Why Patient History is Important

When most of us learned musculoskeletal assessment, we spent hours practicing clinical tests—Lachman, Neer’s, Spurling’s, McMurray’s. These maneuvers became the cornerstone of our physical exams, tools we hoped would pinpoint pathology with precision. But here’s the reality: the single most powerful diagnostic tool isn’t a clinical test—it’s the patient’s history. Multiple studies across medicine support the same conclusion:

Up to 80–85% of diagnoses can be made from a thorough patient history alone.
The physical exam and clinical tests refine the picture, but they rarely replace the insights gained through a well-structured interview.

Variable accuracy: Many tests have inconsistent sensitivity and specificity, often depending on examiner skill and patient factors. Pain and weakness, for example, are common factors for a positive clinical test. But how much pain and how much weakness, constitutes a confident interpretation of a test?
Overlapping findings: Different pathologies can produce positive results on the same test (e.g., shoulder impingement tests). Many tests incriminate multiple structures (e.g., Speed’s test).
Context dependency: A positive test without clinical context can easily mislead decision-making. A positive test may not correspond with the “pain that caused the individual to seek treatment.”

Mechanism of Injury
- Was the ankle twisted inward during sport?
- Was the pain gradual from overuse?
- What were the conditions around the injury? Weather, field, shoes, etc
Symptom Behavior
- Does pain worsen at night?
- Does pain change with activity?
- Does pain get better with rest?
Past Medical and Surgical History
- A prior ACL reconstruction changes the likelihood of new instability.
- A history of cancer reframes bone pain entirely.
- Systemic issues can drive thoughts about comordities.
Functional Limitations
- What can the patient no longer do? Climbing stairs, gripping objects, running? Function points directly to structures under stress.
Red Flags
- Only history reveals critical signs like unexplained weight loss, fevers, or changes in bladder function.

Patient A: Reports a fall onto an outstretched hand with immediate weakness and inability to lift the arm.
Patient B: Reports months of dull shoulder pain, worse with overhead activity, and improved with rest.