Chapter 1. Introduction

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.

1. Screening musculoskeletal examination (SMSE): a rapid assessment of structure and function

2. General musculoskeletal examination (GMSE): a comprehensive assessment of joint inflammation and arthritis

3. 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.

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.

The general musculoskeletal examination (GMSE) is designed to build directly on the sequence and techniques taught in the SMSE. It is intended to provide a comprehensive assessment of joint inflammation through the use of palpation and permits the recognition of joint swelling, essential to the physical diagnosis of arthritis. The skills involved require practice and careful attention to detail, but the proper techniques of joint palpation can be mastered on normal individuals. The GMSE is clinically useful as the initial examination in individuals with generalized musculoskeletal complaints (possible arthritis or connective tissue disease) and in individuals with apparently local or regional musculoskeletal complaints found to have additional abnormalities on the SMSE. With practice, the GMSE can be preformed in ∼6 to 8 minutes.

The regional musculoskeletal examinations (RMSE) of the shoulder, knee, neck, and low back are designed to build on the sequences ...