Musculoskeletal Examination Skills: Are We Still Interested?


This article explores problems and solutions of Musculoskeletal (MSK) examinations skills and points out that it is very important to keep medical educators interested to improve the situation of MSK teaching. MSK conditions are usually overlooked though they represent 20% of both primary care and emergency-room visits of the most common health complications that require medical attention across the world. MSK disorders can lead to serious disabilities and significant burden and though its problems are expected to increase, there is a continuous neglect in musculoskeletal examination skills in clinical practice. To participate in solving this problem, the article accentuates the necessity of defining MSK competencies and of agreeing on standards of MSK exams and calls for an integrated teaching of MSK examination skills that uses interactive methodologies like patients’ educators and peer-assisted learning. This article comprises four parts, an introduction, a description of the deficiencies in musculoskeletal examination skills, the causes of these deficiencies and finally some solutions of musculoskeletal examination skills deficiencies. We venture to bring attention to an overlooked but major analyses constituent that impacts patients’ overall health.

Share and Cite:

H. Almoallim and A. Gelidan, "Musculoskeletal Examination Skills: Are We Still Interested?," International Journal of Clinical Medicine, Vol. 3 No. 5, 2012, pp. 335-340. doi: 10.4236/ijcm.2012.35065.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] H. Almoallim, “Determining and Prioritizing Competencies in the Undergraduate Internal Medicine Curriculum in Saudi Arabia,” Eastern Mediterranean Health Journal, Vol. 17, No. 8, 2011, pp. 656-662
[2] E. M. Badley, I. Rasooly and G. K. Webster, “Relative Importance of Musculoskeletal Disorders as a Cause of Chronic Health Problems, Disability, and Health Care Utilization: Findings from the 1990 Ontario Health Survey,” The Journal of Rheumatology, Vol. 21, No. 3, 1994, pp. 505-514.
[3] H. Almoallim, S. Attar, N. Jannoudi, N. Al-Nakshabandi, B. Eldeek, O. Fathaddien, et al., “Sensitivity of Standardised Musculoskeletal Examination of the Hand and Wrist Joints in Detecting Arthritis in Comparison to Ultrasound Findings in Patients Attending Rheumatology Clinics,” Clinical Rheumatology, 2012. doi:10.1007/s10067-012-2013-5
[4] MOH, “The Annual Health Report,” 1430H-2009, Riyadh Ministry of Health, 2009.
[5] A. D. Woolf and B. Pfleger, “Burden of Major Musculoskeletal Conditions,” Bulletin of the World Health Organization, Vol. 81, No. 9, 2003, pp. 646-656.
[6] A. D. Woolf, N. E. Walsh and K. Akesson, “Global Core Recommendations for a Musculoskeletal Undergraduate Curriculum,” Annals of the Rheumatic Diseases, Vol. 63, No. 5, 2004, pp. 517-524. doi:10.1136/ard.2003.016071
[7] A. D. Woolf and K. Akesson, “Understanding the Burden of Musculoskeletal Conditions. The Burden Is Huge and Not Reflected in National Health Priorities,” BMJ, Vol. 322, No. 7294, 2001, pp. 1079-1080. doi:10.1136/bmj.322.7294.1079
[8] A. D. Woolf, “The Bone and Joint Decade 2000-2010,” Annals of the Rheumatic Diseases, Vol. 59, No. 2, 2000, pp. 81-82. doi:10.1136/ard.59.2.81
[9] J. Dequeker, J. J. Rasker and A. D. Woolf, “Educational Issues in Rheumatology, Bailliere’s Best Practice & Research,” Clinical Rheumatology, Vol. 14, No. 4, 2000, pp. 715-729.
[10] A. Jones, P. Maddison and M. Doherty, “Teaching Rheumatology to Medical Students: Current Practice and Future Aims,” Journal of the Royal College of Physicians of London, Vol. 26, No. 1, 1992, pp. 41-43.
[11] K. Akesson, K. E. Dreinhofer and A. O. Woolf, “Improved Eduaction in Musculoskeletal Is Necessary for All Doctors,” Bulletin of Health Organization, Vol. 81, No. 9, 2003, pp. 677-682.
[12] H. Almoallim, E. Khojah, R. Allehebi and A. Noorwali, “Delayed Diagnosis of Systemic Lupus Erythematosus Due to Lack of Competency Skills in Musculoskeletal Examination,” Clinical Rheumatology, Vol. 26, No. 1, 2007, pp. 131-133.
[13] K. A. Beattie, R. Bobba, I. Bayoumi, D. Chan1, I. Schabort, P. Boulos, et al., “Validation of the GALS Musculoskeletal Screening Exam for Use in Primary Care: A Pilot Study,” BMC Musculoskeletal Disorders, Vol. 9, 2008, pp. 115-122. doi:10.1186/1471-2474-9-115
[14] M. Doherty, J. Abawi and M. Pattrick, “Audit of Medical Inpatient Examination: A Cry from the Joint,” Journal of the Royal College of Physicians of London, Vol. 24, No. 2, 1990, pp. 115-118.
[15] M. J. Ahern, M. Soden, D. Schultz and M. Clark, “The Musculo-Skeletal Examination: A Neglected Clinical Skill,” Australian and New Zealand Journal of Medicine. Vol. 21, No. 3, 1991, pp. 303-306. doi:10.1111/j.1445-5994.1991.tb04694.x
[16] M. S. Lillicrap, E. Byrne and C. A. Speed, “Musculoskeletal Assessment of General Medical In-Patients— Joints Still Crying Out for Attention,” Rheumatology, Vol. 42, No. 8, 2003, pp. 951-954. doi:10.1093/rheumatology/keg259
[17] D. Sirisena, H. Begum, M. Selvarajah and K. Chakravarty, “Musculoskeletal Examination—An Ignored Aspect. Why Are We Still Failing the Patients?” Clinical Rheumatology, Vol. 30, No. 3, 2010, pp. 403-407. doi:10.1007/s10067-010-1632-y
[18] E. Matzkin, E. L. Smith, D. Freccero and A. B. Richardson, “Adequacy of Education in Musculoskeletal Medicine,” The Journal of Bone and Joint Surgery American, Vol. 87, No. 2, 2005, pp. 310-314. doi:10.2106/JBJS.D.01779
[19] C. S. Day, A. C. YEh, O. Franko, M. Ramirez and E. Krupat, “Musculoskeletal Medicine: An Assessemnt of the Attituide and Knoweledge of Medical Studnets at Harverd Medical School,” Academic Medicine, Vol. 82, No. 5, 2007, pp. 452-457. doi:10.1097/ACM.0b013e31803ea860
[20] (AAMC) AoAMC, “Contemprory Issues in Medicine: Muscluskeletal Medicine Education,” Washington, 2005.
[21] M. L. Clark, C. R. Hutchison and J. M. Lockyer, “Musculoskeletal Education: A Curriculum Evaluation at One University,” BMC Medical Education, Vol. 10, No. 93, 2010. doi:10.1186/1472-6920-10-93
[22] S. Pinney and W. Regan, “Educating Medical Students about Musculoskeletal Problems: Are Community Needs Reflected in the Curricula of Canadian Medical Schools?” The Journal of Bone & Joint Surgery, Vol. 83, No. 9, 2001, pp. 1317-1320.
[23] D. L. Goldenberg, J. K. Dehoratius, J. Mason, R. Meenan, S. G. Perlman and J. B. Winfield, “Rheumatology Training at Internal Medicine and Family Practice Residency Programs,” Arthritis & Rheumatism, Vol. 28, No. 4, 1985, pp. 471-476. doi:10.1002/art.1780280420
[24] D. K. Clawson, D. W. Jackson and D. J. Ostergaard, “It’s Past Time to Reform the Musculoskeletal Curriculum,” Academic Medicine, Vol. 76, 2001, pp. 709-710. doi:10.1097/00001888-200107000-00012
[25] A. D. Woolf and K. Akesson, “Primer: History and Examination in the Assessment of Musculoskeletal Problems,” Nature Clinical Practice Rheumatology, Vol. 4, No. 1, 2008, pp. 26-33. doi:10.1038/ncprheum0673
[26] J. Dequeker, G. Esselens and R. Westhovens, “Education Issues in Rheumatology. The Musculoskeletal Examination: A Neglected Skill,” Clinical Rheumatology, Vol. 26, 2007, pp. 5-7. doi:10.1007/s10067-006-0288-0
[27] E. Matzkin, E. Smith, D. Freccero and A. B. Richardson, “Adequacy of Education in Musculoskeletal Medicine,” The Journal of Bone and Joint Surgery, Vol. 87, 2005, pp. 310-314.
[28] A. E. Thompson, “Improving Undergraduate Musculoskeletal Education: A Continuing Challenge,” The Journal of Rheumatology, Vol. 35, No. 12, 2008. doi:10.3899/jrheum.080972
[29] K. Saleh, R. Messner, S. Axtell, I. Harris and M. L. Mahowald, “Development and Evaluation of an Integrated Musculoskeletal Disease Course for Medical Students. The Journal of Bone and Joint Surgery American, Vol. 86, No. A8, 2004, pp. 1653-1658.
[30] A. E. Oswald, J. Wiseman, M. J. Bell and L. Snell, “Musculoskeletal Examination Teaching by Patients Versus Physicians: How Are They Different? Neither Better nor Worse, but Complementary,” Medical Teacher, Vol. 33, No. 5, 2011, pp. e227-e235. doi:10.3109/0142159X.2011.557412
[31] N. Raj, L. J. Badcock, G. A. Brown, C. M. Deighton, S. C. O’Reilly, “Undergraduate Musculoskeletal Examination Teaching by Trained Patient Educators—A Comparison with Doctor-Led Teaching,” Rheumatology, Vol. 45, No. 11, 2006, pp. 1404-1408. doi:10.1093/rheumatology/kel126
[32] L. Schrieber, G. D. Hendry and D. Hunter, “Musculoskeletal Examination Teaching in Rheumatoid Arthritis Education: Trained Patient Educators Compared to Nonspecialist Doctors,” The Journal of Rheumatology, Vol. 27, No. 6, 2000, pp. 1531-1532.
[33] A. E. Oswald, M. J. Bell, J. Wiseman and L. Snell, “The Impact of Trained Patient Educators on Musculoskeletal Clinical Skills Attainment in Pre-Clerkship Medical Students,” BMC Medical Education, Vol. 11, No. 65, 2011. doi:10.1186/1472-6920-11-65
[34] K. Graham, J. M. Burke and M. Field, “Undergraduate Rheumatology: Can Peer-Assisted Learning by Medical Students Deliver Equivalent Training to That Provided by Specialist Staff?” Rheumatology, Vol. 47, No. 5, 2008, pp. 652-655. doi:10.1093/rheumatology/ken048
[35] J. Burke, S. Fayaz, K. Graham, R. Matthew and M. Field, “Peer-Assisted Learning in the Acquisition of Clinical Skills: A Supplementary Approach to Musculoskeletal System Training,” Medical Teacher, Vol. 29, No. 6, 2007, pp. 577-582. doi:10.1080/01421590701469867
[36] M. E. Perry, J. M. Burke, L. Friel and M. Field, “Can Training in Musculoskeletal Examination Skills Be Effectively Delivered by Undergraduate Students as Part of the Standard Curriculum?” Rheumatology, Vol. 49, No. 9, 2010, pp. 1756-1761. doi:10.1093/rheumatology/keq166
[37] M. Doherty, J. Dacer, P. Dieppe and M. Snaith, “The GALS Locomotor Screen,” Annals of the Rheumatic Diseases, Vol. 51, 1992, pp. 1165-1169. doi:10.1136/ard.51.10.1165

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.