Subjective examination – Analysis

Please read the case study SE and form as many hypotheses as you can with each
piece of information as you read (under each of the sections of the SE). You need to
start forming hypotheses from the first section of the SE, i.e. social history - age, as
clinical reasoning is an evolving concept that we do as we assess

What hypotheses can you form about:

-age

-occupation

-hobbies

- activity/exercise levels

- Information on body chart: symptom distribution, nature / description of

pain/symptoms etc

- factors

- factors

- 24 hr pain pattern

- Mandatory questions

- HPC

- PMH

- Patients perceptions and expectations

Which of your hypotheses is most positive – i.e. what is your working

diagnosis that you need to negate or prove in the OE? what is the
main driver of pain?

Then complete the planning the OE worksheet (see below)

Updated September 2019 (D Liddle) 1

 PLANNING THE OBJECTIVE EXAMINATION

1. What is the irritability of the patient’s condition?

2. How much can you assess on day one?

3. Does any aspect of the S/E indicate caution?

4. What aspects of the S/E may indicate there are neurological

changes?

5. What psychosocial involvement is there?

6. What areas must you examine?

7. Do you expect an objective comparable sign to be easy or hard to

find? Explain.

8. On palpation what relationship do you think you might find

between pain and resistance?

9. What aspects of the S/E indicate likely objective findings?

10.What are the main drivers of this patient’s pain/disability?

Updated September 2019 (D Liddle) 2