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MSK0015.txt

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+
+D: How may I help you?
+
+P: Yeah, so I'm I'm George, the father, my daughter is 5 years old and I noticed just a few days ago that she was walking a little bit funny and kind of having a limp when she came back from school. And since since that then, she's been saying that it just hurts too much to put any weight on on that leg, on the right leg. And since then I've been like carrying her around. It's been very painful for her. So I just wanted to come in and check what might be going on. 
+
+D: OK and so so. And this, when did this exactly start?
+
+P: So just two days ago.
+
+D: OK, an um did she have any trauma to her right hip or or to hurt your right leg like a fall or any injuries? 
+
+P: Sorry um no. Not that I know of at least and she hasn't told me anything like that. She does do some activities, some sports, but I haven't seen her fall anywhere.
+
+D: OK. Um. Alright, and uh, has she has she not not been able to walk then?
+
+P: Yeah, so I've I've been carrying around for at least like she's missed school too, but been carrying her around for the last 1 1/2 to two days. As soon as I had like ask her to walk she starts kind of a hopping and saying that there's a lot of pain near the top of her leg and by your hips whenever she puts her foot like a foot down. So yeah, she's in pain crying, so I kind of have to carry her.
+
+D: OK. And, uh, how has her behaviour been recently like her mood and things like that?
+
+P: She's definitely been more just, a bit anxious about the pain. Very scared about putting her foot down and just overall, I think also more irritable crying more because of the pain so but I I guess I understand if there's something going on it must be very painful.
+
+D: OK, and. Alright, has she had any fevers or chills?
+
+P: Uhm I. Did notice a couple of days ago she felt a bit warm but we didn't really measure her temperature. Over the last few weeks, though, she has had a. Kind of a runny nose and a cough and I think she might have had a fever last week as well so she has been sick recently.
+
+D: OK, so it sounds like she might have had a cold last week and did like the runny nose and cough go away?
+
+P: Yeah, the runny nose and cough are gone. Fever was gone too, but she did feel a little bit warm yesterday so I'm not sure about that.
+
+D: OK, so she's at a a bit warm now still OK. 
+
+P: Yup.
+
+D: Has she had any any headaches?
+
+P: No, no headaches.
+
+D: Any sensory changes like things to her vision or hearing or taste or smell?
+
+P: No. 
+
+D: OK. Any um sore throat or cough?
+
+P: No.
+
+D: Alright, any shortness of breath?
+
+P: No.
+
+D: Any chest pain?
+
+P: No.
+
+D: Has she had a loss of appetite?
+
+P: No.
+
+D: OK, and has she had any unexpected weight loss?
+
+P: Oh no, nothing like that. 
+
+D: Any night sweats?
+
+P: No. 
+
+D: Any nausea or vomiting?
+
+P: No.
+
+D: Any abdominal pain?
+
+P: No abdominal pain. 
+
+D: OK, any diarrhea or constipation or blood in the stool?
+
+P: No, nothing like that.
+
+D: Alright, and any problems with urination like pain or frequency?
+
+P: No, not that she's mentioned, no.
+
+D: OK. And any skin rashes or changes?
+
+P: No.
+
+D: OK, and any muscle aches or body pains or any other pains anywhere else?
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+P: No, it's mainly just her upper right leg and hip.
+
+D: OK, I have she had any numbness or tingling?
+
+P: No, not that she's mentioned no.
+
+D: OK and and, how about a muscle weakness?
+
+P: No. 
+
+D: No OK. And any confusion or or memory loss?
+
+P: Um no.
+
+D: OK, I'm and in the past has she been diagnosed with any medical conditions?
+
+P: She did have this condition with her hips. Dysplasia, like developmental dysplasia of the hip. So when she was born she she was getting like this clicking noise and her, in her hips and so she was in this splint for probably almost two months at the start, like after she was born.
+
+D: OK, and did her hips, did like was she able to walk afterwards?
+
+P: Yeah, yeah. And we were seeing a specialist, an orthopedic surgeon and they were managing her and after one year they stopped following her. She was well like she was walking, no issues.
+
+D: OK, so she's walking around one year. 
+
+P: Mmm
+
+D: Have you had any other concerns about her, either social or physical development?
+
+P: No, she's been really great. She's good with people, she's has great social skills. She has grown well, met all her milestones, she's doing really well at school and gets along well with her peers as well.
+
+D: OK, excellent. And were there any concerns throughout pregnancy, such as gestational diabetes or hypertension or any exposures to infections?
+
+P: No, her mom's pregnancy was perfectly normal. She was born, like she was delivered vaginally at 39 weeks. She was breech at that time, which the doctor said might have to do with her clicking hips. But yeah, but since then or during pregnancy, no other complications.
+
+D: OK, that's great. And. Uh, in regards to, you mentioned her hurt hip any other past medical history?
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+P: Um no other than that she's been healthy.
+
+D: OK, and does she take any medications regularly over the counter or prescribed?
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+P: No no, no medications.
+
+D: OK, any allergies to medications?
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+P: No, not that I know.
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+D: And sorry has she taking anything for the, the pain?
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+P: No, I haven't really given her anything, I didn't know what to give.
+
+D: OK all right, we'll talk more about that. Has she had any prior surgeries or hospitalizations?
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+P: No.
+
+D: Can you tell me about who she's living with and whereabouts she's living?
+
+P: Yeah, so she's currently living at home with me, my wife, and she has an older brother. We live in a small house just near near the city.
+
+D: OK, and what do you guys do for work?
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+P: Yeah, so I'm a lawyer and my wife is a music teacher.
+
+D: OK, is there anybody who smokes in the home?
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+P: No, none of us smoke.
+
+D: OK um, OK, And any family history of heart or lung conditions?
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+P: Uhm, no, no family history our family is pretty healthy.
+
+D: OK, how about any family history of any autoimmune conditions such as hypothyroidism?
+
+P: No nothing like that.
+
+D: OK. And then any musculoskeletal or neurological conditions in the family?
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+P: No. 
+
+D: OK, so next on um just the exam. Um when you're looking at the right hip are you seeing any swelling, redness?
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+P: Uh, no, not that I see anything.
+
+D: No OK, and is there any like muscle atrophy around the hip?
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+P: No, not that I see at all. 
+
+D: OK and then is there any misalignment or deformity of the joints that you can see?
+
+P: No, I can't. Yeah, I don't see anything in the hips or legs that really points out to me.
+
+D: OK um and is there any pain to palpation over the hip or or knee?
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+P: Uh, if I if I press on it, I don't think she's in that much pain. It's mainly just when she's trying to walk or put put weight on it.
+
+D: OK, and is she able to move the hip in a full range of motion of like flexion, and extension, abduction, adduction?
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+P: Uhm, so she does. She is able to move it if she really tries. But it's mainly just the putting her weight on it and anytime she puts her weight on it is is when it really hurts.
+
+D: OK, so more about the weight on it, and is she able to move that her knee with a full range of motion? 
+
+P: Yeah.
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+D: OK, and any any muscle weakness when testing around the joint?
+
+P: No. 
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+D: No, OK. So I think that was everything that I wanted to ask on history and check was there anything I maybe forgot about you thought would be more important today,
+
+
+P: No I think that's all just just was wondering what might be going on?
+
+D: Yeah, certainly, so a couple of things that it could be. One is that it can be common in this age group is something called transient synovitis. Where, which can happen in the hip where there's some inflammation and it causes some pain following a viral infection. And it sounds like she had a viral infection last week with the cough, fever and and runny nose and her. She was feeling a bit warm and maybe feverish today as well, which could be a sign with the lower kind of slightly elevated temperature, pointing towards transient synovitis, which is a condition that will be self limiting and can use anti- inflammatories to help with the pain such as ibuprofen, but also something that would be important to rule out would be is septic arthritis because it could could lead to damage of the joint, but this will be lower on the differential and then finally something to consider is Legg-Calve-Perthes disease. And, but this would be more of progressive  onset, but if she's not getting any better and or if she becomes more sick like develops a really high fever or a red hot swollen joint, then we'd be thinking more along the lines of septic arthritis and we want to reassess.
+
+P: OK, sounds good. Thank you so much.
+

MSK0016.txt

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+D: What brings you in?
+
+P: I've um I've been having this numbness and tingling and I guess kind of burning sensation that well uh it's been happening more often in my uh left hand.
+
+D: On your left hand, OK. And sorry when did you say this started?
+
+P: Uh it's been going on for probably four or five months um.
+
+D: OK.
+
+P: Yeah, it first uh it would only bug me for a couple of minutes at a time and I could kind of shake my hand out, like flick like flick my wrist and um and it would go away after a few minutes. But now I'm starting to get uh like symptoms at night sometimes as well.
+
+D: OK, so um it's gotten worse then, you said over the past few weeks?
+
+P: Yeah it has. 
+
+D: OK um and is it always there? Is it persistent or does it come and go?
+
+P: It comes and goes.
+
+D: OK and what makes it better or worse?
+
+P: Uh better uh I've tried some um Advil um and Tylenol and it's kind of the, hasn't done much um for the pain really, uh I think only the thing that kind of helps it is just not using it as much, um yeah. 
+
+D: Yeah, alright, um have you tried any like cold compresses, um topical creams? Anything like that?
+
+P: No.
+
+D: No, OK. And uhm if you were to describe the quality of how it feels like, does it does it, is it painful, is it tender, or is it just numb and tingling, kind of like when your foot goes to sleep?
+
+P: Uh I guess I have, it is a bit painful as well, yeah. I have um like a burning kind of pain.
+
+D: OK and 1 to 10, 10 being the worst pain ever, how bad is this pain?
+
+P: Uh when it gets to its worst, I would say about a 6.
+
+D: OK, OK. Um and have you ever experienced this before or is this kind of like the first time you're experiencing this?
+
+P: Yeah, this is the first uh really like over these last three months, the first time I've been experiencing it, I think uh the first time that it started it started to wake me up at night though has been like about a couple of weeks ago.
+
+D: Oh I see, OK. Um alright and do you feel like your symptoms are getting worse over the past few weeks or is it kind of the same?
+
+P: Uh over these past couple of weeks, about the same. It's woken me up uh like two or three times at night.
+
+D: OK, alright and do you have any numbness or tingling elsewhere on your body?
+
+P: No, it's just um just kind of the the outside of my hand here, it's really only the first like 3 fingers.
+
+D: OK, first three fingers so your um thumb, index finger and uh middle finger? Or your pinky to middle finger?
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+P: Yeah, it's just the uh my thumb index finger and ring finger.
+
+D: And ring finger, OK.
+
+P: And maybe just like a little bit of the um like of the ring finger too, but not all of it.
+
+D: OK, um alright, so um any weakness in your arms or do you feel like you can still use your arms OK?
+
+P: Uh yeah I haven't had any, uh, any muscle um weakness, I guess I may be a bit more clumsy um with uh with my left hand like I've dropped a few things, I've had it, a little bit more difficult time like opening jars or like car doors and stuff like that.
+
+D: OK, OK, and any confusion or memory loss?
+
+P: No.
+
+D: Headaches?
+
+P: No.
+
+D: OK, um how about weight loss?
+
+P: No, I haven't had any weight loss.
+
+D: Uh fevers or chills?
+
+P: No.
+
+D: Uh rashes? 
+
+P: No rashes.
+
+D: Changes in your vision, hearing, smell or taste?
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+P: No, that's been normal.
+
+D: OK, how about um a cough?
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+P: Uh no, I haven't had a cough.
+
+D: OK, um wheezing or shortness of breath?
+
+P: Nope, neither of those.
+
+D: OK. Chest pain or heart palpitations?
+
+P: Um nope, I haven't had that. 
+
+D: OK, how about um changes in your bowel movements?
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+P: Uh nope, I haven't had any diarrhea and no no constipation and no blood either.
+
+D: OK, good. Any nausea or vomiting?
+
+P: No I haven't had any of that.
+
+D: OK, any changes in your voiding? 
+
+P: Uh, no I I um haven't had any problems with urination.
+
+D: OK, um are you otherwise healthy? Do you have any longstanding medical conditions?
+
+P: Um I have hypothyroidism, so I take um like uh thyroxine for that and um I am overweight as well, or in obesity class one I think.
+
+D: OK, and um do you take any medications for the hypothyroid? 
+
+P: Yeah I do, I take um I take uh Synthroid, I think.
+
+D: OK, alright, and are you on any weight loss medications?
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+P: No, I've just been trying to uh change diet around when I can and um and trying to um exercise a bit more, but uh it's been it's been tough, especially now with my wrist or my hand bugging me.
+
+D: Yeah, for sure. Um alright, and then are you up to date with your immunizations?
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+P: I am, yeah and I get the flu shot every year. 
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+D: OK, that's good. Um and have you had any hospitalizations or surgeries in the past? 
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+P: Um I, I, no, I haven't had anything like that.
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+D: No, OK. Um any allergies?
+
+P: Uh no allergies. 
+
+D: OK, family history of lung or heart conditions?
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+P: Um my grandfather had a stroke when he was in his uh 70s, um and my dad has high cholesterol.
+
+D: Have you been worked up for all of that? Like high blood pressure, diabetes, cholesterol?
+
+P: Uh yeah, I think my family doctor checked a few years ago, but I've been healthy besides this um uh this this pain um so maybe that, yeah maybe that could be investigated as well.
+
+D: OK, um any neural, neurological, or musculoskeletal issues in the family?
+
+P: Um I think osteoarthritis, a few few people have that.
+
+D: OK, um how about autoimmune conditions?
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+P: Uh no, I think I'm the only one with the thyroid.
+
+D: OK, um how about cancers?
+
+P: Uh no cancer.
+
+D: No cancers, OK. Um alright and then, do you smoke?
+
+P: I do, yeah, I smoke about um 5 to 10 cigarettes per day. 
+
+D: OK, and um for how long have you been doing that?
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+P: Uh probably yeah about the last 10 years, it was kind of around when I started working um in the warehouse here, um yeah.
+
+D: OK, and have you ever thought about quitting?
+
+P: I have, yeah I've tried, it's just such uh I mean people just go out and I mean have their coffee and cigarettes and it's sort of a social thing while at work, it it's kind of what people do so, I have been trying to cut down though.
+
+D: OK, OK, that's good. If you need any resources, we have some that we can refer you to. Um and do you consume marijuana in any form?
+
+P: Um no, I don't.
+
+D: No, OK. Any recreational drugs.
+
+P: Um nope, I don't use anything like that.
+
+D: OK, how about alcohol? Do you drink? 
+
+P: Um I'll have wine every once in awhile on the weekends, maybe maybe a drink per week, something like that.
+
+D: OK, um and have you been in contact with anyone sick recently?
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+P: Uh no, I don't believe so.
+
+D: OK, how about travel? 
+
+P: No, I've been I've been at home and and just going to work.
+
+D: OK. Um and and where do you live and who do you live with?
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+P: So I live with my husband and our two daughters and we live and we live in a house.
+
+D: OK, um any concerns for STI's?
+
+P: No, I'm just um, I've been monogamous with my partner now for uh over 10 years and um no concerns for uh an STI at this time.
+
+D: OK, alright good, um so now we're just going to move on to the physical exam part um of this interview. Um so I'm going to get you to look at both your arms, hands, and wrists, um side by side. Does your left one seem at all more red, swollen, uh or hot.
+
+P: No, no symptoms like that.
+
+D: No, OK. And um do you, does that one seem to be more atrophied or are there any deformities or skin changes on that one? 
+
+P: Um maybe uh a little less muscle bulk on the, like where my thumb is. 
+
+D: OK, OK. Um and then I'm gonna get you to palpate certain areas of that arm. So let's start um at the top, when you when you press down on your shoulder blades or just at the very top of your um arm where your, or at the very top where your arm connects to your shoulder, does it hurt over there?
+
+P: No, no pain there.
+
+D: OK. So no pain on the acromion process or the scapula. Um any pain where your biceps are?
+
+P: No.
+
+D: No, OK. How about at your elbows?
+
+P: Uh no pain at the elbows and full, I can move my elbows and shoulders, uh no problem either. And my neck doesn't hurt at all either, I can move my neck around.
+
+D: How about when you um palpate your wrists, both sides, medial and lateral?
+
+P: Uh, yeah no, no pain if I'm just pressing or palpating the wrist.
+
+D: OK. Um and I'm going to get you to um straighten out your arm and flex at your shoulder and extend at your shoulder, does that hurt?
+
+P: No.
+
+D: How about when you flex your elbow and extend your elbow?
+
+P: No.
+
+D: Um how about when you flex your wrist and extend your wrist?
+
+P: No.
+
+D: OK, so I'm going to do a special test for something called carpal tunnel syndrome. Um so um I'm gonna get you to straighten out your left arm again um and right where um alright, how do we do this? OK, so with your right hand or with your yeah, with your right index finger and middle finger, you're going to tap um just below uh where the bulk of your thumb muscles are um connecting to your wrist. I'm just going to get you to tap that area. Do you feel tingling like an electric shock sensation in your hand or anything like that.
+
+P: I do, yeah.
+
+D: You do, OK, so that's a positive Tinel's sign. Um and then we're going to do one more test, so I'm going to, OK so make like a prayer motion with your hands like um putting your 2 palms together and then um and then instead invert your hand so that the outer parts are touching and your fingers are pointing towards the ground.
+
+P: OK.
+
+D: So kind of like upside down but with your outer parts of your hands touching. Um and then I'm going to get you to uh just hold your arms like that um for about 60 seconds. Do you feel any tingling, numbness, or pain in those fingers?
+
+P: Yeah, I get a bit of uh numbness and tingling when when I do that.
+
+D: OK, so that's a positive Phalen's sign test. Um alright, so that brings me to the end of um this interview, did you have any questions or concerns, anything that you wanted to bring up?
+
+P: Uh just wondering about um what this could be.
+
+D: Oh yeah, so um it seems like you have something called carpal tunnel syndrome. Um and that is, it's pretty common um so it can be caused by um a lot of things, but basically your median nerve runs through your forearm into your wrist, and anything that squeezes or irritates that median nerve can lead to carpal tunnel syndrome, um and some things include um like repetitive movements at work, um obesity, um any nerve damaging conditions like diabetes, um inflammatory conditions, but mostly just like workplace factors can can do it, um especially if you're working with like vibrating tools or on an assembly line that requires like repetitive and prolonged flexing of the wrist. Um so uh diagnosis, we just do that through like symptoms, physical exam, um we don't really need to do any imaging at this at this point. And to treat it um basically work modification, so taking frequent breaks, uh not doing those repetitive movements um as often um and then you can do things at home, like apply cold packs. Um and then we also have some like non-surgical treatments where we can uh splint, we can put like a wrist splint um while you sleep to relieve those nighttime symptoms. Uh you can take some NSAIDs to relieve pain, um and if those don't work, we can try corticosteroids, um and if that doesn't work, then we can also discuss surgery sometime down the line. Does that sound OK?
+
+P: It does, yeah, thank you.
+
+D: Yeah no problem.

MSK0017.txt

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+D: What brings you in?
+
+P: Hi, yeah, so I've had this uh back pain that's been going on now for the last uh two weeks, it's just kind of right in the lower back and it just hasn't gone away. 
+
+D: OK, um last two weeks you said, is it getting worse?
+
+P: Uh no, it's not really getting any worse, uh it's just been uh limiting my abilities at work.
+
+D: Right, OK, and what do you do for work?
+
+P: So I work um at a butcher shop. 
+
+D: OK.
+
+P: Yeah, and we're like always like carrying heavy things and yeah, it's a lot a lot of like lifting and standing.
+
+D: OK. Did anything trigger this back pain two weeks ago? Did you have some sort of injury or trauma to the area?
+
+P: No, I can't think of anything uh like specific that happened, but there was one night where um like after work, I was sitting down after dinner and um I got pretty stiff that night. It was pretty sore and kind of ever since then, it's been been sore.
+
+D: OK, OK, um and is this a persistent kind of back pain or does it come and go?
+
+P: It's um, I can kind of always feel it, but it certainly gets worse if I am moving. So if I'm just kind of sitting at rest, I don't really, yeah, I don't really feel it that much.
+
+D: OK, OK, and if you were to describe the quality of this pain, um would you say it's sharp, throbbing, achy, crampy? 
+
+P: I'd say I get kind of uh, it's a sharp pain. 
+
+D: Sharp pain, OK. Um does anything make it better or worse?
+
+P: Um better would just be uh resting.
+
+D: OK.
+
+P: Um kind of just lying down, or um yeah, just just trying to uh rest. But um making it worse, yeah, if I'm uh like really any movement um if I'm like bending forward or um kind of like leaning to the side, I start to get um get some pain in the lower back. 
+
+D: OK, OK. And then 1 to 10, 10 being the worst pain you've ever felt, how bad or uh how severe would you rate it? 
+
+P: I would say 7. 
+
+D: A 7, OK. And have you ever had pain like this in the past?
+
+P: Uh yeah, I've I've hurt my lower back before like many years ago. Um but it's been OK since then. 
+
+D: OK. Uh did you get any sort of treatment or management for that pain um back in the day?
+
+P: At that time it was just rest and like did some stretching and I took some um anti inflammatories and it went away after a couple of months. 
+
+D: OK, OK. Um and are you having any sort of like numbness or tingling, anywhere on your body?
+
+P: No, nothing like that. 
+
+D: Alright, how about any muscle weakness?
+
+P: Uh no muscle weakness. 
+
+D: No, OK. Are you still able to walk and do things that you normally would do in a day?
+
+P: Uh yeah, I'm able to walk still. 
+
+D: OK. Um any dizziness or fainting spells?
+
+P: Nope, nothing like that.
+
+D: OK. Any pain elsewhere on your body?
+
+P: No, just just the lower back, yeah. 
+
+D: OK. Headaches?
+
+P: Uh nope. 
+
+D: OK, weight loss?
+
+P: No, I haven't had any weight loss.
+
+D: OK. Fevers or chills? 
+
+P: Nope, no fevers or chills. 
+
+D: Um rashes?
+
+P: Uh no rashes.
+
+D: Changes in your vision, hearing, taste or smell?
+
+P: No changes like that.
+
+D: OK. Any coughing, shortness of breath or wheeziness? 
+
+P: Um nope, nothing like that.
+
+D: Um chest pain or heart palpitations?
+
+P: Nope, nothing like that.
+
+D: OK. Issues or changes in your bowel movements?
+
+P: Uh no changes to bowel movements, no diarrhea and no incontinence or anything like that.
+
+D: OK, um and then uh nausea or vomiting?
+
+P: Nope, nothing like that. 
+
+D: OK, how about um changes to your appetite?
+
+P: Um nope, I've been eating uh, I've been eating well.
+
+D: Changes in your voiding?
+
+P: Uh nope, I haven't had any changes to urination.
+
+D: OK. Um and then are you otherwise healthy or do you have any longstanding medical conditions?
+
+P: Uh I I've had a few sports injuries when I was younger, uh like to my my knee, but that's it, I've been healthy otherwise.
+
+D: OK and um those injuries, are they all healed?
+
+P: Uh sometimes I'll get um like a little achiness in my knee from from doing like too much activity, but I know when those, when that happens.
+
+D: OK. Are you on any medications?
+
+P: No, I I don't uh take any medications.
+
+D: OK. Are you up to date with all your immunizations? 
+
+P: I am, yep.
+
+D: OK. Um do you have any allergies?
+
+P: Uh, no allergies.
+
+D: OK, any family history of um muscular or skeletal issues?
+
+P: Um no, nothing like that.
+
+D: OK, how about um heart or lung diseases?
+
+P: Uh, no, no heart or lung diseases. 
+
+D: OK, uhm how about autoimmune conditions?
+
+P: Um nope, nothing like that.
+
+D: OK. Cancers?
+
+P: Uh no cancers.
+
+D: OK. Um and do you smoke?
+
+P: Um no, I don't smoke.
+
+D: OK and do you consume marijuana?
+
+P: Uh sometimes, I'll have like uh edibles, little candy, sometimes at nighttime they they help me uh relax and sleep, but I don't use that very often.
+
+D: OK, how often do you use them? 
+
+P: I would say maybe uh once a week.
+
+D: Once a week, OK. Alright um and then, what else did I wanna ask you? Um do you, do you take any recreational drugs?
+
+P: No, and I haven't used any before.
+
+D: OK, and how about alcohol, do you consume alcohol?
+
+P: Yeah I'll have a couple of beers on the weekend, so maybe like two or three. 
+
+D: OK, uhm and who and where do you live right, who with and where do you live right now?
+
+P: Yeah, I live with my wife and our um and our son who's in high school. We live in a in a house.
+
+D: OK, OK. Um alright, and any concerns for STI's at all?
+
+P: Oh no, I've been with my wife now for a long time and we've been monogamous so no concerns for uh sexually transmitted infection right now.
+
+D: OK, how about um sick contacts, have you been in contact with anyone sick recently? 
+
+P: No, I don't think so.
+
+D: OK, any travel recently? 
+
+P: Uh no, I haven't traveled anywhere.
+
+D: OK um and well, let's move on to the physical exam part of this interview. Um so I'm going to get you to stand up from a sitting position. Does that hurt your back?
+
+P: Um yeah it does. I I do feel a little bit of a a twinge there.
+
+D: OK, and where about specifically?
+
+P: Kind of just, yeah, on the lower uh lower right side like more on the, more on the right side.
+
+D: More on the right side, OK. Now, if you have a mirror with you, or if you have someone there with you who can um speak to this, does your right side appear more red, swollen, or hot compared to your left side of the lower back?
+
+P: Uh no, nothing like that. 
+
+D: No, OK, and does it seem like it's more atrophied or do you see any deformities or skin changes in that area?
+
+P: Uh nope, no deformities or skin changes. 
+
+D: OK, um alright and I'm gonna get you to um bend down all the way and touch your toes if you can.
+
+P: Um yeah I I can get part part way down.
+
+D: You can get partway down, does it hurt?
+
+P: Um a little bit, I can feel it pulling and stretching, yeah.
+
+D: OK. Um alright, and then I'm gonna get you to uh like laterally flex to your right side. So kind of like you're doing an exercise um and you're just like bending towards that side.
+
+P: Yeah, that hurts.
+
+D: That hurts, OK, how about the other side, the left side?
+
+P: Yeah that hurts too.
+
+D: OK. Um and now I wanna get you to uh bring your knees up towards the ceiling. Does that hurt? One at a time, like your right right knee and your left knee.
+
+P: Uh, not really.
+
+D: No, OK, how about when you um flex your knees backwards?
+
+P: Nope.
+
+D: And kind of point your knees towards the ground.
+
+P: No, no pain there.
+
+D: OK, so no pain on knee extension or flexion. Um how about when you point your toes to the ceiling?
+
+P: Uh no pain there.
+
+D: OK so no pain on plantar flexion, how about when you point your uh toes to the ground?
+
+P: No pain there.
+
+D: OK, so no pain on dorsiflexion, and then sorry I forgot to ask you earlier, do you have any sort of numbness in the groin area?
+
+P: No, no numbness in the groin area.
+
+D: OK, so no numbness in the groin area, no weakness, no um changes in your bowel or bladder habits, including no incontinence, so uh no red flags?
+
+P: Yeah, nothing like that.
+
+D: OK, OK, good um and, OK so those are all the questions that I had for you. Did you have any questions for myself?
+
+P: Uh, no I was just uh yeah, kind of wondering do I do I need any X Rays or like what what what's going on?
+
+D: Yeah, so um what it sounds like right now is that you have something called mechanical back pain. It's pretty common and um it can be anything from your spinal joints to the discs to the vertebrate or soft tissue or muscle. Um and a lot of these can be caused by um hard activity at work, um like carrying heavy things um and then carrying them in like an improper position or something like that. Um and we diagnose that on history and physical exam, um but if after we try some management and treatment plans, it doesn't go away and it persists for more than eight weeks, we do recommend imaging, including an MRI. So uh in terms of management for right now, um modified activity at work, um some short term bed rest, uh very short term though um and bed rest is only really recommended if you have severe back pain and muscle spasms, um and you definitely shouldn't be doing that for more than like 24 to 48 hours, and physical activity can help, um so referral to physical therapy or physiotherapy um can help in rehab and they'll give you some exercises that you can try at home to kind of um strengthen those muscles. And then ice and heating packs um temporarily can help, uh medications like NSAIDs can help as well with the inflammation. Um so we'll try these things out and then we'll continue to follow up. Um yeah, did you have any questions or does that sound like an OK plan?
+
+P: Uh that sounds like a good plan.
+
+D: OK, sounds good, thank you.

MSK0018.txt

@@ -0,0 +1,173 @@
+D: What brings you in?
+
+P: I just came in because of I just got into like this uh, incident while I was playing rugby. I kind of got tackled and then fell onto my right shoulder. Um, and after I got up, I haven't, I've just been, this just happened a couple hours ago actually and uh, I've just been in intense pain in my right shoulder and I can't seem to move it at all.
+
+D: Okay, um, and sorry, when was this exactly?
+
+P: Uh, probably 2 hours ago.
+
+D: 2 hours ago, okay. Um, and is this pain persistent or is it like on and off?
+
+P: It's, it's constant. It hasn't gone away at all.
+
+D: Okay. 1 to 10, 10 being the worst. How bad is this pain? 
+
+P: I don't know, like probably like 8 or, 8 or 9.
+
+D: 8 or 9, okay. Um, and is it a sharp kind of pain or is it dull and aching?
+
+P: It's, it's sharp. Like if I try to move it at all, it's like a sharp pain.
+
+D: Okay, um, and have you ever had anything like this in the past?
+
+P: Uh, no, never.
+
+D: Never, okay. And are you able to move your arm at all or you can't move it?
+
+P: I could move my fingers and hand and elbow, but um, elbow a little bit, but like uh, yeah, I can't move my shoulder whatsoever.
+
+D: Okay, um, and do you, are you experiencing any tingling or numbness?
+
+P: Um, no, I don't think so.
+
+D: No, okay. Uh, how about any muscle weakness? 
+
+P: Um, in that area, I don't know if it's weakness or pain, but I just can't move it up and I, I, I do feel some like numbness just above my shoulder. No tingling though.
+
+D: Okay, any pain elsewhere in your body? 
+
+P: No.
+
+D: No, okay. Any headaches?
+
+P: Um, no.
+
+D: Confusion or memory loss?
+
+P: Uh, no.
+
+D: Uh, weight loss?
+
+P: Uh, no.
+
+D: Fevers or chills?
+
+P: No.
+
+D: Rashes?
+
+P: Um, no. 
+
+D: Uh, changes in your vision, hearing, smell or taste?
+
+P: Uh, no.
+
+D: Um, coughing, shortness of breath or wheezing?
+
+P: Um, no.
+
+D: Chest pain or heart palpitations?
+
+P: No.
+
+D: Changes in your bowel movements?
+
+P: No.
+
+D: Changes in voiding?
+
+P: No.
+
+D: Um, okay. And then with regards to this pain, does anything make it better or worse?
+
+P: Um, um not anything that I've tried that's made it better. Worse is probably just if I try to move it at all.
+
+D: Okay, and the pains in your shoulder, does it radiate down or up elsewhere?
+
+P: Uh, mostly towards my shoulder, um, kind of down towards my upper arm as well.
+
+D: Okay, I see. Um, alright, and um, are you otherwise healthy? Do you have any other medical conditions?
+
+P: No. Yeah, otherwise I'm healthy. I've never been to the doctor much.
+
+D: Okay, alright. Um, and are you on any medications?
+
+P: No.
+
+D: No, okay. And um, are you up-to-date with your immunizations?
+
+P: Yes.
+
+D: Okay, and do you have any allergies?
+
+P: Uh, no.
+
+D: Any family history of musculoskeletal diseases?
+
+P: No, not that I know of.
+
+D: Okay. Uh, and any family history of autoimmune conditions?
+
+P: Um, no.
+
+D: Okay. Um, do you smoke at all?
+
+P; No. 
+
+D: No. Um, do you consume marijuana?
+
+P: Uh, no.
+
+D: Uh, do you drink alcohol?
+
+P: Uh no, just, just with friends sometimes on the weekends, but not really.
+
+D: Okay. Um, and then, where do you live right now and who do you live with?
+
+P: Uh, I live just outside of town with my parents in a house.
+
+D: Okay. And um, have you traveled anywhere recently?
+
+P: Um, no, I've been at home.
+
+D: Okay, any sick contacts? 
+
+P: No.
+
+D: No, okay. So now we're just going to move on to um, the physical exam part of this. So can you take a look at both your shoulders and let me know if you see any redness or swelling?
+
+P: Um, I don't think I see any redness or swelling, but um, my right shoulder and my arm just seems a little bit lower than my left one.
+
+D: Okay, okay, any um, warmth on, on that shoulder?
+
+P: Uh, no, not that I can feel.
+
+D: Okay, any atrophy, deformities, or skin changes?
+
+P: Um, deformity, I, I do feel like kind of uh, like my shoulder's dropped and like there's just kind of this uh, little, like divots, where like the shoulder should be.
+
+D: Okay, okay. And can you palpate that area for me? Just um, the bones in that area, so like right where your arm would connect to your shoulder and then kind of on your shoulder blade. Does that hurt when you press down?
+
+P: Yeah, it hurts a lot.
+
+D: Okay, so some tenderness and pain in the acromion process and scapula. Um, and if you press down on your biceps, triceps, does that hurt?
+
+P: Not as much, no.
+
+D: No, okay. And then can I get you to um, can you lift your shoulder up at all? Like to where, to the point where your fingers are touch, like reaching the ceiling?
+
+P: No, I, I can't. I can't move it at all.
+
+D: Alright, so um, it sounds like you have a shoulder dislocation. Um, so we are going to do an x-ray of your shoulder joint first to make sure that it's, it's just a dislocation and there aren't any broken bones or fractures. And then um, we can resolve this by doing something called a closed reduction, um, to try to put the joint back in its place. 
+
+P: Okay.
+
+D: Um, and if that closed reduction doesn't work, then uh, you may need surgery for like a, um, a weak shoulder joint, or if like ligaments um, aren't like, strong enough and it's it continues to happen.
+
+P: Okay.
+
+D: Um, otherwise, we can keep it immobilized for a few days to a few weeks, um, depending on how bad the dislocation is. Um, and then once that's removed, you can do some rehab as well to restore some range of motion. Does that sound like a good plan? Do you have any questions or concerns in the meantime?
+
+P: Uh, no, I think that's, uh, that's great.
+
+D: Okay.

MSK0019.txt

@@ -0,0 +1,213 @@
+D: What brings you in?
+
+P: I've just been having uh, this pain in my um right, right elbow, and it's just been getting worse over the last few days. I started having it around three days ago. Um, and it's just been getting worse with any kind of gripping motion or, yeah, so it's, it's been getting worse.
+
+D: Okay, so you said it started three days ago. Um, has it been persistent since, or has it been like on and off?
+
+P: It's been pretty persistent, um, but it's mainly when I'm uh, doing some activities or lifting anything. Um, and yes, I've just been trying to rest it mostly.
+
+D: Okay, okay, that's good. And um, you said it's worse with activity and better with rest. Have you tried anything else for it?
+
+P: Um, I've tried some Advil, it, it seemed to help a little bit, but uh, it just comes back.
+
+D: Okay, um, and if you were to describe the quality of this pain, would you say it's sharp, burning, throbbing, achy?
+
+P: It's more um, like if I don't extend my wrist, it's kind of like achy, but then if I extend my wrist, I feel like a sharp pain at um, on the um, just on the outside of my elbow.
+
+D: Okay, alright. Um alright, and then um, in terms of severity, 1 to 10, 10 being the worst pain you've ever felt, how bad is the pain?
+
+P: Um, probably like a 6 or 7.
+
+D: Okay. Alright, um, and have you ever experienced this type of pain before?
+
+P: No, I, I, I've never experienced any kind of pain there at least.
+
+D: Okay. Um, how about um, in terms of like timeline, is it getting worse?
+
+P: Um, just over the past three days, I feel like it's, I have tried not to use it that much. Uh, like when I was at work, I have to use like tools a lot um, and I noticed that when I was using a screwdriver, like it, it hurt a lot. So it hasn't been getting worse, but if I try to do anything at work, it definitely hurts a lot more.
+
+D: Okay, um, alright. And then have you noticed any numbness or tingling?
+
+P: Um, no, no, nothing like that.
+
+D: No, okay. How about um, pain elsewhere on your body?
+
+P: Sorry, what was that?
+
+D: Pain elsewhere on your body?
+
+P: Oh no, no pain elsewhere.
+
+D: Okay, um, and have you noticed any muscle weakness?
+
+P: Uh, no.
+
+D: No. Any headaches?
+
+P: No. 
+
+D: Dizziness?
+
+P: No.
+
+D: Uh, weight loss?
+
+P: No.
+
+D: Fevers or chills?
+
+P: No.
+
+D: Rashes?
+
+P: No.
+
+D: Uh, changes in your vision, hearing, smell, or taste?
+
+P: No.
+
+D: Uh, coughing, shortness of breath, or wheezing?
+
+P: No.
+
+D: Chest pain or heart palpitations?
+
+P: No.
+
+D: Uh, changes in your bowel movements? 
+
+P: No.
+
+D: Nausea or vomiting?
+
+P: No.
+
+D: Changes in your voiding? 
+
+P: No.
+
+D: Okay, and are you otherwise healthy? Do you have any longstanding medical conditions?
+
+P: Yeah no, I've been healthy, uh, no other issues in my Life.
+
+D: Okay, that's good. Um, how about, um, medications, are you on any?
+
+P: No, no medications. I've just been taking some Advil for this pain. 
+
+D: Okay, I see. And how about immunizations? Are you up-to-date?
+
+P: Yeah.
+
+D: Do you have any allergies?
+
+P: Uh, no.
+
+D: Family history of any musculoskeletal issues?
+
+P: No, just uh, I guess my dad, he's, he's getting some knee pain and hip pain now, starting now. But like that's about it.
+
+D: How old is he? 
+
+P: My dad, he's 60.
+
+D: Okay, and any lung or heart conditions?
+
+P: No.
+
+D: Autoimmmune condition?
+
+P: Uh, not that I know of.
+
+D: Okay, and how about cancers?
+
+P: Um, I think my aunt on my mother's side, um, she, she had, uh, uterine cancer.
+
+D: Okay, I see, alright. Um any allergies, or sorry, you answered that. Do you, do you smoke?
+
+P: Uh, no. 
+
+D: No. Um, do you consume any marijuana?
+
+P: Uh, no.
+
+D: Do you drink alcohol?
+
+P: Um, just, like maybe some wine on uh, wine, beer every couple days. 
+
+D: Okay, um, and where do you live right now? And who do you live with? 
+
+P: Um, I live with my wife and uh, four year old daughter.
+
+D: Okay. Um, any concerns for STIs?
+
+P: No.
+
+D: Any sick contacts recently?
+
+P: No.
+
+D: Have you traveled anywhere recently?
+
+P: No.
+
+D: Okay, well um, let's move on to the physical exam part of this interview then. Um, so I'm going to get you to look at both your uh, arms and hands and you let me know if you see any redness or swelling in uh, your right arm compared to your left. 
+
+P: Okay. Um, so like, with movement?
+
+D: Uh no, uh, just on inspection, do you see any redness or swelling?
+
+P: Um, no, I don't really see anything that's too different, no.
+
+D: No, okay. Uh, do you see any deformities, atrophy, or skin changes in your right compared to your left arm or hand?
+
+P: No, they look pretty similar to me.
+
+D: Okay. Alright, and then I'm gonna get you to press down on certain areas of your right arm. So you can start with the back of your elbow. Does that hurt?
+
+P: Uh, just like right on the elbow, it doesn't hurt, but when I go on the outside part, it does hurt on the back.
+
+D: Okay, so like the lateral aspect of your elbow?
+
+P: Yeah, it's like sore if I press down.
+
+D: Okay, how about the medial aspect of your elbow?
+
+P: Um, so yeah, on the inside, not so much. Maybe a little bit, not, not that much.
+
+D: Okay, how about when you press down on your biceps or triceps?
+
+P: Uh, nothing.
+
+D: Nothing. How about when you um, press down on your like, forearm extensor muscle group?
+
+P: Um, just, yeah, so just on the outside of my forearm, close to where the elbow pain is, if I go down a little bit and press down, it does definitely feel sore.
+
+D: Okay, and then how about with your forearm uh, flexor, flexors.
+
+P: So on the inside, um, not so much, no.
+
+D: No, okay. And now I'm gonna get you to walk through some movements with me. Um, can you uh, get a piece of paper and, actually can you get a pencil and grip it as tight as you can. Um, do you find that you feel weak when you do that?
+
+P: Um, not weak, but it does definitely like um, when I picked up the pencil and moved my wrist up, it did, it did uh, cause some, some pain.
+
+D: Okay, alright. So would you mind extending or like straightening out your elbow all the way and then also straightening out your wrists. Um, does that hurt?
+
+P: Uh, straightening out, no, it doesn't hurt. 
+
+D: Even with uh, like the wrist um, straightened out? 
+
+P: Um, yeah if I, if I completely straighten out my wrist uh, then like I just feel a bit of uh, soreness, but not as much pain as when I, um, am lifting something with my wrist or just raising my wrist upwards.
+
+D: Okay. Okay, how about when you flex your wrist all the way?
+
+P: Um, that hurts a little bit, but not nearly as much as when I extend it.
+
+D: Okay. Okay, um, those are all the questions I had for you today, and did you have any questions of your own for myself? 
+
+P: Uh, yeah, I was just wondering what this, this might be.
+
+D: Yeah, so um, it sounds like you have something called tennis elbow or lateral epicondylitis. Um, and it's usually related to some overuse, um, injury, so whether at work, or if you play a lot of tennis or some sort of sport, that um, overuses a certain muscle group, um, particularly like the forearm extensors. Um, and so basically for this, um, we suggest a few things. We'll start with like some conservative management, like activity modification. So at work, if you're doing repetitive movements, maybe not do them so much and take frequent breaks, you can try some like ibuprofen, we'll refer you to some um, physiotherapy to help build those muscles around that, that area. And if those still do, don't work, um, we can try some um, other things like operative um, operative management, but we'll, we'll come back to that in about 6 to 12 months, um, once we uh, we try all of the other stuff. Does that sound okay?
+
+P: Yeah, that sounds good. Thank you.
+
+D: Yeah, no worries.

MSK0020.txt

@@ -0,0 +1,237 @@
+D: What brings you in?
+
+P: I've just come in today because I've been having some issues with my hips as well as my knees. Just over the last probably a month or two, I've been just getting, this stiffness and pain especially, uh, throughout the day as the day goes along, and I also experience some stiffness when I wake up in the morning, uh, in my hips and knees, so I just wanted to come and check out what that might be.
+
+D: OK, and you said it started in the past month?
+
+P: Yeah, maybe up to two months actually. Yeah, I would say two months.
+
+D: OK, and is the pain and stiffness always there or does it come and go?
+
+P: It's, it comes and goes. It's worse in the, so it's stiff, more stiff in the morning first, but like as the day goes on, probably near the afternoon it gets worse. So I've had to stop some of my activities like gardening and being outdoors and things like that.
+
+D: OK. And you said it's, it gets worse with activity. Is there anything else that makes it better or worse?
+
+P: Uhm, it probably, yeah, if I'm just exerting myself too much. Uh, in terms of better, I I think I've taken some Advil that does help with the pain.
+
+D: OK, OK. And then if you were to describe the quality of this pain, would you say it's achy, throbbing, dull, or sharp?
+
+P: It's kind of like this uh, achy pain, kind of deep within the joints themselves.
+
+D: OK.
+
+P: Yeah, it just gets worse. I, as I walk more and do more activities.
+
+D: OK, and does the pain radiate also or does it, or is it pretty localized to your hips and knees?
+
+P: It's mainly in those areas.
+
+D: OK. And severity wise, one to 10, 10 being the worst pain you've ever felt, how bad is this pain?
+
+P: Probably like a 7.
+
+D: Seven, OK. And have you ever experienced this type of pain before?
+
+P: Uh, no, not really.
+
+D: And do you think your pain is getting worse?
+
+P: Uhm, I think so. Like over the last two months, I feel like my pain, there's more stiffness, there's more pain throughout the day.
+
+D: OK, OK. And yeah, so do you, are you experiencing any sort of numbness or tingling in the areas?
+
+P: No, not really.
+
+D: No, OK. Any muscle weakness?
+
+P: Nope.
+
+D: No. Are you still able to walk and do the things that you used to enjoy doing? I know you said gardening was hard for you. How about like other activities of like daily living like, uhm, cooking, using the washroom, things like that?
+
+P: Yeah, those things I don't really have too much trouble with.
+
+D: OK, OK, that's good at least. And any dizziness or fainting spells?
+
+P: No.
+
+D: No, OK. How about memory loss or confusion?
+
+P: No, nothing like that.
+
+D: Any headaches?
+
+P: No.
+
+D: No, OK. How about joint pains or muscle aches elsewhere?
+
+P: Uhm, no, I haven't really felt any other pain in any other joint so far.
+
+D: OK. And any weight loss recently?
+
+P: No. 
+
+D: No, OK. How about and fevers or chills?
+
+P: Uh, no fevers or chills.
+
+D: No fevers or chills, OK. How about rashes?
+
+P: No.
+
+D: And changes in your vision, hearing, smell or taste?
+
+P: Nope. 
+
+D: Uhm how about coughing, wheezing or shortness of breath?
+
+P: Nope.
+
+D: Uhm, chest pain, heart palpitations or fainting?
+
+P: No.
+
+D: Changes in your bowel movements?
+
+P: Nope.
+
+D: Uh, changes in your urinating?
+
+P: Uh, no.
+
+D: OK. And then are you otherwise healthy or do you have any past medical conditions?
+
+P: Uhm, so I do have a prior history of hypertension as well as high cholesterol, diabetes, type 2 diabetes and also a bit more on the overweight side.
+
+D: OK, uhm, are you taking any medications for all of this?
+
+P: Yeah, so blood pressure, I'm taking this medication called Telmisartan. And then for blood pressure, I'm taking uh, metformin. Sorry, not blood pressure, for diabetes I'm taking metformin.
+
+D: OK.
+
+P: And then for the cholesterol I'm taking, and this medication, called Atorvastatin.
+
+D: OK. Alright, and do you have any allergies?
+
+P: No allergies.
+
+D: No allergies. And how about immunizations? Are you up to date with them?
+
+P: Yeah, as far as I know.
+
+D: OK, that's good. How about family history of musculoskeletal issues?
+
+P: Not that I know of, no.
+
+D: No, OK. Then how about uhm, lung or heart conditions?
+
+P: No. I I think my father, maybe he had some heart issues. He did have a heart attack in his, let's see, like in the 70s.
+
+D: In his 70s, OK. OK, and then alright, and how about autoimmune conditions?
+
+P: Uhm, I don't think so. Uh, I can't, I can't recall any autoimmune condition.
+
+D: OK, an and do you smoke?
+
+P: Yeah, I used to smoke a probably up until when I was like 65 or something. So, probably for 40 years of my life.
+
+D: OK, how much did you used to smoke?
+
+P: Probably a pack a day pack a day.
+
+D: OK, uhm well, congrats for quitting. I'm sure that wasn't hard. I mean sorry, I'm sure that was hard. Uhm, yeah, so that's good. And have you, do you consume marijuana? 
+
+P: No.
+
+D: Go to other recreational drugs?
+
+P: No. No other recreational drugs.
+
+D: OK, that's good. Do you drink alcohol?
+
+P: Uh, nope, not anymore. I used to probably drink some wine here and there, but I've stopped drinking alcohol too.
+
+D: OK. And who do you live with right now? And where do you live?
+
+P: Right now, I live with my wife and we live in a small condominium. 
+
+D: OK. Uhm, alright, and then any recent sick contacts?
+
+P: No. 
+
+D: No, OK, how about uhm, uh travel anywhere?
+
+P: No.
+
+D: No, OK, that's good. And now I'm just going to get you to do the physical exam part of this interview with me, is that OK?
+
+P: Yeah.
+
+D: OK, so we'll take a look at, if you can, if you have a mirror, we'll take a look at both hips first. Do you notice any redness or swelling on those hips?
+
+P: No, not really.
+
+D: No, OK. How about any atrophy, deformities, or skin changes?
+
+P: No.
+
+D: No, OK. And then how about on your knees? Do you see any redness or swelling there?
+
+P: Not really, no.
+
+D: No. Any atrophy, deformity, or skin changes there?
+
+P: Uh, no.
+
+D: No, OK. I'm gonna get you to palpate your hipbones. Does that hurt?
+
+P: No, not really. 
+
+D: OK, how about when you do that to your knees?
+
+P: Uh, the knee I can feel a little bit of I would say it's more of a discomfort then tenderness.
+
+D: OK, so some discomfort on the patella palpation. Uhm, alright and then when you palpate those areas, do you feel like there is a grading sensation? How, does it feel warm?
+
+P: No. 
+
+D: No, OK. And then I'm gonna get you to, can you flex your hips all the way so bend so from a sitting position stand up first? Does it hurt when you extend your hips like that?
+
+P: Not right now. I think, I'm pretty sure my hips are pretty well rested right now, but there is still a little bit of stiffness. 
+
+D: OK. OK, so some stiffness on hip extension. How about when you bend your hips all the way?
+
+P: Yeah, that's a I can't really go down that far. But yeah, even bending, as much as I can, there is some discomfort there.
+
+D: OK, so some discomfort and some pain on hip flexion as well as limited range of motion. 
+
+P: Mhmm.
+
+D: OK. Alright, and when you do both of those, do you hear any like what's called a crepitus or like a grating sensation where you feel like bone maybe hitting bone?
+
+P: No, not really.
+
+D: No, OK. Alright, and I'm going to get you to, uh, extend your knee, so straighten it out. Yeah, does that hurt?
+
+P: Uhm, yeah, a little stiffness in my knees. I feel like I feel more of the grating sound in my knees. 
+
+D: OK, OK. And then how about when you bend your knees all the way backwards? You can do one at a time.
+
+P: Uh, yeah I, yeah I definitely feel some discomfort there as well.
+
+D: Yeah, OK. Alright, and how about when you point your toes to the ceiling?
+
+P: No, that's fine. I can do that.
+
+D: And then how about when you point your toes to the ground?
+
+P: Yeah no issues.
+
+D: OK, so no pain or limited range of motion with plantar flexion or dorsiflexion. OK, so those were all the test that I want to do with you today. Did you have any questions or concerns?
+
+P: Uh, no, not really.
+
+D: No, OK, uhm, so it sounds like what you may have is something called arthritis, which basically happens, uhm, when the cushions at the ends of your bones and your joints kind of degenerate over the years, and so bone can eventually rub on bone, which causes like the grading sensation and causes the pain. Uhm, and it's it happens in old age, it happens with wear and tear so to diagnose it, we we'll, yeah, we did the physical exam. We can also get an x-ray of your hips and knees which can have some findings that align with osteoarthritis and basically for now we'll try to manage it conservatively so you can take and sets like ibuprofen for the pain or acetaminophen for the pain. We'll also refer you to physiotherapy to strengthen those muscles around your joint and to increase flexibility and reduce that pain. Uhm, and another thing that may be worth considering is occupational therapy because they can help you find ways to do everyday tasks without putting too much stress on an already painful joint. And if these things don't work in the future, we can also discuss things like steroid injections or joint replacement. Does that sound like a good plan?
+
+P:: Yeah, that sounds great, thank you so much.
+
+D: OK yeah, no worries.

MSK0021.txt

@@ -0,0 +1,234 @@
+D: What can I do for you?
+
+P: Hi there, yeah I've had this pain in my knee that's been going on for a few weeks now and it hasn't gone away and and so I thought I would get checked out. It's been really impacting my running. I just haven't been able to run as often as I would like to and so that's why I wanted to get this looked at.
+
+D: Yeah, for sure. You said it started a couple of weeks ago. Was that two weeks ago, three weeks ago? Or more than that?
+
+P: Yeah, I would say maybe it's been going on for the past four weeks, for the past month.
+
+D: Past month. OK. And is it a constant type of pain or does it come and go?
+
+P: It comes and goes, yeah, and it depends on what I'm doing.
+
+D: OK. Uhm, alright and what kind of makes it worse or better?
+
+P: So if I'm out while running, what will bug it, but I think like that the main things that hurt are if I'm walking down stairs or if if I'm squatting. I like to lift weights as well, and yeah, I could barely even do body weight now 'cause if I I'm squatting down it causes a lot of pain, it's a sharp pain.
+
+D: OK. OK, and if you were to describe the quality of your pain, would you say it's achy, throbbing, dull, sharp, burning?
+
+P: Uh, it's a sharp pain.
+
+D: Sharp pain, OK. And one to 10, 10 being the worst pain you've ever had. How bad is this pain? 
+
+P: It's about a 7.
+
+D: 7. And have you ever had pain like this in the past?
+
+P: Uh, no, I haven't.
+
+D: OK, and do you feel like your pains getting worse over the past four weeks?
+
+P: Uh, yeah it has gotten, has gotten a bit worse.
+
+D: OK, uhm, alright, and do you, are you experiencing any sort of muscle weakness?
+
+P: No muscle weakness.
+
+D: No, OK. How about numbness or tingling?
+
+P: No numbness or tingling.
+
+D: Headaches?
+
+P: No.
+
+D: Confusion or memory loss?
+
+P: Nope.
+
+D: Any joint pains or muscle aches outside of the area of this left knee?
+
+P: No, just, just the left knee.
+
+D: And whereabouts on the left knee, is it?
+
+P: It's on the anterior aspect. Like on the front of it, but I I could, it feels like the pain is right behind my like right underneath the kneecap. 
+
+D: Right underneath the knee, OK. 
+
+P: Yeah. 
+
+D: OK. Alright and otherwise like have you had any weight loss?
+
+P: No, my way it's been the same.
+
+D: OK, how about fevers or chills?
+
+P: No fevers or chills.
+
+D: OK. How about fatigue?
+
+P: No fatigue, energy's been good.
+
+D: OK. Changes in your hair or nails like rashes?
+
+P: No, nothing, nothing like that.
+
+D: OK. Changes in your vision, hearing, smell or taste?
+
+P: Nope, that's all been normal.
+
+D: OK, alright. How about coughing, shortness of breath, or wheezing?
+
+P: Uh, no, not not-nothing like that.
+
+D: OK, chest pain or heart palpitations?
+
+P: Nope. No chest pain or or anything like that.
+
+D: OK. Any changes in your bowel movements? 
+
+P: Nope, I haven't had any diarrhea or any blood.
+
+D: OK, any changes in your urination?
+
+P: No. 
+
+D: No, OK. Alright, and are you otherwise healthy or do you have any longstanding medical conditions?
+
+P: I do have, ah, asthma, so I I do take a, an inhaler. I have a daily, a daily one that I'll use and then, just a, like rescue one. So like the blue one that I'll use sometimes, but I haven't needed that one for for awhile. I've been pretty good. I don't even need it when I'm going or runs anymore.
+
+D: OK, OK that's good. And are you on any medications?
+
+P: Yeah, just the just the inhalers and then I took uh, birth control as well. I've been taking that since I was 16 so, yeah, so for like 6 years? 7 years?
+
+D: OK alright. And are you, have you been hospitalized or had surgeries in the past?
+
+P: No, I haven't had any.
+
+D: OK, how about immunizations? Are you up to date? 
+
+P: I am, yes.
+
+D: OK, how about allergies? Do you have any?
+
+P: Uh, I, uhm, I don't, no.
+
+D: No allergies, OK, good. And any family history of musculoskeletal issues.
+
+P: Uh, no, ah, well, I think my grandparents have like osteoarthritis or something like that. They, but, that's it.
+
+D: OK. Uhm, how about longer heart conditions?
+
+P: No, nothing like that.
+
+D: OK. And any autoimmune conditions?
+
+P: No, I don't believe so.
+
+D: No, OK. How about cancers?
+
+P: Uh, no, no cancers in the family.
+
+D: OK, And, and do you smoke?
+
+P: No, I I try to stay away from that with all the running and stuff that I'm doing. I'm uh, I want to make sure that I'm able to to improve.
+
+D: Yeah, for sure. And how about marijuana? Do you consume that in any form?
+
+P: No, I don't.
+
+D: No, OK, and how about recreational drugs?
+
+P: No, I stay away from that stuff too.
+
+D: OK, OK, good. And who do you live with and where do you live right now?
+
+P: So I live with a couple of roommates at school, just finishing up my undergraduate degree.
+
+D: OK, OK. Uhm, have you been in contact with anyone sick recently?
+
+P: No, I don't, I don't think so. Everybody's been been healthy.
+
+D: OK, OK, and travel anywhere?
+
+P: No, we've been at, been at home.
+
+D: OK. OK, uhm, alright, so I think those are all the questions that I have for you. Let's move on to the physical exam part of this interview, if that's OK with you. So I'm going to get you to take a look at both your knees and let me know if you see more redness or swelling in your left knee compared to your right.
+
+P: Uh, no, I'm not noticing any swelling.
+
+D: Do you see any redness?
+
+P: No, no redness.
+
+D: No, OK. How about any atrophy, deformities, or skin changes in your left knee compared to your right knee?
+
+P: No, nothing like that.
+
+D: No, OK. I'm gonna get you to press down and palpate on your quadriceps on both knee. Sorry, on both thighs. Do you feel any pain there?
+
+P: Uh, no pain there.
+
+D: OK, how about when you press down on your knee caps?
+
+P: Yeah, I do get some pain when I push on the on the kneecap, uhm, on my left knee.
+
+D: OK, how about just below that where your shins start?
+
+P: No pain there.
+
+D: No pain there, and then how about on the lateral aspects of your knee?
+
+P: Ah, no pain there.
+
+D: And then the medial aspects of your knee?
+
+P: No pain there.
+
+D: No pain there. OK, good. When you are palpating, was there a difference in temperature between the left and right knee? Was the left knee a little bit more warm than the right knee?
+
+P: No, the temperature feels the same.
+
+D: OK, OK, good. So now I'm going to uhm, are you sitting down? 
+
+P: I am yes. 
+
+D: OK, so from a sitting position I'm going to get you to stand up uhm, and you let me know if that is painful.
+
+P: It is, yeah. 
+
+D: Yeah, OK. Uhm, and then how about when you bend your knees? 
+
+P: Uhm, no, no pain with just bending.
+
+D: OK, how about when you, uh, when you flex your hips so you can do one leg at a time, does that hurt?
+
+P: Oh no, that doesn't hurt.
+
+D: OK. And how about squatting down?
+
+P: That does hurt. Yeah, squatting hurts.
+
+D: Squatting hurts OK. OK and then how about when you point your toes towards the ceiling?
+
+P: No pain.
+
+D: OK. How about when you point your toes towards the ground?
+
+P: No pain.
+
+D: No pain. So no pain on dorsiflexion or planter flexion, OK. Do you hear any like popping or crackling sounds in your knees when you climb stairs or when you're standing up after sitting down for a long time?
+
+P: Yeah, yeah, sometimes I will hear, uhm, some, some like yeah, crackling sounds.
+
+D: OK, alright and yeah, you mentioned that you do a lot of running. Do you do any other sorts of exercises?
+
+P: Yeah, I'll do some weight lifting and like cycling as well. I mean, all kinds of different stuff. We just, like staying as active as I can.
+
+D: OK, alright yeah, given your young age and the fact that you do a lot of running and a lot of physical activity like cycling and lifting weights, what you have is most likely something called a Patellofemoral syndrome and that is basically a nerve. Uh kind of pain and then in the in the soft tissues and bone around your kneecap. Uhm, and it's basically happens because of overuse, so vigorous physical activities that put repeated stress on your knees, like running and cycling, uhm, can cause that or just like improper sports training techniques. Uhm, we can do a few things that that'll help with the pain. So for a little bit, if you could hold off on the running that would be good. So, in the meantime, while you while you switch to like low impact activities, whether that's like riding a stationary bike or swimming, you can also try something called the RICE method and so that stands for resting, uhm, so avoiding putting any strain on that knee using ice packs for several days, compression, so wrapping your knee in like an elastic bandage, as well as elevating your knees higher than your, then the level of your chest can help. And then with the sharp pain you could also also take ibuprofen for pain management. Uhm, yeah, so we can start there if it doesn't get better we can also order an x-ray just to rule out other things that could have caused this pain in your knee. And if none of those nonsurgical treatments work, oh sorry, I also forgot to mention will also refer you to physiotherapy to help you with the range of motion and strength and endurance. But of those non surgical treatments work we'll also refer you to like am arthroscopy or some sort of surgery that may be able to fix the issue more permanently. Does that sound OK?
+
+P: It does, yeah, thank you.
+
+D: OK, yeah, no worries.
+

MSK0022.txt

@@ -0,0 +1,221 @@
+D: What brings you here today?
+
+P: I have been having this, pains in my in my joints that's been ongoing now for the last several months and it's been getting worse over this period of time.
+
+D: OK, so several months, is the pain, so where, where exactly is the pain?
+
+P: So I get it in some of the joints in my hands. And then also my feet as well. So yeah my. Yeah, really in my feet and my hands.
+
+D: OK, and what kind of pain is it, is it like an aching pain, is it sharp pain?
+
+P: It'll be a bit at achey when it's there, but I if I move the joints at all when it's really sore, I can get a sharp pain as well.
+
+D: OK, and is this pain worse at all at any particular time of the day?
+
+P: Yeah, I would say in the morning time or if there's any period of time where I I'm like sitting and resting for awhile and I get up to move. I have a lot of stiffness and it takes me over an hour, sometimes to just get moving.
+
+D: OK, um so so if I understand it clearly it's. You get, do you get like morning you get morning stiffness and then when you're not very active or not doing things but then it gets better with movement?
+
+P: Yeah, exactly, yeah there's morning stiffness and it does get a little bit better with with movement.
+
+D: OK, do you have any of this pain or stiffness in the bigger joints in your body, like the hips or the knees or your shoulders?
+
+P: Uh, no nothing, no. Just really the small joints.
+
+D: OK in the morning stiffness lasts more than 30 minutes you said?
+
+P: It does, yeah.
+
+D: Yes, OK. Is is it symmetrical like is the pain symmetrical as in is it happening in both hands in the same areas and both feet in the same areas?
+
+P: Yeah it is actually now that you mentioned that, it is symmetrical. I'm noticing that it's the same. It's the same joints on both sides of my body that I'm seeing that are affected.
+
+D: OK now yeah, I I just have. Yeah, this one particular question. It's pretty specific, so when you look at your hands in which joints are painful. In your fingers is, do you, do you have any pain or swelling in the last joints like so just um, just, below the tip of your fingers?
+
+P: No, actually like the those joints are all, have been fine. I can move the tips of my fingers no problem, and I haven't had any joint swelling or pain in the tips of my fingers.
+
+D: OK, and how about, have you had any pain at all in the, I guess the first joints of the finger. So when you make a fist like the first joint that bends?
+
+P: Oh yeah, like my knuckles, you mean?
+
+D: Yeah that your knuckles.
+
+P: Yeah, yeah those actually. Those are the worst I can notice, those kind of on the like on my index finger, middle finger and and ring finger on both sides they they all look like they're swollen and and those hurt hurt really bad.
+
+D: OK, and in your feet, which joints would you say are hurting the most?
+
+P: I, I would say the like the big toe joint. On both of my feet, those bother me. Yeah, but my big my big toe on on both feet, but my right foot's worse than the other.
+
+D: OK, I see OK. And are you getting any pain in any other joints?
+
+P: Um actually yeah my my right ankle bugs me a little bit. I'm sorry if that's considered a large joint. But yeah, my ankle hurts and then also my in my hands I have. Like the middle one. Not proximal interphalangeal joint, yeah those ones hurt too.
+
+D: OK. 
+
+P: I think I have like more than 10 joints that are swollen and painful. 
+
+D: OK, I see and has this pain been pretty constant or have there been days that you don't have the pain?
+
+P: Yeah, there are days that are better than others for sure. It just. I'm not really too sure what the reason it is like. Maybe I'm just more rested or something like that, but. There are days that that are better, but over the last several months it's been getting getting worse.
+
+D: OK, and how much would you rate the pain from zero to 10, 10 being the worst pain you felt in your life?
+
+P: I would say it's probably a 6.
+
+D: OK, have you tried any medications at all to help with your, help relieve your symptoms?
+
+P: Yeah, I've been trying. Um acetaminophen and different types of anti-inflammatories like ibuprofen or Advil and I've tried creams and stuff too but it it doesn't seem to, help.
+
+D: OK. Are you feeling any other symptoms at all, like fevers or chills?
+
+P: Um I do. I have felt a bit warm.
+
+D: A bit warm, OK and how long has that been going on for?
+
+P: So it that varies as well, like some days I'll get. I'll feel like feverish for a little bit and it will kind of go away. I haven't checked my temperature, but, it I have felt warm at times.
+
+D: OK, and have you lost any movement in any of these joints at all?
+
+P: Uh it is harder to to make a fist. Yeah I can't fully close my my fingers all the way down to make a fist.
+
+D: I see. OK. Any kind of a um night sweats at all? 
+
+P: No.
+
+D: Any weight loss?
+
+P: Um, well I think a few pounds, I just haven't really been as as hungry now. Yeah, my appetite hasn't been been as good recently.
+
+D: OK, any skin changes or rashes?
+
+P: I over a couple of the joints, I do notice some some redness, but just over the the joints on my hand I can have some redness.
+
+D: OK, but you don't notice any changes anywhere else?
+
+P: No nowhere else.
+
+D: OK, any changes in your vision or hearing?
+
+P: No changes to vision or hearing.
+
+D: OK. Any shortness of breath, chest pain?
+
+P: No. 
+
+D: Any changes in your bowel movements?
+
+P: No, that's been normal.
+
+D: OK, any changes in your urinary patterns?
+
+P: Nope, I haven't had any pain or anything like that. 
+
+D: OK, any numbness or tingling sensation anywhere, anywhere in your body?
+
+P: Nope, I haven't had anything like that.
+
+D: OK, have you been sick at all recently, either with like cold symptoms of any viral symptoms?
+
+P: No, I felt OK.
+
+D: OK and any muscle weakness? 
+
+P: I. I don't think so. I've just I I have had trouble like opening jars and various things, but I think that's part of the, um like pain that I'm having in my in my hands it makes it hard to grip. 
+
+D: OK, uhm. And in terms of your medical history, have you been diagnosed with any conditions?
+
+P: Uh, yeah I have a low thyroid and or or hypothyroidism. I think it's called I and I also have. Uh, high blood pressure, so I take my medication for high blood pressure and and something for the thyroid as well.
+
+D: OK, and when were you diagnosed with the hypothyroidism?
+
+P: Um this was about I like four years ago.
+
+D: OK, today tell you what it was caused by it at all. 
+
+P: Oh, I think I was, I think they said Hashimoto's.
+
+D: OK, OK, OK, and since then you've been on the thyroid medication?
+
+P: Yeah, I think it's like Synthroid or or something like that. Yeah I think Synthroid.
+
+D: Alright. Any other medications at all that you take regularly?
+
+P: Yeah, I think it, I'm taking an ACE inhibitor for the blood pressure.
+
+D: OK, any allergies to any medications that you know?
+
+P: Uh, no. 
+
+D: OK, any hospitalizations or surgeries in the past?
+
+P: No.
+
+D: OK. Any family history of any autoimmune conditions? 
+
+P: My mom had hypothyroidism as well, and uh, and that's it. 
+
+D: OK, so anything else like rheumatoid arthritis, ulcertaive colitis, Crohn's disease, type one, diabetes, anything like that?
+
+P: I I think my cousin actually has type one diabetes. He's a, like he's much younger than me, but yeah, I think he I have a cousin with type one diabetes as well. 
+
+D: OK. Alright, and um currently do you work?
+
+P: Yeah, I've been working as a administrator so it's been tough on the computer with with how my hands have been causing me pain.
+
+D: Oh so from the typing also gives you some pain?
+
+P: Yeah I can. It can give me a little bit of pain, but once my hands start moving it's it's OK. It's just I'm a bit slower at my job with with how it is, especially starting in the morning.
+
+D: OK, I see. OK, and currently what's your living situation like?
+
+P: So I live with my husband as well as our, uh, our daughter. She's 4.
+
+D: OK, and are you currently right now, do you smoke at all?
+
+P: I I don't. I quit smoking four years ago when my daughter was born and before that I didn't smoke much to me anyway it was I was only smoking like you like maybe four or five cigarettes a day so I just stopped then.
+
+D: OK, that's really good. Uh, uh, congratulations.
+
+P: Thank you.
+
+D: Yeah, and other than that, do you use any recreational drugs like marijuana?
+
+D: Uh, no, I don't. OK, how about alcohol?
+
+P: I'll have a glass of wine sometimes, but very rarely.
+
+D: OK. Um yeah, so those are just some of the questions I had for you now. I just wanted to ask a few questions regarding just physically examining the joints that hurt. So when you look at those joints, do you notice any kind of swelling, redness, or when you feel any warmth to them?
+
+P: Yes I yeah I do. I feel swelling, warmth and redness.
+
+D: OK, and do you notice any kind of deformities, for example like you're not able to bend your finger or any kind of deformities that you didn't see before? Or, like, for example, your wrist is turned uh, outwards a little bit. Anything like that?
+
+P: Uh, no, nothing like that, no deformity.
+
+D: No deformities. OK, when you go over your joints, do you notice any kind of like nodules or harder materials that don't seem to be your bones?
+
+P: Not really, no. No, I don't notice anything like that. They just share a bit larger from the swelling it feels like.
+
+D: OK, I see. Are you able to make a fist with both both hands?
+
+P: Not completely, I can close my hands part of the way, but I can't make a full fist.
+
+D: I see. OK and are you able to completely extend your fingers and show your palms?
+
+P: Yeah I can do. I can do that.
+
+D: OK. And are you able to walk without a limp or anything like that?
+
+P: Um, yes I can. 
+
+D: OK. Alright, so those are just all the questions I had for you today. Do you have any questions or concerns?
+
+P: Um no, I'm just wondering what what this could be.
+
+D: Yeah, so from what you're describing to me you do fit into. The age range and all the symptoms are kind of point towards arthritis, and in this case it sounds more like rheumatoid arthritis. Ddefinitely it can be different types of arthritis that we will investigate just in case as well. But given that it's symmetrical, you have the morning stiffness that doesn't go away for more than 30 minutes and just the pattern of where those where the stiffness and pain is occurring itt sounds more likely to be rheumatoid arthritis, especially since you've also, you also have another autoimmune condition with hypothyroidism, it's more likely to be another autoimmune condition. So what we will do is get a few tests done. This will involve some blood work as well. And we will also get some imaging done, so we will get like the CRP and ESR for inflammatory markers we will get like your full CBC blood count we will get rheumatoid factor test done as well as antinuclear antibody and a lot of other different just markers to rule out anything else besides rheumatoid arthritis and then we will also get just X-Rays of your hands and feet as well. So does that sound good?
+
+P: It does, yeah, thank you.
+
+D: You're welcome. And then if it does come out to be rheumatoid arthritis arthritis, which seems likely, you will need a referral to a rheumatologist to manage and treat your, uh, treat you with medications.
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+D: OK, thank you alright, you're welcome. Take care.