The musculo-skeletal examination: a neglected clinical skill

Aust N Z J Med. 1991 Jun;21(3):303-6. doi: 10.1111/j.1445-5994.1991.tb04694.x.

Abstract

One hundred and sixty-six patients admitted to general medical wards of a teaching hospital were examined on the day of discharge to determine whether they had been assessed for musculoskeletal disorders during their admission. Of these patients, 54.8% had musculo-skeletal symptoms with 17.5% having a significant rheumatological disorder which had been ignored. A history of musculo-skeletal symptoms was recorded in 40.4% of all patients and the examination in only 14.5%. This contrasted with the documentation of the cardiovascular (99.4%), respiratory (100%), gastrointestinal (97.6%) and central nervous (53%) systems' examination. Eighty per cent of symptomatic patients received either no treatment for their rheumatic disorder, or treatment that we regarded as suboptimal or inappropriate. Musculo-skeletal symptoms are common in patients admitted to medical wards, but are being inadequately assessed or at worst ignored. The omission of the musculo-skeletal system examination, in contrast to the almost universal inclusion of other systems' examination, demands correction. Undergraduate and postgraduate training programmes require re-evaluation. The implications of these findings are discussed.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Diseases / diagnosis*
  • Clinical Competence
  • Diagnostic Tests, Routine / methods*
  • Diagnostic Tests, Routine / statistics & numerical data
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscular Diseases / diagnosis*
  • Physical Examination / methods*
  • Physical Examination / statistics & numerical data