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Clinical Guide
MSK History Manual
Integrating GMT's SQITARPS Framework with Advanced Clinical Pearls.
Why MSK is Different
MSK pathology requires specific biomechanical and temporal discriminators. Mechanism (how it happened) and timing (when it swelled, when it hurts) are diagnostic keys that generic frameworks miss.
Includes:
- The Full SQITARPS Framework
- Path-Specific Dialogue Scripts
- Advanced Red Flag Screening
Edition: 2026 Clinical Format Version
1
Introduction, Consent & Confidentiality
What to say
"Hello, I'm Dr. [Name]. Can I confirm your name and date of birth? I've been asked to take your history today, would that be alright with you? Everything we discuss will remain strictly confidential."
- WIPER: Always wash hands, ensure privacy, and introduce your specific role.
2
Handedness & Baseline
What to ask
"Are you right or left-handed? What do you do for a living, and what is your normal baseline mobility?"
- Handedness: Mandatory for any upper limb presentation to assess functional impact.
3
Presenting Complaint & Shared Agenda
What to ask
"What has brought you in to see me today?"(If the patient lists multiple complaints): "You’ve mentioned a few problems today. Which issue is your top priority right now?"
4
HPC: SQITARPS (Site, Quality, Intensity)
What to ask
"Can you point with one finger to exactly where it hurts the most? Does the pain shoot anywhere else?What does the pain feel like—is it an ache, a sharp catch, or burning?
On a scale of 0 to 10, how bad is the pain when you are completely resting, and how bad is it when you move or put weight on it?"
- The 'One Finger' Rule: Helps distinguish joint vs tendon/bursa.
- Dual-Assessment Intensity: MSK pain must be quantified at rest AND under mechanical load.
5
HPC: Mechanism & Timing
Choose the Correct Path
TRAUMA PATH
"Talk me through exactly what happened. Did you get hit, or did you twist it? Did you hear or feel a pop or snap? Were you able to continue playing/walking, or did you stop immediately?"
"Talk me through exactly what happened. Did you get hit, or did you twist it? Did you hear or feel a pop or snap? Were you able to continue playing/walking, or did you stop immediately?"
CHRONIC PATH
"How long has this been building up? Is the pain constant, or does it come and go?"
"How long has this been building up? Is the pain constant, or does it come and go?"
6
HPC: Aggravating, Relieving, Previous
What to ask
"Are there specific movements or positions that guarantee the pain will happen? What have you found that helps ease it?"
TRAUMA PATH
"Have you ever dislocated this joint or broken a bone before?"
"Have you ever dislocated this joint or broken a bone before?"
CHRONIC PATH
"Have you had a flare-up of this pain before? Have you ever been diagnosed with arthritis or a joint condition?"
"Have you had a flare-up of this pain before? Have you ever been diagnosed with arthritis or a joint condition?"
7
HPC: Secondary Symptoms
What to ask
TRAUMA PATH
"Did it swell up immediately within the first hour, or not until the next day? Have you felt the joint lock, catch, or give way underneath you?"
"Did it swell up immediately within the first hour, or not until the next day? Have you felt the joint lock, catch, or give way underneath you?"
CHRONIC PATH
"Does the joint feel stiff first thing in the morning? If so, exactly how many minutes does it take to loosen up?"
"Does the joint feel stiff first thing in the morning? If so, exactly how many minutes does it take to loosen up?"
8
Red Flags (Trauma & Urgent)
Critical Rule-outs
"Since this happened, have you been able to take four complete steps without help?Have you noticed any numbness, tingling, or coldness in the limb below the injury?
Is the pain getting severely worse despite painkillers?
Have you felt feverish, had chills, or felt generally unwell?"
9
Red Flags (Systemic & Spine)
Critical Rule-outs
"Does the pain wake you up at night even when you are resting?Have you had any unexplained weight loss?
(If Back Pain): Have you noticed any numbness around your groin or saddle area? Have you had any new problems controlling your bladder or bowels? Have you noticed weakness in both of your legs?"
10
Ideas, Concerns & Expectations (ICE)
What to ask
"What do you think is going on with the joint?What is your main concern right now regarding this injury?
What were you hoping we would do for you today?"
11
Past Medical & Surgical History (PMH/PSH)
What to ask
"Do you have any medical conditions, specifically diabetes, osteoporosis, or bleeding disorders? Have you had any previous operations on this joint or any metalwork put in?"
12
Medications & Allergies
What to ask
"Are you taking any blood thinners, steroids, statins, or over-the-counter anti-inflammatories?Do you have any allergies, and if so, what happens when you take them?"
13
Family History
What to ask
"Do any joint diseases, autoimmune conditions, or bleeding disorders run in your family?"
14
Social History & Functional Impact (ADLs)
What to ask
"Do you smoke or drink?What sports do you play, and at what level?
Are you struggling with daily tasks like walking up stairs, driving, or getting dressed?"
15
Systemic Review
What to ask
"Before we finish, have you had any unexpected weight loss or night sweats? Any new rashes, red or painful eyes, mouth ulcers, or changes in your bowel habits?"
16
Summary & Verification
What to say
"To summarize, you are a [age]-year-old presenting with [mechanism/onset], and it has been affecting your ability to [ADL]. Does that sound accurate? Is there anything else I've missed?"
17
Safety Netting & Closing
What to say
"If your pain drastically worsens, you develop numbness, the limb turns pale or cold, or you spike a fever, you must return to the emergency department immediately. Thank you for your time."
Live Session Score
0 / 17
History-Taking Flow
01 Intro & Consent
02 Handedness
03 PC & Agenda
04 SQITARPS
05 Mechanism
06 Agg/Rel/Prev
07 Secondary Sxs
08 Acute Flags
09 Spine Flags
10 ICE
11 PMH / PSH
12 Meds / Allergies
13 Family Hx
14 Social / ADLs
15 Systemic
16 Summary
17 Safety Net