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.
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.
Imaging of bones and joints, blood tests and synovial fluid analysis are the three main types of investigations which can be useful in assessing a patient’s joint problems. This section provides further detail on each of these.
The musculoskeletal history
History taking is an important skill for doctors or practitioners - achieved with regular practice. Learn the four important areas for musculoskeletal history.