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The Orthopaedic History
The author wishes to acknowledge the contribution of John G. Birch for his work in the previous edition version of this chapter.
The comprehensive pediatric orthopaedic history includes questions that are not normally asked as part of routine history taking in adult patients. A history of the mother’s pregnancy, the neonatal period, the child’s neurologic development, and the family history often have a much greater impact on the subsequent physical examination and diagnosis in children than in adults. An outline of pertinent historical features included in the initial history and physical examination used at Texas Scottish Rite Hospital for Children in Dallas is presented in Chapter 3 (see Appendix 3.1).
Chief Complaint
The orthopaedic history starts by recording the chief or presenting complaint or complaints. Common musculoskeletal complaints include deformities, limp, localized or generalized weakness, and joint swelling, pain, and stiffness. With pediatric patients, the orthopaedist needs to determine whether the chief complaint is the concern of the child, the parents, a schoolteacher, or some other person.
History of Present Illness
Next the examiner should develop a clear, chronologic narrative of the present problem, including its onset, the setting in which it developed, its manifestations, and any previous treatments. The principal symptoms should be described according to their location, quality, quantity or severity, timing (onset, duration, frequency), setting, aggravating or relieving factors, and any associated manifestations.
Because the musculoskeletal system is involved with support and locomotion, many related symptoms are caused by physical stress and motion. Thus it is important to determine whether the patient’s symptoms are related to physical activity. If the patient has any history of injury, details of the trauma should be investigated to determine its significance to the present complaint.
All this information must be put into the proper context based on the patient’s age (i.e., what the child’s status should be in normal growth and development). Finally, the examiner should determine how each family member responds to the child’s symptoms, why he or she is concerned, and the secondary gains the child (or other individuals) may acquire from the illness.
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