Musculoskeletal

Core Generalist#

Knowledge#

CG.K.1#

Describe basic anatomy, physiology and biomechanics relevant to musculoskeletal disorders including:

  • normal functioning of the axial and appendicular skeleton and musculature
  • pathways of innervation of muscles
  • dermatome innervation and trigger point distribution
  • functional anatomy of joints surface anatomy

CG.K.2#

Illustrate the mechanisms, characteristics and patterns of pain, including:

  • somatic
  • referred somatic
  • radicular
  • referred visceral
  • referred trigger point pain

Skills#

CG.S.1#

Take an accurate and relevant musculoskeletal history including:

  • a general history
  • history of the presenting complaint including:
    • mode and context of onset
    • detailed characteristics of the pain\
    • effects on the patient's life and work

CG.S.2#

Perform an appropriate musculoskeletal examination, including:

  • Look: inspection including surface appearance, symmetry, alignment and gait
  • Feel: palpation of surface temperature, bones, muscles, tendons, joint lines
  • Move: active, passive, resisted, relative smoothness and end point quality
  • Test function: appropriate provocation tests (special tests)
  • Measure: length or circumference
  • Look elsewhere: compare to the other side for all aspects above, assess neurovascular if appropriate
  • Image: interpret along with clinical finings

CG.S.3#

Conduct a musculoskeletal examination of the all parts of the body with functional testing that includes:

  • Cervical spine glide and foraminal compression test, brachial plexus tension
  • Shoulder apprehension and specific impingement tests
  • Wrist: Tinel’s and Phalen’s sign
  • Spine: Waddell’s test when appropriate
  • Hip: Trendelenburg’s sign and special tests for the hip in children: Barlow’s, Ortolani’s tests
  • Knee tests: Lachman’s, McMurray’s, Apley’s, and pivot shift tests as appropriate to assess functionality
  • Active, passive and resisted movements in examination, including neurological testing by resisted movement

CG.S.4#

Order and interpret appropriate imaging, including X-ray, CT, bone scan, ultrasound scan and MRI

CG.S.5#

Use algorithms for the differentiation of visceral and somatic pain in the thorax and pain referred to the abdomen, especially for red flag conditions, such as;

  • cardiac ischaemia
  • aortic dissection
  • pneumothorax
  • pulmonary neoplasm
  • spinal infections
  • neoplasia
  • painful conditions such as: herpes zoster, oesophagitis, peptic ulcer, cholelithiasis and psychogenic pain

CG.S.6#

Apply diagnostic reasoning to arrive at one or more provisional diagnoses, considering conditions affecting the musculoskeletal system, including:

CG.S.7#

Management common musculoskeletal presentations in community, primary care, including:

  • osteoarthritis,
  • pain back, shoulder, knee, foot, toe
  • neck symptoms
  • muscle symptoms, not otherwise specified (NOS)

CG.S.8#

Perform the following procedures:

  • soft tissue injection
  • corticosteroid injections of joints, ganglions and around tendons
  • aspirate of bursae and joints
  • soft tissue injury strapping
  • apply fibreglass and plaster casts and immobilisation of other fractures
  • stabilisation of injured spine
  • unlock a locked temporomandibular joint and knee
  • reduce joint dislocations
  • reduce simple fractures

CG.S.9#

Use a comprehensive evidence-based approach to recovery including:

  • specific therapy
  • psychological support
  • self-directed activities
  • therapist conducted therapies
  • motivation
  • a supportive environment and
  • general health initiatives

CG.S.10#

Teach exercises and stretches relevant to all common musculoskeletal conditions, including techniques for self-correction of posture, use of appropriate lumbar support and improving posture whilst lying down

CG.S.11#

Refer, facilitate and coordinate access to specialised support services as required to assist patients to return to functional work and/or life

CG.S.12#

Recognise and manage abuse in its various forms including those at risk or in a situation of abuse, violence, neglect, homelessness or accidental injury

Attributes#

At.2#

Adaptability

At.6#

Compassion

At.11#

Integrity

Musculoskeletal presentations and conditions#

  • Inflammatory conditions, including gout, pseudogout, osteoarthritis, rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, polymyalgia rheumatica, ankylosing spondylitis, Reiter’s disease, inflammatory bowel (disease related), fibromyalgia syndrome
  • Infections, including TB, other bacterial, herpes zoster, discitis, osteomyelitis, osteoporosis and spinal wedging, Paget’s disease
  • Referred pain, including referred visceral and somatic pain both serious and benign, vascular claudication, migrainous phenomena, neurological conditions including Complex Regional Pain Syndromes, depression induced spinal pain, psychogenic pain, anticoagulant intraspinal haemorrhage, Raynaud’s phenomenon and other neurovascular disorders, sympathetic dystrophy (diabetics)
  • Cervical spine, including vertebral stiffening - age, ankylosis, spondylitis, postural syndromes, facet joint dysfunction, disc prolapse, disruption, foraminal obstruction, radiculopathy, myelopathy, torticollis (wry neck), trauma, sprain, ‘whiplash’, (fractures), cervical syndromes/cervicogenic headache
  • Temporomandibular conditions including dental malocclusion, stress-related tooth grinding, referred cervical (e.g. whiplash), temporomandibular joint dysfunction (TMJ) syndrome, locked jaw, sprains, arthritic conditions, trauma
  • Shoulder conditions including capsulitis/frozen shoulder, subdeltoid bursitis/supraspinatus tendinitis, infraspinatus and other shoulder muscle conditions, rotator cuff syndromes, bicipital tendinitis, acromioclavicular conditions, sternoclavicular arthritis, psychogenic shoulder/arm syndromes, recurrent shoulder dislocations
  • Elbow and arm conditions including lateral elbow pain, medial elbow pain, toddler's pulled elbow, biceps lesions, olecranon bursitis, entrapment neuropathies, loose bodies, overuse syndromes, industrial, psychosomatic, thoracic outlet syndromes
  • Wrist and hand conditions including carpal tunnel syndrome (and pronator teres syndrome), de-Quervain's tenosynovitis, trigger finger and thumb, spindle finger, scaphoid fracture, ganglion, lunate avascular necrosis, dislocation, occult foreign body
  • Thoracic spine conditions including postural syndromes including minor kyphoscoliosis and TV backache, simple thoracic spine dysfunction, sprains, costovertebral and facet joint syndromes, T4 syndrome, combined thoracic and cervical dysfunction, thoracic myofascial syndrome, Tietze’s costochondritis, kyphoscoliosis (moderate to severe), Scheuermann’s disorder, age changes, osteoporosis, vertebral compression
  • Lower back conditions including mechanical back pain including facet/zygapophyseal and disc joint dysfunction, posture syndromes, dysfunction syndromes, sprains and ‘derangements’, minor and major trauma to muscle/bone, spondylosis (degenerative osteoarthritis), symptomatic spondylolysis and spondylolisthesis, acute and chronic intervertebral disc prolapse and other discogenic pain, nerve root compression, spinal stenosis, acute cauda equina syndrome
  • Buttock, hip, pelvis and thigh including sacroiliac joint related pain sacroiliitis, mechanical hypermobile and hypo mobile sacroiliac syndromes, psoas bursitis, trochanteric bursitis, hip arthritis, capsulitis, loose bodies in the hip, muscle strain, irritability, referred spasm, tendinitis including psoas, glutei, piriformis, adductors (rider's sprain), quadriceps, hamstrings, coxalgia, coccydynia, referred lumbar and sacral syndromes: nerve entrapment/meralgia paraesthetica, injuries, fracture, snapping hip (iliopsoas tendinitis or dancer's hip), pregnancy related pain
  • Knee including minor trauma, strain, sprain, synovitis, bursitis, tendinitis, cartilage, ligamentous injury (anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral), effusion, hemarthrosis, fracture, loose bodies, Baker's cyst (simple and leaking), osteochondritis dissecans, locking and pseudo locking, chondromalacia patella (jogger’s knee), patella subluxation and dislocation, patellar tendinitis (jumper’s knee), Osgood-Schlatter's, traction epiphysitis, osteoarthritis, iliotibial band syndrome
  • Lower leg, ankle and foot including achilles tendinitis, bursitis, partial and complete rupture, peroneal muscle strain, tibialis posterior tendinitis, Periostitis (shin splints), compartment syndrome, common peroneal entrapment, ankle sprains and associated minor fractures, deltoid ligament sprain, loose body in ankle, plantar fasciitis, mid-tarsal sprain, metatarsalgia, stress fracture, tarsal tunnel syndrome, disparate leg length, corns, calluses, in-growing toenail, bunion, hallux rigidus and other osteoarthritis’s, Morton’s neuroma, fractured 5th toe or metatarsal, claw toe, hammer toe, postural problems including inversion, eversion and bumbling
  • Children including congenital dislocation of hip, synovitis, Perthes disease, slipped upper femoral epiphysis, stress fracture, iliac traction apophysitis, gait problems, calf tightness, Sever’s traction apophysitis, Toddler’s pulled elbow, injury, sprain, bone and chondral fracture, Kohler’s and Freiberg’s Diseases, Infection including septic arthritis
Last updated on by acrrmbot