Introduction to the musculoskeletal assessment

It is estimated that musculoskeletal disorders account for approximately 30 per cent of a GP’s workload ⁽¹⁾ and are the most common cause of repeat consultations in primary care. About 30 per cent of those with any physical disability, and 60 per cent of those with a severe disability, have a musculoskeletal disorder as the primary cause of their problems.

Clinical assessment skills – i.e. history taking and examination – are the key to making an accurate diagnosis and appropriately managing any patient presenting with a musculoskeletal problem. 

Initial approach

Before considering a diagnosis, it is useful to try to broadly categorise the symptoms and signs (from the history and examination) by answering the following key questions:

• Are the symptoms from the joint itself or the soft tissues (tendons/muscles)?
• Is the condition acute or chronic?
• Is the condition inflammatory or non-inflammatory?
• What is the pattern of affected areas/joints?
• What is the impact of the condition on the patient’s life?
• Are other systems involved?

The answers to these questions should enable you to produce a succinct summary of the patient’s condition and would lead you to a narrower differential diagnosis. An example of a patient summary produced using this method might be:

‘This patient has a chronic symmetrical inflammatory polyarthritis, mainly affecting the small joints of the hands and feet, which is causing pain, difficulty with dressing and hygiene, and is limiting their mobility.’

References: ⁽¹⁾ Department of Health, 2006. The musculoskeletal services framework. A joint responsibility: doing it differently.