it too, like after practice and stuff like that which does seem to help a little bit, but uh. Yeah, that's about it. 
+
+D: OK. OK, and other than that, did you like have a fall or did you have any injuries recently before you started having this pain?
+
+P: No, it's kind of come on on its own, no falls or like trauma to the knee. 
+
+D: OK. And other than that, are you healthy, do you have any medical conditions at all?
+
+P: Um, yeah, I don't have anything I am healthy.
+
+D: OK, any medications that you take on a regular basis?
+
+P: No, not not. Nothing. I don't take anything. 
+
+D: OK. Any allergies? 
+
+P: No allergies.
+
+D: OK, and have you been sick recently at all with fevers, chills, any cold or viral symptoms?
+
+P: No, I haven't had anything like that. I've been feeling well. 
+
+D: OK, uhm. Any changes in your skin, like any rashes?
+
+P: No, I haven't had any any rashes.
+
+D: OK, and any kind of shortness of breath, chest pain?
+
+P: Nope, nothing like that.
+
+D: OK. And any changes in your bowel movements or urinary patterns?
+
+P: No, I haven't had any changes there. 
+
+D: OK, OK. And do you have any recent or like past history of any hospitalizations or surgeries?
+
+P: No, I I haven't had anything like that.
+
+D: OK, and any family history of any musculoskeletal conditions or any anything that runs in the family?
+
+P: No, not nothing like that, no. 
+
+D: OK, OK. And currently right now. Do you do you go to school or do you work at all?
+
+P: Yeah, I go to school. And, uh, I play on the, uh soccer team and the basketball team. It's basketball season right now. And, uh, in grade 10.
+
+D: OK in grade 10 OK. And school going well, any issues at all with bullying or anything like that?
+
+P: No school's been been going well. I have been doing well in my courses and have a good group of friends so I enjoy it. It's fun.
+
+D: OK. And what's your home situation like, do you, who do you live with?
+
+P: So I live with both of my parents and I have a a younger sister as well. She's in grade grade 7 and we have a dog as well.
+
+D: OK, and do you generally feel safe at home as well as outside of your home environment?
+
+P: I do, yeah my I get along well with my parents and we. Yeah, but my parents are great.
+
+D: That's good and and this is just wanted to let you know that anything that you talk about in here with us stays confidential and won't leave this room unless there is potential harm to yourself or others. So have you tried any recreational drugs like marijuana, have you tried smoking or alcohol at all?
+
+P: No, I've been trying. I stay away from that, that sort of thing. I've I know about other people in my class who have and stuff, but I always just, I'm just trying to stay as ready as I can for the sports.
+
+D: OK, that's good. And yeah, so and are you up to date with all your immunizations?
+
+P: Yeah yeah, my mom made sure that I got all of that stuff done. 
+
+D: OK. Alright, so yeah, those are some questions I had. I just have a few more questions with regards to just examining your knee. Are you able to walk or do you have any kind of a limp?
+
+P: No limp I can. I can walk OK.
+
+D: OK and are you able to run?
+
+P: Yeah I can. I can run, but when I do it it causes some pain. I'm able to still run but yeah it it hurts.
+
+D: OK and. So when you palpate your lower knee just under the patella, you said it's a sharp pain, right?
+
+P: Yeah exactly and then when I it's, and it feels kind of achey or when when, like after practice or something like that, but if you press on it it it's sharp.
+
+D: And, uh. Any any kind of like are you able to flex and extend your knee right now if you tried?
+
+P: I can yeah.
+
+D:  OK and have you noticed any kind of rotation of your knee at all?
+
+P: No, nothing like that. 
+
+D: No OK. OK, and no weakness below your knee, right?
+
+P: No weakness. I just feel like my muscles are really tight like my fly and my hamstring muscles. Think I need to stretch them out some more, they do just feel tight.
+
+D: OK, and do you notice any kind of swelling or redness or bruising in the area?
+
+P: No.
+
+D:  no OK, and your ankle and hips you don't have any pain or issues with movement, right?
+
+P: No, not at all. No, no problems with my ankle or hip.
+
+D: OK alright yeah. So those are just all the questions I had for you today. Do you have any questions?
+
+P: I was just wondering what I can do to make this go away.
+
+D: Yeah, so definitely this is something that is what we call Jumpers knee. It's fairly common, uh, amongst younger athletes, especially those that play sports like volleyball or basketball. But right now we don't really need to do any kind of imaging or anything like that. It seems like you're in the earlier phases and it's good that you came in. We definitely do need to manage it with some conservative management where we're going to keep having taking a look at it as well as I would recommend icing it every, like for half an hour, like around four to six times a day, especially after you're doing your activities. Then you can you can take the, continue taking the Tylenol and Advil, as well. As long as you're following the maximum amount per day depending on if you're taking extra strength Tylenol for example versus the regular strength. And then I will also refer you to some physiotherapy that will kind of a teach you some strengthening and stretching exercises that you can do to help what we call like that you will you might be having is just um some inflammation in your patellar tendon, right below your patella. So we need to strengthen the muscles around it. So we'll do some referral to physiotherapy and then we'll see how you you do based on all those treatment options and then if it gets worse and if or if it doesn't get better, we might need to do some imaging, either ultrasound or an MRI and then see where to go from there. But for now does that sound OK with you?
+
+P: It does, yeah, thank you. So you said that you think it's like a patellar tendonitis or something like that?
+
+D: Yeah, it's patellar tendonitis is commonly called the jumpers knee and it should resolve with the steps that we, especially since it seems like you're in the earlier stages. So it seems like it should be pretty responsive, but if it isn't, there are other steps we can discuss in the future.
+
+P: OK, that sounds great. Thank you.

MSK0034.txt

@@ -0,0 +1,214 @@
+
+D: What brings you here today?
+
+P: Yeah, I'm so I'm here with my mom because I am having this pain in my right hip and groin area. Um I was playing with my friends too. Maybe yeah, yesterday and I fell down. I didn't fall down hard, but I had a small fall and since then my hip has been hurting and it's painful for me to bear any weight on my right leg.
+
+D: OK, and did you have this pain at all before your fall or is this something that just started after the fall?
+
+P: It just started after.
+
+D: OK and when did you have the fall?
+
+P: Yesterday.
+
+D: OK and can you describe what you were doing and from how high did you fall and if like on what surface you fell on?
+
+P: Sure um we were playing soccer on like a field and I and I just fell on the grass, like it was a flat surface.
+
+D: OK, and so did you say it was the right hip that's giving you pain?
+
+P: Yes, that's right.
+
+D: OK, did you fall on the right hip?
+
+P: I did.
+
+D: OK an after you fell were you able to um weight bear like get up, get back up on your feet or was it difficult?
+
+P: It was difficult an I'm still limping.
+
+D: OK and you're still limping on. Have you noticed, so any pain anywhere else, or is it just your hip?
+
+P: Um just my hip.
+
+D: OK and where exactly is your pain on the hip?
+
+P: It's like on the side of my hip as well as like in the groin area.
+
+D: OK I see, and what kind of pain are you experiencing, is it a sharp pain or is it a dull aching pain? 
+
+P: It's pretty sharp.
+
+D: It's sharp OK. And do you experience any other symptoms, like any dizziness or fainting spells?
+
+P: No.
+
+D: And are you able to move your hip at all, like are you able to flex it, or extend it, rotate it? 
+
+P: I can move it, but it comes with a lot of pain.
+
+D: OK, and do you find that your hip is at all rotated outwards?
+
+P: Yeah, it looks um. Yeah, it looks like it is. 
+
+D: OK. Alright, have you taken any medications for your pain?
+
+P: I just took some ibuprofen.
+
+D: OK. And. Other than that, have you recently been sick at all?
+
+P: No, I haven't. 
+
+D: OK, and on a scale of zero to 10, 10 being the worst pain you've found in your life, how much would you rate this?
+
+P: How would say like an 8.
+
+D: An eight, and as the pain travel anywhere, to other parts of your body?
+
+P: No, just stays in that area.
+
+D: OK, any numbness or tingling?
+
+P: No.
+
+D: No OK. Any fevers or chills?
+
+P: Um noo.
+
+D: Any skin changes?
+
+P: No.
+
+D: So no swelling redness or anything like that? 
+
+P: Uhm no it doesn't seem to be red. Maybe some slight swelling.
+
+D: OK.
+
+P: Uhm yeah.
+
+D: OK, any shortness of breath, chest pain?
+
+P: No.
+
+D: OK, any pain in any other joints? 
+
+P: No. 
+
+D: OK. Do you feel any weakness in your upper legs or lower legs at all?
+
+P: No, not that I can tell no. 
+
+D: OK. And do you have any past medical conditions that you've been diagnosed with?
+
+P: No, I've been pretty healthy otherwise.
+
+D: OK, and you take any medications on a daily basis?
+
+P: Uh no.
+
+D: OK, any allergies that you know of?
+
+P: No.
+
+D: OK. Are all your immunizations up to date?
+
+P: Yep, they should be.
+
+D: OK and have you ever been hospitalized or had any surgeries in the past?
+
+P: No.
+
+D: No OK. And yeah, I'll just ask you as well as your mother during the time she was pregnant with you, did you have any kind of complications during pregnancy at all?
+
+P: Um no, no complications 
+
+D: OK and when when you were born any complications after birth, any stay in the hospital for any reason?
+
+P: No.
+
+D: And was it a vaginal delivery or a c-section?
+
+P: It was a vaginal delivery.
+
+D: OK and was there the use of any kind of instruments like forceps or vacuum for any reason? 
+
+P: No.
+
+D: No OK. So it was like a fairly normal pregnancy and were you at term or premature?
+
+P: At term.
+
+D: Alright, and any complications difficulties while you were growing up at all with your growth like height or weight, or any kind of developmental issues that you know? 
+
+P: No, um I hit all my milestones and otherwise, doing pretty well on par with my peers in terms of milestones.
+
+D: OK, and schools going well?
+
+P: Yeah, schools going well. 
+
+D: OK. And in terms of your family history, any musculoskeletal or rheumatologic conditions?
+
+P: Uhm no, nothing like that in my family.
+
+D: OK, and currently right now, who do you live with?
+
+P: I live with both my parents as well as my 7 year old sister.
+
+D: OK Alright. And yeah, if I can, just, uh, is it OK if I just talk to you alone for a little bit? 
+
+P: Sure, yeah.
+
+D: Alright, yeah, so anything that we talked about here today will stay confidential as long as there is no harm to yourself or others or risk of harm to yourself or others. So yeah, I'm just going to ask you a few questions pertaining to your health.
+
+P: Sure, that sounds good.
+
+D: Yeah, so at home, do you find that you're in a safe environment even outside of your home in your neighborhood do you feel safe?
+
+P: I do.
+
+D: OK and how about at school, do you feel safe? Have you experienced any kind of bullying or anything like that? 
+
+P: No.
+
+D: OK. Have you tried any alcohol, recrea' recreational drugs or cigarettes or do you know any friends that have tried?
+
+P: I know, I know, older kids that have tried in the school, but we haven't. 
+
+D: OK, and are you sexually active?
+
+P: No.
+
+D: No OK alright yeah so those are just a few questions I had I'll call your mom back in. OK, so yeah, we're just gonna try and do a couple of examinations. So are you able to stand up by yourself?
+
+P: Um I can, but I need a lot of assistance like I have to hold on to the desk or have a crutch or something like that.
+
+D: OK, uh, no worries and then while laying down, are you able to lift your right leg with your knees straight?
+
+P: I don't know about straightening my knees. My leg seems to have permanently turned outward and look shorter than my other leg.
+
+D: OK and yeah, I forgot to ask you this earlier. I don't I don't think we weighed you when you were coming in, but approximately how much would you say you weigh?
+
+P: I weigh about um 130 pounds.
+
+D: OK, and do you know how tall you are?
+
+P: Uhm I'm about 4'8".
+
+D: OK. OK, alright, so yeah those were just some of the questions I had today we'll do a full physical examination and have you come in. Alright, sorry and like well will continue with the full examination today and what currently it seems like it can definitely be from the fall. You may have injured yourself and we just want to make sure there's no fractures like a hip fracture. 
+
+P: OK.
+
+D: One thing that's also something that we have to investigate is something called slipped capital femoral epiphysis. So this is, this is a common hip issue in adolescents, especially from boys aged 10 to 16. And usually it's the left hip that's affected, but it it can be the right. And as adolescents are in a phase where they were growing, there is, if they have some predisposed disposition too slipping of the capital femoral if epiphysis, which is right between your hips, you can get some slipping. It can be after a fall or it can happen just as the child is growing, and it can also it is also associated with the increasing weight that a child may have. So what we can do is just get first an X-Ray of both the hips. 
+
+P: OK.
+
+D: And see like what we can find on the X-Ray and then will also do a full examination. And it, if it does turn out that there is a fracture or there's a slipped capital femoral epiphysis we will need to send out a referral to pediatric orthopedic surgery.
+
+P: OK.
+
+D: Yeah, so yeah, first we'll just get the image Ng done and see what's going on in there and then we'll get back to you shortly.
+
+P: OK, that sounds great. Thank you so much.
+
+D: Welcome. Take care. 

MSK0035.txt

@@ -0,0 +1,259 @@
+D: How may I help you?
+
+P: I'm so I was skiing yesterday and I fell on my arm and now and it's it's my hands very painful and it looks swollen and bruised. So I thought I should come in and get it checked out.
+
+D: Yeah, certainly alright and so you fell while while you're skiing, so did you use your hand to brace the fall, like with your hand kind of with your wrist extended backwards?
+
+P: Yea. Yeah, so I kind of yeah had my arm stretched out and I fell right on it.
+
+D: OK, and did you feel pain right away?
+
+P: Yes.
+
+D: OK, um, and during the fall did you injure any other parts of your body like your elbow or shoulder or even your head?
+
+P: No, I don't think so. I didn't have, I don't have any pain anywhere else.
+
+D: OK. Uhm and like are you able to move your wrist currently?
+
+P: I can, but it's very painful.
+
+D: OK, and so when did this happen, was it yesterday?
+
+P: Ah yes, it was yesterday.
+
+D: OK, and how would you describe the pain, is it's a sharp pain, dull pain, achy?
+
+P: It's pretty sharp.
+
+D: Sharp, OK and are you feeling the pain radiate anywhere else like down into your hand or up into your arm?
+
+P: Uhm no it's pretty local the pain. Yeah, it's pretty, it's right below the thumb area and just kind of on my wrist an on the right side.
+
+D: OK. Is there anything you've done that's made it that made it better? Like, have you tried any medications or any ice or topical creams?
+
+P: I've been taking ibuprofen for the pain and try not to move it too much and that's been helping a little bit.
+
+D: OK. And is the pain constant or intermittent? 
+
+P: It's constant. 
+
+D: OK. And, have you done anything that's that's made the pain worse?
+
+P: Um, I guess moving it. 
+
+D: OK. And what is the severity of the pain on a scale of 1 to 10, with 10 being the worst pain you've ever felt?
+
+P: I give it like a five or six.
+
+D: OK, have you had an injury like this to your wrist or your hand before?
+
+P: No.
+
+D: Alright, and are you having any neurological symptoms, such as numbness, tingling, or or sensory loss over any areas? 
+
+P: No.
+
+D: OK, and how about muscle weakness?
+
+P: No. 
+
+D: Alright. And so have you been having any fevers or chills? 
+
+P: Nothing like that.
+
+D: Um have you been having any headaches?
+
+P: No. 
+
+D: How about any sensory changes like changes to your vision or hearing or loss of smell or loss of taste?
+
+P: No, nothing like that.
+
+D: OK, have you had a runny nose or or felt congested?
+
+P: No.
+
+D: Have you had a sore throat or a cough?
+
+P: No.
+
+D: Have you had any shortness of breath or wheezing? 
+
+P: No.
+
+D: Have you had any chest pain? 
+
+P: No.
+
+D: Have you had any heart palpitations or feeling like your heart's racing? 
+
+P: Uh nope.
+
+D: Have you had any dizziness or fainting?
+
+P: No. 
+
+D: OK yeah, and so did you lose consciousness at all during the fall?
+
+P: No.
+
+D: OK. And and have you had any nausea or vomiting?
+
+P: No.
+
+D: Any abdominal pain?
+
+P: No.
+
+D: Any changes to your bowel habits like diarrhea, constipation or blood in the stool?
+
+P: Uhm nope.
+
+D: OK. And how about any urinary problems like pain or frequency?
+
+P: Uh no nothing like that.
+
+D: Alright and, have you had any muscle aches or body pains or like any other musculoskeletal pains besides the wrist?
+
+P: No.
+
+D: OK. And have you had any appetite loss or or fatigue?
+
+P: No. 
+
+D: Alright, and have you had any night sweats?
+
+P: No.
+
+D: and have you had any unexpected weight loss over the last several months? 
+
+P: Uhm no.
+
+D: OK. And have you been diagnosed with any medical conditions in the past or do you see a physician regularly for any reason? 
+
+P: Uh no.
+
+D: OK, so uh, do you take any medications, regularly prescribed or over the counter?
+
+P: Uh nope.
+
+D: Alright, and have you had any hospitalizations or surgeries in the past?
+
+P: No. 
+
+D: OK. And you have any allergies?
+
+P: No.
+
+D: Alright and are your immunizations up to date? 
+
+P: Um I think so, I think I just need to get the Gardasil.
+
+D: OK. Have you gotten like the first dose of that yet, or are you still still waiting to get that?
+
+P: I'm still waiting to get that.
+
+D: OK. And could you tell me just a little bit about your living situation currently like who you're living with and and whereabouts?
+
+P: I live by myself in an apartment downtown.
+
+D: OK, I'm an are you in school or are you working right now?
+
+P: I'm in school.
+
+D: OK, and have you been around anybody who's been sick? 
+
+P: Uh no, no one's been sick around me. I haven't really been leaving my home.
+
+D: I see OK. And have you traveled anywhere recently?
+
+P: Uh nope.
+
+D: Alright. And just staying active, which is good. Do you do any other activities besides the skiing? 
+
+P: I do, I like I go snowboarding in the winter, I go camping, I like playing tennis, and volleyball.
+
+D: OK cool yeah it sounds fun. And like do you smoke cigarettes? 
+
+P: No I don't.
+
+D: OK, uh, do you drink alcohol?
+
+P: I'll have a beer once in awhile.
+
+D: OK, how often is once in awhile, like how many drinks per week?
+
+P: Oh. Not that many, I'll maybe have like 2 every other week.
+
+D: I see OK and you use cannabis or or any cannabis products?
+
+P: I'll take an edible once in awhile as well, like maybe once a month.
+
+D: OK, and how about the use of any other recreational drugs?
+
+P: No. 
+
+D: Alright, and in the family, are there any history of neurological or musculoskeletal problems?
+
+P: No.
+
+D: How about any autoimmune conditions such as hypothyroidism?
+
+P: No.
+
+D: OK so next I will ask you to just have a look at the wrist for the physical exam portion. Are you seeing any swelling or redness?
+
+P: Uhm no, I don't see anything like that.
+
+D: OK, and if you touch the joints around the wrist on both sides, is the right wrist, does it feel hot? 
+
+P: No, actually. Yes it does.
+
+D: OK. Alright, and but there's no swelling there.
+
+P Uhm. There's maybe a little bit of swelling compared to my left.
+
+D: OK, and are you noticing any muscle atrophy or or any deformity at the wrist?
+
+P: Uh, I guess there's like a slight bruise.
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+D: OK, and are there any like raised bumps if you put your finger over it over the bony edges?
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+P: Uhm no bumps but just a general kind of swelling in the area that makes it look raised.
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+D: Alright, and and if you palpate or press on some areas of the wrist are there any areas that you're feeling pain like at the distal radial head, the distal ulna, uh or any areas of the wrist?
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+P: Uhm there's some pain at the distal radius for sure.
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+D: OK, uh, alright and is this on the back of the hand or the that the palm side.
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+P: It's on the palm side.
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+D: OK. Do you feel any pain if you push in the what's called the anatomical stuff box, so it's at the base of the thumb um on yeah, the base of the thumb on the back of your hand?
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+P: Base of the thumb, um no, I don't feel any pain there.
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+D: OK. And. OK, so no pain at the the dorsal anatomical snuffbox and in terms of range of motion are you able to flex and extend your wrist?
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+P: I am.
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+D: OK and then how about move it like side to side, kind of deviating it?
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+P: Uhm I can do all of these things, it just hurts a lot.
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+D: OK, are you able to make a fist?
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+P: Yes.
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+D: Alright, and do you have any problems at the elbow or are you able to flex and extend the elbow OK?
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+P: I can flex and extend OK.
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+D: OK, so I think that was everything that I wanted to check today. Did you have any questions or concerns?
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+P: Uhm no, just do I need any sort of surgery for this, and do I need an X Ray? How do I go about trying to treat this?
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+D: Yeah, so I think I it, X-Ray would be the first step here because from what you're describing, and particularly with the mechanism of the injury and where you're feeling pain can be a common cause of a distal radial radial fracture which is one of the forearm bones. And so yeah, we will need an X-Ray to look to see if there is a distal radial fracture. And it's not sounding like this right now, but another thing that will look for on on the X Ray of the hands too is a scaphoid fracture to make sure that that's OK, but you didn't have any pain in the area of the scaphoid, which is reassuring, but we still want to image and make sure, although that most likely thing would be the distal radial fracture an if that's the case, then there will be like we will have to go into a cast for a period of time. And depending on how much joint involvement there is, there might be the possibility of surgery, but cannot comment too much on on that just yet. We will need to get the imaging first.
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+P: OK, OK, that sounds good. Thank you.