Accurate and thorough history-taking, followed by a meticulous clinical examination and laboratory investigations and imaging modalities (when required) are essential to treat patients who visit your clinic with symptoms associated with musculoskeletal dysfunction. Although the diagnostic and therapeutic approach should follow clinical practice guidelines outlined for physicians, a flexible approach needs to be employed. Although it is important that clinicians have thorough knowledge of diseases, it is advisable not to adhere too strictly to existing knowledge but to analyze facts and data obtained during the clinical interview.
Many muscle diseases show an onset during the early years of life. An alert woman may notice paucity of fetal movements during pregnancy. When interviewing adults, it is useful to obtain details if possible, regarding their developmental motor milestones and exercise ability in childhood. Moreover, their performance at gymnastic classes and sports activity, for example, might prove informative. Most patients tend to remember such information, and these details can provide vital clues for accurate diagnosis.
Obtaining a patient’s occupational history and details regarding his/her daily routine is important to assess whether the patient’s present muscle power is normal or weakened. Establishing an accurate timeline to assess changes in a patient’s motor ability is difficult. The following questions could provide clues: “Could you participate in hiking, mountain climbing, swimming, or golf?”, “When did you first notice difficulty in climbing stairs?” or “When did you notice deterioration in sports performance?”
Information regarding difficulties in routine tasks, such as rising from a low chair, toe standing, raising arms overhead to brush hair, and unscrewing a bottle cap, provides clues regarding the pattern of muscle weakness (proximal vs. distal muscle involvement). Therefore, listening to patients carefully and asking relevant questions is essential.