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Principles of clinical examination in adults 

Principles of clinical examination in adults
Principles of clinical examination in adults
Oxford Textbook of Rheumatology (4 ed.)

Lesley Kay


Clinical examination of the musculoskeletal system is upheld as being of fundamental importance, and yet it is generally poorly performed, and individual clinical examination tests have a scanty evidence base. This chapter covers the importance of musculoskeletal examination skills and evidence that such skills have been poorly taught and are poorly performed in practice. Surveys of practitioners show low confidence in the ability to perform musculoskeletal examination. Reviews of clinical practice show low levels of undertaking and recording of musculoskeletal examination, and many conditions are missed. The chapter describes also the efforts made to address and improve this situation and describes in particular two programmes of examination. These are the Gait, Arms, Legs and Spine (GALS) screening examination, and the Regional Examination of the Musculoskeletal System (REMS) core set of examination skills for medical students. These are based on best available evidence and consensus, and have a limited evaluation. Short courses based on these skills show an increase in confidence which appears to be maintained in the short term. Postgraduate examination skills requirements are less well defined. Examination tests should be evaluated in terms of their validity, reproducibility, sensitivity, and specificity in the situations in which they are to be used. Rheumatologists and others using this textbook will be in key positions to address the training and competence of doctors and other practitioners working with patients with musculoskeletal conditions in their normal working lives as well as in formal teaching situations.

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