腰痛和膝关节痛是骨科常见病。本节通过模拟腰痛患者和关节痛患者门诊首诊时与骨科医生的情景对话，介绍了常用英语专业词汇和句型，其病史采集过程符合临床实际和其内容的完整性。此外，对话中所用的语气语态旨在体现国外医患间交流时的氛围和常用语。帮助中国医生了解东西方文化背景方面的差异和提高专业英语交流水平，避免因“中式英语”的生硬造成外籍患者的误解和失礼。文尾的框内提示病史采集中必须问及的内容。

Low back pain is a common disorder involving the muscles and bones of the back and is one of the most common complaints in the outpatient setting.Almost everyone will experience low back pain at some point in their lives.

There are many causes of low back pain.Conditions commonly linked to back pain include: muscle or ligament strain, bulging or ruptured disks, arthritis,skeletal irregularities and osteoporosis.Degenerative disc disease is the most common cause of low back pain,especially in the elderly and middle-age adults.

Obtaining a good history and physical examination is essential for the diagnosis.X-ray is often used as an initial screening of low back pain.CT and MRI can further display bone structure and degeneration of the intervertebral discs clearly.

In spite of the multiple reasons attributed to low back pain, it is usually manageable with various conservative treatment options.Patients can take measures, such as rest, physical therapy and medication, to prevent or lessen most back pain episodes.Simple home treatment and proper body mechanics will often heal your back within a few weeks.Surgery, in general, is rarely needed to treat back pain but is helpful in cases of severe disc herniation or spinal stenosis, which can cause compression of nerve root or spinal cord.

Scene: Mr.Robinson, a 46 years old male, visits a spine clinic for his low back pain.

P: Hi, doctor!

D: How are you, Mr.Robinson! I’m Dr.Charles, a spine doctor.Please have a seat.How can I help you today?

P: I have had pain in my lower back for a week now,and it’s getting worse for the past two days.

D: I’m sorry to hear that! Could you tell me more about it? How did it start?

P: I was bending over to lift a box a week ago, and suddenly felt a sharp pain in my lower back.I didn’t worry about much, but for the last two days, I started to feel pain and numbness over the outer side of my right leg in addition to my back pain.

D: How would you describe your pain?(Is it sharp,stabbing, dull, achy, or burning?)

P: It has been dull type and continuous.Sometimes the pain was sharp, which radiated from my buttock to the right ankle after sitting down for long or try to stretch my legs.

D: What makes the pain worse and what makes it better?(What will aggravate and alleviate it?)

P: Ah yes, the pain gets worse when I cough, sneeze,or when I sit down in a chair.Lying down in bed or taking a hot bath makes it better.

D: How bad is the pain now? If you could rate the pain from 1 to 10, with 1 being no pain and 10 being the worst pain you’ve ever experienced, what would you give it?

P: Oh I think it’s a six to seven out of ten.I cannot drive or walk for long because of the pain.

D: Did you hurt your back before this time?

P: Not at all.

D: Did you have any other symptoms, such as fever,chills, night sweats, weight loss, decreased appetite,or waking up in middle of the night because of the pain?

P: No, none of that.

D: Do you have problems controlling your urine or bowel?(Asking for urinary and bowel incontinence).

P: No.

D: Do you have painful or swollen of joints?

P: No, I do not have(Negative).

D: Does anyone in your family have similar problems?

P: No, they don’t.

D: What other medical problems do you have?

P: I was diagnosed with high cholesterol last summer.I have been taking medicine for that since.I am also overweight.

D: Do you smoke, drink, or do any recreational drugs?(Would you mind to tell me about your personal habits?)

P: I am a vegetarian, non-drinker but a heavy smoker.I do exercise but not very often.

D: Do you have any allergies to medications or any other allergies(asking for allergy to food, seasonal allergies,etc.)

P: Yes.I am allergic to penicillin.

D: Great! Now I need to do a physical exam.Is it okay if I begin by taking a look at your back and legs first?

P: No problem, go ahead.

D: Mr.Robinson, from your history and my physical exam, I suspect that you have dislocated a disc of your lower back(lumbar spine).I recommend(would like to suggest)that we get an X-ray and MRI of your lumbar spine, as well as some blood tests in order to confirm the diagnosis.

P: Sure, no problem.

D: Good! Let me schedule the imaging studies for you and order the blood tests.You can get them done this afternoon at our imaging department before leaving the hospital.The results should be back tomorrow and I will update you then.Let’s have you come back in a few days to discuss treatment options.In the interim,you should rest your back and can take some mild pain medications(such as acetaminophen, ibuprofen)for relief.Do you have any questions?

P: No.Thank you Doc!

D: My pleasure!

Knee pain is a common complaint that affects people of all ages.Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage.Medical conditions including arthritis, gout and infections and rarely bone tumors also can cause knee pain.Degenerative arthritis is the most common cause of knee pain in old population.

It is important to make an accurate diagnosis of the cause of knee pain so that appropriate treatment can be directed.X-ray is an effective method to diagnose the knee joint degeneration and exclude other problems of the bones.For differential diagnosis, blood tests or aspiration may be needed.As routine X-rays do not reveal cartilage and soft tissue, MRI and arthroscopy are recommended for identifying disorders of meniscus and ligaments in the joints.

Many types of minor knee pain respond well to selfcare measures.Physical therapy and knee braces also can help relieve knee pain.In some cases, surgery is required.For severe degenerative arthritis, arthroplasty is the final solution.

Scene： Mr.Philip, a middle-age male with painful knees,visits an orthopaedic surgeon at a knee clinic.

P: Hello, doctor!

D: Good morning, Mr.Philip! Please have a seat.I am Dr.Ryan, a specialist in knee surgery.How can I help you today?

P: Nice to meet you, doctor.I am experiencing pain in my knees for the past two weeks.(I have knee pain that started two weeks ago.)

D: I am sorry to hear that! How did it start?(Can you recall how it started?)For example, was there any injury to your knees before the pain started?(Did your knee get hurt before the pain started? / Did the pain started after some kind of knee injury?)

P: No, there was not.It started without a particular cause.At first, I felt the pain only while climbing up and going down stairs.Now, they hurt while I walk for a long distance or when I squat.

D: Can you describe the nature(character)of your knee pain?

P: I feel pain and swelling in both knees but it’s more severe in the right.The pain is dull with some tingling.

D: Does the pain radiate(move to)to other parts of your legs?

P: No.It’s just inside my knees, particularly, in inner(medial)side of the knee.

D: Does the pain affect your sleep at night?

P: No.It does not.However, my knees are stiff the next morning.After moving for a while, they get better.

D: Have you ever felt your knees stuck while walking?

P: No, I have not, but they feel weak recently.

D: Do you have pain in other joints besides the knees?

P: No, I do not.

D: Have you suffered from red, hot and swollen knee before?

P: No, I never have.

D: Have you tried(received)any method(medication)to relieve(manage)your knee pain?

P: Yes, I did hot compress(hot fomentation)which did help for reducing the pain.If it got worse, I took pain killers to relieve the pain.

D: Have you had other pain accompanied with other problems like fever, decreased appetite, weight loss or skin rashes?

P: None.

D: Would you mind to tell me what you are doing for a living?

P: I was in the army for 35 years and retired one year ago.Now I live in countryside and do a bit of farming and gardening daily.

D: Do you have any other illnesses or significant medical problems in your family?

P: I have had high blood pressure and have been taking medication for three years.My blood pressure is well controlled now.

D: Do you smoke, drink, or do any recreational drugs?(Would you mind to tell me about your personal habits?)

P: I eat a regular diet and do not smoke.I drink but not very often, once per week usually.I used to do sports but no longer do so because of my knee problem.

D: Do your parents or siblings have the same problem?

P: Yes, my mother suffered from severe knee pain when she was older.

D: Do you have any medication allergies?

P: No, not that I am aware of.

D: Well, thank you for telling me about your problem.Next,I would like to examine your knees if you don’t mind.

P: No problem.

D: Mr.Philip, now, I suspect highly that your knee pain is the result of osteoarthritis of the joints after your story and my exam.I will need to order X-rays of your knees to confirm the diagnosis.After viewing the X-ray films I will be able to explain to you what is going on in your knees and how serious the condition may be.I will also advise you on treatment, or may ask you to do further tests if they are necessary,accordingly.Do you have any questions so far?

P: Sure, where can I have my x-ray done? Does it take long time?

D: It doesn’t take long! A nurse will accompany you to do it while you are here.It will take about one hour to complete.

P: Thank you very much, Dr.Ryan!

D: You are welcome! See you soon!