Musculoskeletal Physical Examination Research Articles

Visual aid for pediatric virtual musculoskeletal exams: A Barbie girl in a telehealth world.

Telehealth is rapidly advancing, yet musculoskeletal physical examinations pose a unique challenge with limited clinically tested tools. To measure whether visual aid use improves accuracy and efficiency of musculoskeletal exam maneuvers within a mock pediatric telehealth encounter. Randomized controlled trial. Mock telehealth encounter. A total of 30 volunteer dyads of children aged 4-17 years old and their parent/guardian. To be eligible to participate, the parent/guardian was required to speak and read English proficiently and have access to Zoom technology on a personal electronic device. The control group received verbal prompts to complete 12 musculoskeletal exam maneuvers. The intervention group had the addition of a Barbie (Mattel) visual aid. Primary outcomes were accuracy (number of completed maneuvers) and efficiency (total verbal prompts, total time). Secondary outcomes were ratings of comfort using telehealth technology, ease of understanding, and perceived usefulness of the visual aid. Standard multiple regression analysis was employed, with significance defined as a p value <.05. The intervention group completed an average of 11.67 ± 0.7 maneuvers versus 11.27 ± 1.0 in the control group (p = .21), 13:31 ± 4.02 total time (mm:ss) versus 14:47 ± 4:04 (p = .05), and 4.87 ± 4.4 verbal prompts versus 8.40 ± 4.6 (p = .04), respectively. The overall model of group allocation controlling for age was not statistically significant for total maneuvers (p = .255), total time (p = .061) or total verbal prompts (p = .095). However, group allocation significantly predicted total verbal prompts (p = .032), with participants in the intervention group requiring an average of 4.1 fewer prompts. All participants in the intervention group rated the visual aid as 'definitely helpful'. Visual aid use improved virtual musculoskeletal exam maneuver ease and efficiency in a pediatric population.

The Development of Online Resources to Support Medical Trainees in Providing Virtual Rheumatology Care.

The musculoskeletal (MSK) physical examination is one of the core components of the rheumatologic clinical assessment for trainees. The pandemic has restricted in-person assessments, and as such, rheumatologists have found themselves having to adapt their clinical skills in the virtual setting while dealing with the restrictions of such an approach to "hands-on" rheumatology education.

A structured multimodal teaching approach enhancing musculoskeletal physical examination skills among undergraduate medical students

ABSTRACT Current evidence indicates that undergraduate medical students display deficits in musculoskeletal physical examination skills (MPES). While various instructional methods are recommended for teaching clinical skills, effective methods for teaching MPES have not been established. This study compared the effectiveness of a multimodal teaching approach incorporating video-based learning, interactive small-group teaching, hands-on practicing, peer-assisted learning, formative assessment, and constructive feedback with traditional bedside teaching in developing undergraduate orthopedic MPES. Participants were 151 fifth-year medical students divided into two groups. One group received multimodal teaching, and the other received traditional bedside teaching. In both groups, the participants learned how to physically examine the knee and shoulder. The primary outcome was objective structured clinical examination (OSCE) scores, while the secondary outcomes included teaching sessions’ total durations, facilitator’s demonstration time, participants’ practice time, and proportion of students with passing checklist scores and global ratings-based assessments for the two teaching approaches. The multimodal teaching group had significantly higher OSCE scores (checklist scores, global ratings, and passing rates; p = 0.02, 0.02, 0.01, respectively) than the comparison group. Individual OSCE component assessments showed significant improvements in the special musculoskeletal physical examination test. The overall duration and amount of participants’ hands-on time were significantly longer for the multimodal than for the traditional bedside teaching group (p = 0.01 and 0.01, respectively), and the facilitator’s demonstration time was significantly shorter (p = 0.01). The multimodal learner-centered teaching approach evaluated in this study was effective for teaching MPES. It appeared to maximize learner engagement through enhancing interactions and providing increased time to engage in hands-on practice. This teaching approach improved MPES levels, maximized teaching efficiency for scenarios with limited instruction time and resources, and enhanced competency of undergraduate medical students in performing special musculoskeletal physical examinations compared to traditional bedside teaching.

High Number of Medical Conditions Detected in Elite Athlete Periodic Health Evaluations, But Only Mild Consequences.

To evaluate the number of medical conditions detected by periodic health evaluations (PHEs) in elite athletes, and their consequences for management and medical clearance. Retrospective design. Elite athletes of various sports in a high-performance program in The Netherlands, in the period between 2009 and 2020. The PHEs consisted of a questionnaire, general and musculoskeletal physical examination, laboratory blood test, electrocardiogram, pulmonary function testing, and (cardiopulmonary) exercise test. We extracted and analyzed the medical conditions that led to advice, clinical follow-up, further diagnostic investigation or treatment, and the medical clearance status of the athlete (clearance, temporarily no clearance, or permanently no clearance). We included 721 PHEs of 451 elite athletes. We found 1389 medical conditions that led to advice (n = 923, 66%), clinical follow-up (n = 124, 9%), further diagnostic investigation (n = 190, 14%), treatment (n = 132, 10%), or sports restriction (n = 20, 1%). Only 20 cases (3%) led to temporarily no medical clearance. After further investigation or treatment, no permanent sports restriction was imposed on any of the athletes. We found a high number of medical conditions detected with a PHE in elite athletes. However, the vast majority of detected conditions were mild, with consequences limited to preventive advice and follow-up. The yield of PHE to detect (potentially) severe pathological conditions seems low. Clinical relevance of PHE in elite athletes and potential future health benefits remain unclear.

Undergraduate Medical Students' Perceptions of an Online Audio-Visual-Based Module for Teaching Musculoskeletal Physical Examination Skills.

IntroductionVideo-based learning has gained prominence in medical education and, more recently, in musculoskeletal teaching. This study investigated medical students’ perceptions of the effectiveness of online video-based learning for musculoskeletal physical examination skills.MethodsFor one academic year, undergraduate medical students were instructed online through video-based learning before bedside teaching about the physical examination of knee and shoulder joints. At the end of the course, the students participated in a survey to assess their perceptions of the online video-based learning module using a pre-validated questionnaire. The questionnaire consisted of closed-ended and open-ended questions. The closed-ended question responses were assessed using a Likert scale; the open-ended responses were analyzed qualitatively.ResultsIn total, 242 out of 310 students who participated in the online video-based learning responded to the survey. Most students found the teaching approach to be satisfactory and preferable to traditional teaching methods. However, they also felt that these modules could not replace hands-on practice. The most helpful aspects of the training modules were a better understanding of the specific tests, technique, and sequence of administering the physical examination. Perceived limitations included the inadequately addressed theoretical basis of the physical examination and the special tests, the need for more time to explain clinical anatomy, and the practical implications of the positive special tests.ConclusionUndergraduate medical students perceive VBL as helpful for MPES learning. The positive aspects of the VBL approach in teaching MPES are that it is comprehensive, easily accessible, offers standardized teaching, save times, and it includes demonstrations of special tests, examination techniques, and the sequence and organization of the clinical examination. The main perceived limitations were lack of content regarding clinical reasoning and the anatomical basis of the clinical tests.

ARTIFICIAL INTELLIGENCE FOR EARLY DETECTION AND MANAGEMENT OF MUSCULOSKELETAL COMPLICATIONS POST HEMATOPOIETIC CELL TRANSPLANT. FUTURE PERSPECTIVES

Introduction To help monitor and manage complications, monitor disease progression, and help lower morbidity and mortality rates in Hematopoietic cell transplant (HCT) patients, the use of artificial intelligence technology can prove to be an efficient tool. Aim We propose a futuristic vision of an artificial intelligence model which could help in early detection of MSK related complications, improve communication between HCT healthcare professional team, improve diagnostics via machine learning (ML), help monitor symptom/ disease progression remotely, and help integrate services for a more patient-friendly service delivery, i.e., drug prescription, exercise prescription, appointment tracking, referral pathways. Materials and methods The proposed model is a three-phase integrated program where musculoskeletal physical examination is combined with wearable textiles interface platform and machine learning algorithms, thereby providing live and remote feedback of changes as they happen in at the musculoskeletal and vital signs level. Result With the help of machine learning technology, various algorithms can be created to help improve remote and live diagnostic accuracy of post-HCT musculoskeletal manifestations. Subtle changes over the course of time in various patient groups can be detected at the skin, fascia, muscle, bone level; thereby helping in better understanding of the disease and its management.

Difficulties with Learning Musculoskeletal Physical Examination Skills: Student Perspectives and General Lessons Learned for Curricular Design

Phenomenon: The development of foundational clinical skills, such as physical examination, is essential to becoming a competent clinician. Musculoskeletal medicine is often considered a specialized area of practice despite the high prevalence of musculoskeletal conditions in the general population and presenting to general clinical practices. Prior work has shown that medical learners and practicing clinicians have low confidence in these skills but understanding of the student perspective on why these skills are more difficult to acquire is unclear. Approach: Our study was guided by social constructivist learning theory to explore the learner experience and present their perspectives. Qualitative analysis investigated the difference between learning musculoskeletal physical examination versus other body systems, using the voices from 11 semi-structured focus group interviews. Participants included third-year medical students across two academic cohorts at one institution. Our analysis was grounded in the principles of phenomenology and used triangulation and reflexivity to provide rigorous analysis. Findings: Students provided rich and insightful perspectives regarding their experiences in learning musculoskeletal physical examination techniques. Four themes were developed from our data: a) the need for opportunities for both supervised and self-directed practice; b) assessment and competence as motivations for learning; c) the need for a different approach to the content and structure of musculoskeletal medicine and its associated examination techniques; and d) the need for distinct expertise and technical skill from musculoskeletal examination teachers. Insights: This study provides a valuable lens to critically reflect on existing curriculum and pedagogical approaches to musculoskeletal examination skills. Lessons from this study may be applicable to curriculum design in general, especially the teaching of physical examination skills, such as how it is taught and integrated with other content (including anatomy), how much practice is required, who teaches physical examination skills, and what faculty development is needed to standardize teaching. Promoting a learner-centered approach to the teaching and learning of these clinical skills will be beneficial to all stakeholders, especially to our future physicians and their patients. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1954930 .

Using peer role-playing to improve students\u2019 clinical skills for musculoskeletal physical examinations

BackgroundThe traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. Therefore, an effective programme is required to help medical students and residents improve their clinical skills in MSK. This paper aims to assess the clinical skills of medical students who have participated in a peer role-playing simulation programme using a mini clinical evaluation exercise (mini-CEX).MethodsParticipants were 90 female medical students who were completing their first orthopaedic clinical clerkship. They were divided into two groups. The simulation group participated in a role-play focussed on MSK cases as low-fidelity simulation, a structured debriefing with the course supervisor, and a self-reflection on Day 1 (n = 64). The control group did not participate in the role-play due to randomised clerkship schedules (n = 26). On Day 2 of the intervention, we observed and assessed all participants’ performances during MSK outpatient encounters using the mini-CEX. We compared the mini-CEX score between the simulation group and the control group; the Wilcoxon rank-sum test was used for statistical analysis.ResultsThe mini-CEX scores for physical examination, clinical reasoning and diagnosis, and overall clinical competency were significantly higher in the simulation group than in the control group (p < .05, physical examination: p = .014, clinical reasoning: p = .042, overall: p = .016). These findings suggest that medical students who partake in a peer role-playing simulation programme could experience improved clinical skills for physical examination, clinical reasoning and diagnosis, and overall clinical competency in real-life MSK outpatient encounters.ConclusionsThrough a mini-CEX assessment, our findings indicate that medical students who participated in our peer role-playing simulation programme have improved clinical skills. Peer role-playing as a low-fidelity simulation and practical educational opportunity will enable educators to polish the competency of medical students in musculoskeletal physical examinations and clinical reasoning and diagnosis in a clinical setting.

Point-of-Care Ultrasound, the New Musculoskeletal Physical Examination.

The availability of handheld ultrasound offers physicians an opportunity to better define anatomy and pathophysiology, thus enhancing the diagnostic capabilities of a standard physical examination. The medical community increasingly embraces the potential for point-of-care ultrasound across medical specialties. The primary aim of this review was to identify and compile information on the current clinical utility of point-of-care ultrasound for musculoskeletal examination. This information will enable health care providers to understand the current utility and potential of musculoskeletal point-of-care ultrasound, thus facilitating its appropriate adoption into clinical practice.

Deconstructing the Joint Examination: A Novel Approach to Teaching Introductory Musculoskeletal Physical Examination Skills for Medical Students.

IntroductionMusculoskeletal (MSK) disorders are very common, but suboptimal teaching of MSK medicine occurs and expert clinicians agree that MSK physical examination (PE) skills can be confusing and complicated for medical students. An innovative approach in introductory teaching of MSK PE skills was developed using constructivist theory for second-year medical students.MethodsWe implemented the MSK PE curriculum innovation in the second year of a four-year MD program, utilizing a standard framework with spaced practice and clinician coaching. We evaluated this curriculum by comparing the innovation group (n = 123) to a historical control group (n = 134) using an anonymous survey and OSCE station scores. Data analysis included repeated measures analysis of variance comparing students' self-confidence in MSK PE to students' self-confidence in other systems-based PEs, as well as independent t-test comparisons of self-confidence scores and MSK-specific OSCE station scores between the historical and innovation groups.ResultsThe mean self-assessed confidence of the historical group was significantly lower for the MSK PE than all other PEs (p < 0.001), except for the neurological PE. Significant improvement in MSK PE self-confidence was noted with the innovation group (t(259) = −4.05, p < 0.001). OSCE scores significantly improved in MSK-specific stations, with medium to large effect size across the different stations.DiscussionWe successfully used a framework of deconstruction, repetition, and spaced practice to develop fundamental MSK PE skills in preclerkship medical students. This curriculum structure provides an effective example for teaching introductory MSK PE skills to early medical learners.

Does Ultrasound‐Enhanced Instruction of Musculoskeletal Anatomy Improve Physical Examination Skills of First‐Year Medical Students?

Ultrasound imaging is commonly used to teach basic anatomy to medical students. The purpose of this study was to determine whether learning musculoskeletal anatomy with ultrasound improved performance on medical students' musculoskeletal physical examination skills. Twenty-seven first-year medical students were randomly assigned to 1 of 2 instructional groups: either shoulder or knee. Both groups received a lecture followed by hands-on ultrasound scanning on live human models of the assigned joint. After instruction, students were assessed on their ability to accurately palpate 4 anatomic landmarks: the acromioclavicular joint, the proximal long-head biceps tendon, and the medial and lateral joint lines of the knee. Performance scores were based on both accuracy and time. A total physical examination performance score was derived for each joint. Scores for instructional groups were compared by a 2-way analysis of variance with 1 repeated measure. Significant findings were further analyzed with post hoc tests. All students performed significantly better on the knee examination, irrespective of instructional group (F = 14.9; df = 1.25; P = .001). Moreover, the shoulder instruction group performed significantly better than the knee group on the overall assessment (t = -3.0; df = 25; P < .01). Post hoc analyses revealed that differences in group performance were due to the shoulder group's higher scores on palpation of the biceps tendon (t = -2.8; df = 25; P = .01), a soft tissue landmark. Both groups performed similarly on palpation of all other anatomic structures. The use of ultrasound appears to provide an educational advantage when learning musculoskeletal physical examination of soft tissue landmarks.

Assessing musculoskeletal examination skills and diagnostic reasoning of 4th year medical students using a novel objective structured clinical exam.

BackgroundMedical students have difficulty performing and interpreting musculoskeletal physical examinations and interpreting the findings. Research has focused on students' knowledge deficits, but there are few direct assessments of students' ability to perform a hypothesis-driven physical examination (HDPE). We developed a novel musculoskeletal Objective Structured Clinical Exam (OSCE) focusing on HDPE skills for disorders of the shoulder, back and knee, and used it to explore medical student diagnostic reasoning.MethodsA multidisciplinary group of musculoskeletal specialists developed and gathered validity evidence for a three station OSCE focusing on the HDPE of the shoulder, back and knee, emphasizing the ability to anticipate (identify pre-encounter) expected physical exam findings, and subsequently perform discriminatory physical examination maneuvers. The OSCE was administered to 45 final year medical students. Trained faculty observed and scored students’ ability to anticipate exam findings and perform diagnostic examination maneuvers on simulated patients. Encounters were digitally recorded and scored again by another trained faculty member. Inter-rater reliability for each maneuver was estimated using type-2 intra-class correlations (ICC). Percentages of perfect scores for anticipation and performance were calculated. Pearson’s correlation between anticipation and performance scores was computed for each maneuver and their relationship to diagnostic accuracy was tested with logistic regression.ResultsInter-rater reliability was good (ICC between .69 and .87) for six exam maneuvers. Maneuver performance was overall poor, with no discriminatory maneuver performed correctly by more than two thirds of students, and one maneuver only performed correctly by 4 % of students. For the shoulder and knee stations, students were able to anticipate necessary discriminatory exam findings better than they could actually perform relevant exam maneuvers. The ability to anticipate a discriminatory finding correlated with the ability to perform the associated maneuver correctly, with the exception of the ability to perform maneuvers needed to diagnose a torn anterior cruciate ligament of the knee. Neither the ability to anticipate or perform was predictive of identifying correct diagnoses for the different cases.ConclusionsA novel musculoskeletal OSCE, based on principles of the hypothesis-driven physical examination, was able to identify significant deficiencies in examination skills needed to diagnose common disorders of the shoulder, back and knee amongst graduating medical students. In addition, the OSCE demonstrated that accurate anticipation of discriminatory examination findings correlates with ability to perform the associated maneuver; however, the ability to anticipate exceeds the ability to perform. Students do not appear to be using the physical exam to inform their diagnostic reasoning. The findings of this study have implications for both assessment and teaching of the musculoskeletal exam.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0780-4) contains supplementary material, which is available to authorized users.

The “Near-Peer” Approach to Teaching Musculoskeletal Physical Examination Skills Benefits Residents and Medical Students

BackgroundThe musculoskeletal physical examination (MSK PE) is an essential part of medical student training, and it is best taught in a hands-on, longitudinal fashion. A barrier to this approach is faculty instructor availability. “Near-peer” teaching refers to physicians-in-training teaching their junior colleagues. It is unknown whether near-peer teaching is effective in teaching this important physical examination skill. ObjectiveTo investigate attitudes of medical students and physical medicine and rehabilitation (PM&R) residents regarding near-peer teaching in an MSK PE curriculum. DesignQualitative, anonymous paper and online surveys. SettingTertiary academic center with a medical school and PM&R training program. ParticipantsNinety-nine second- and third-year medical students and 13 PM&R residents in their third or fourth postgraduate year. MethodsAttitudes of second- and third-year medical students were measured immediately after their MSK PE course. Resident attitudes were measured in a single cross-sectional sample. Main Outcome MeasurementsStudent attitudes were assessed via a questionnaire with 5-point Likert scales and a free-text comment section. The resident questionnaire included a combination of multiple-choice questions, rankings, free-text responses, and Likert scales. ResultsAll 99 students completed the questionnaire. The majority of students (n = 79 [80%]) reported that resident involvement as hands-on instructors of examination skills was “very useful,” and 87 (88%) indicated that resident-led small discussion groups were “very helpful” or “somewhat helpful.” Fifty-seven of 99 students (58%) reported that the resident-facilitated course was “much better” than courses without resident involvement. Twelve of 13 eligible residents completed the survey, and of those, 8 found teaching “very helpful” to their MSK knowledge, and 11 became “somewhat” or “much more confident” in clinical examination skills. ConclusionsOur study supports educational benefits to medical students and resident instructors in our MSK PE program. We recommend including near-peer teaching in medical student education, particularly for hands-on skills; we also recommend providing opportunities for PM&R residents to participate in formal near-peer education. Level of EvidenceNot applicable.

The Physical Therapistʼs Expertise in the Emergency Medicine Residency Curriculum: An Academic Model for Integrated Health Care Education

BACKGROUND AND PURPOSEDespite higher costs compared with dedicated primary care practice settings, the emergency department (ED) is used as a primary care site and serves as a point of entry into the health care system.1 Patients with musculoskeletal complaints comprise 15%-20% of ED visits per year.2 The National Hospital Ambulatory Medical Care Survey (NHAMCS) data show that 7,400 individuals are diagnosed annually in the ED with acute musculoskeletal injuries.1 More specifically, the NHAMCS found that musculoskeletal injuries categorized as acute sprains and strains ranked as the fourth most-common diagnosis among patients treated and discharged from the ED.1 Thus, it is imperative that physicians practicing in the ED setting are competent in the assessment and initial management of musculoskeletal injuries.Data suggest that musculoskeletal training of graduating medical students is not sufficient to prepare them for practice in an emergency practice setting,3-5 so it could be questioned whether students entering emergency medicine (EM) residencies are prepared for this component of practice. Numerous studies support the need for enhanced musculoskeletal education and training in medical school curricula.3-5 Based on a 2007 study at Harvard Medical School, medical students typically leave medical school with a poor musculoskeletal skill set, as only 7% of students were able to pass a musculoskeletal competency examination.4 A subsequent elective in musculoskeletal medicine resulted in greater confidence and enhanced their performance on the competency examination.4 A review of medical school curricula in the United States showed that approximately 50% of medical schools did not require a musculoskeletal clinical rotation, and fewer than 50% had a formal didactic course dedicated to musculoskeletal medicine. Furthermore, 82% of recent medical school graduates did not pass a musculoskeletal competency examination.3 Similarly, in a study assessing 29,442 medical students' performance on the United States Medical Licensing Examination Step 2 CS (clinical skills test), the physical examination scores for the musculoskeletal and neurological systems were lower than other clinical examinations involving the gastrointestinal, cardiovascular/pulmonary, andintegumentary systems.6Other health care providers have identified deficiencies in students' performance on a clinical musculoskeletal examination. A survey of Doctor of Osteopathy students entering a residency program indicated they were adequately trained to assess patients with musculoskeletal conditions.7 When 1,920 osteopathic medical students were surveyed to assess their perception of formalized training in diagnosing and treating patients with musculoskeletal pain, 26% indicated they were poorly prepared to perform a musculoskeletal physical examination on a patient with low back pain, and 60% indicated they were poorly prepared to assess foot pain.7 Pediatric residency graduates have noted that musculoskeletal injuries and their management are areas where they felt the most uncomfortable.8-12 A subsequent paper in the pediatric literature corroborated the poor musculoskeletal baseline skills.8 At baseline, the residents performed 37% of the ankle and 18% of the knee physical examination techniques correctly. Nine months following a teaching intervention, their clinical examinations skills improved: residents performed 67% of the ankle and 47% of the knee physical examination techniques correctly.8 Based on these studies and the lack of EM literature on the topic, EM residents may face similar challenges with musculoskeletal examination.One approach to expanding musculoskeletal examination and procedural skills in the medical school curriculum is through the expanded role of the physiatrist. Newcomer et al13 discussed the development of the physiatrists' role in the implementation of musculoskeletal physical examination in medical schools through teaching inspection, palpation, range of motion, and application of special tests. …

Musculoskeletal Teaching and Training in Saudi Internal Medicine Residency Programmes

Background: Musculoskeletal (MSK) conditions are among the most common complains presented at the clinical practice, accounting about 15% - 30% of all primary care encounters. However, clinical doctors continue to document a low level of confidence in their musculoskeletal clinical skills. Objectives: The aim of this study is to evaluate the internal medicine (IM) residents for confidence and perception in demonstrating musculoskeletal clinical skills. Methods: 37 items paper-based questionnaire was developed and piloted to investigate IM residents in Saudi Arabia during June-December 2011. Results: The study indicates residents’ low self-confidence in demonstrating MSK physical examinations with total mean (10/24). Respondents also show general agreement that MSK problems are very common in patient visits, and indicate the importance of MSK clinical screening in all standard clinical examination of patients, yet they point to current inappropriate practice in handling most cases. Respondents show lower perception of undergraduate and postgraduate training, regarding the inadequate training and assessment in MSK. Conclusions: The study shows inadequate MSK education, during and post, medical school training and that there are different training approaches for the different specialties, which undermines MSK training altogether.

Impact of a Revised Curriculum Focusing on Clinical Neurology and Musculoskeletal Care on a Required Fourth-Year Medical Student Physical Medicine and Rehabilitation Clerkship

Background. A Required Fourth-Year Medical Student Physical Medicine and Rehabilitation (PM&R) Clerkship was found to increase students' knowledge of PM&R; however the students' overall rotation evaluations were consistently lower than the other 8 required clerkships at the medical school. Objective. To describe the impact of a revised curriculum based upon Entrustable Professional Activities and focusing on basic pain management, musculoskeletal care, and neurology. Setting. Academic Medical Center. Participants. 73 fourth-year medical students. Methods. The curriculum changes included a shift in the required readings from rehabilitation specific topics toward more general content in the areas of clinical neurology and musculoskeletal care. Hands-on workshops on neurological and musculoskeletal physical examination techniques, small group case-based learning, an anatomy clinical correlation lecture, and a lecture on pain management were integrated into the curriculum. Main Outcome Measurements. Student evaluations of the clerkship. Results. Statistically significant improvements were found in the students' evaluations of usefulness of lecturers, development of patient interviewing skills, and diagnostic and patient management skills (p ≤ 0.05). Conclusions. This study suggests that students have a greater satisfaction with a required PM&R clerkship when lecturers utilize a variety of pedagogic methods to teach basic pain, neurology and musculoskeletal care skills in the rehabilitation setting rather than rehabilitation specific content.

Aneurysmal Bone Cyst of the Patella Mimicking Patellofemoral Syndrome: A Case Report.

Anterior knee pain is one of the most common causes for orthopaedic referral1,2. The term describes a clinical presentation for which the differential diagnosis includes numerous derangements of the anterior portion of the knee; however, most cases are secondary to a limited number of conditions1. Although common, the etiology and pathophysiology of individual patients’ symptoms often remain elusive3. Clinicians must have a thorough understanding of knee anatomy, physiology, mechanics, and radiographic imaging to delineate the etiology and appropriate management for affected patients1,4. We report the case of a young athlete who presented to his primary care physician with the symptom of knee pain that mimicked routine patellofemoral syndrome. This patient failed to respond to routine patellofemoral syndrome management; additional workup yielded a cystic tumor within the patella. Patellar tumors are rare occurrences, and this case demonstrates the importance of accurate and timely interpretation of radiographic studies in addition to obtaining a thorough musculoskeletal history and physical examination. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A thirty-three-year-old male runner presented with insidious onset of diffuse pain about the left knee. The discomfort had increased initially with stair climbing and activities that emphasized forceful knee extension against resistance. He had localized the pain to the anterior aspect of the knee and initially had attributed the symptoms to overuse. Three months of self-imposed activity modification and nonsteroidal anti-inflammatory medications had failed to manage the symptoms. He then sought the attention of his primary care physician. At that time, he was having discomfort with routine walking. Radiographs were obtained …

History and Physical Examination of Hip Injuries in Elderly Adults

Hip fracture is the most common injury occurring to elderly people and is associated with restrictions of the activities of the patients themselves. The discovery of a hip fracture can be the beginning of a complex journey of care, from initial diagnosis, through operational procedures to rehabilitation. The patient's history and physical examination form the basis of the diagnosis and monitoring of elderly patients with hip problems and dictate the appropriate treatment strategy to be implemented. The aim of this study is to discuss the different diagnoses of hip pain in a case study of an elderly woman who initially complained of pain in her right knee following a fall at home. It shows that musculoskeletal physical examination determined the management of the hip fracture that was found to be present. In addition, the aim of this article is to review diagnostic tests such as radiographs and recommend appropriate management and treatment of hip fractures in elderly patients.

Efficacy of a Checklist as Part of a Physical Medicine and Rehabilitation Clerkship to Teach Medical Students Musculoskeletal Physical Examination Skills

The aim of this study was to evaluate the efficacy of a checklist as part of a physical medicine clerkship to teach medical students physical examination maneuvers. This is a prospective study performed on fourth year medical students enrolled in a 2-wk mandatory clerkship of the Department of Physical Medicine and Rehabilitation. At the start and end of the rotation, the participating students were tested by performing 20 physical examination maneuvers on an investigator who was both the standardized patient and the evaluator. At the end of the rotation, the students also completed a survey. Data were analyzed using the Bernoulli trial model, with the percentage of students who performed the maneuver correctly on the pretest as the a priori probability. A full Bonferroni correction was applied. The authors enrolled 141 of the 176 fourth year medical students; 121 completed testing. At prerotation, approximately 35% of the physical examination maneuvers were performed correctly; at postrotation, 82%. For 19 of 20 maneuvers, the improvement was statistically significant at P < 0.01. The survey results indicated that the students felt that they had limited exposure to musculoskeletal examination skills at prerotation, that this rotation helped them achieve competency in performing the maneuvers, and that this would improve their future patient care irrespective of field of choice. Considering the high prevalence of musculoskeletal disorders and the anticipated rise in the future, the authors strongly recommend teaching musculoskeletal physical examination maneuvers in medical school, which can be accomplished via a mandatory physical medicine and rehabilitation rotation. The authors conclude that checklists as part of this rotation can effectively help in teaching physical examination skills to medical students.

AB1407 Musculoskeletal teaching and training in saudi arabia: A national survey

BackgroundMusculoskeletal (MSK) symptoms are the most common reason for patients to seek medical attention, accounting approximately 20% of both Primary care and emergency-room visits. Despite the high prevalence of musculoskeletal...