Introduction

Why Systematic Musculoskeletal Examinations?

Musculoskeletal complaints and rheumatic diseases account for at least 15% to 20% of all visits to a physician. Because these problems are most often evaluated and treated by generalist physicians (internists, family physicians, and pediatricians) and physical therapists, it is essential for primary care providers to acquire an organized approach to the musculoskeletal examination.

Systematic Musculoskeletal Examinations is a three-part vertically integrated curriculum designed to teach essential and foundational skills of musculoskeletal physical assessment, particularly useful for students, residents in training, physical therapists, nurse practitioners, physician assistants, and practicing physicians.

Screening musculoskeletal examination (SMSE): a rapid assessment of structure and function
General musculoskeletal examination (GMSE): a comprehensive assessment of joint inflammation and arthritis
Regional musculoskeletal examinations (RMSE): focused assessments of structure and function combined with special testing of shoulder, knee, neck, and low back

The patient’s history is the essential first step in all musculoskeletal diagnosis and directs the focus of an appropriate examination. The musculoskeletal physical examination is used to confirm or refute diagnostic hypotheses generated by a thoughtful history. Since the diagnosis of nearly all musculoskeletal problems depends on the demonstration of objective physical findings, the musculoskeletal examination has enormous importance. The patient’s chief complaint and the clinical context will direct your initial choice of the screening, general, or regional musculoskeletal examinations.

II. Skill Building: More Than “Head” Knowledge

The screening musculoskeletal examination (SMSE) is designed to provide an introduction to the physical assessment of musculoskeletal structures: joints, ligaments, tendons, muscles, and bones. It is intended to facilitate recognition of normal joint appearance and alignment, the spectrum of normal joint range of motion (ROM), and basic abnormalities of musculoskeletal structure and function. As a screening examination, it is brief yet systematic, is easily preformed, and increases examiner confidence that no important musculoskeletal findings have been overlooked. The SMSE is clinically useful as the musculoskeletal component of a complete physical examination (complete checkup) or athletic preparticipation physical examination. With practice, the SMSE can be performed in ∼3 to 4 minutes.