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Think about the joints


Musculoskeletal problems are common in children. The majority are self-limiting and related to trauma; however the symptoms can be feature of serious medical conditions.

It has been previously shown that musculoskeletal examination is poorly documented. Musculoskeletal examination is a station on the RCPCH clinical exam. Teaching resources on how to perform musculoskeletal examinations are freely available together with guidelines on when musculoskeletal examination should be performed.


Recent research has shown that such examinations are highly acceptable to parents and patients; therefore we aimed to see if the situation has improved.


Random selections of patients attending the assessment unit at a large tertiary children hospital in a 1-week period were reviewed. The inclusion of a musculoskeletal examination was reviewed.

Standard used for inclusion of musculoskeletal examination:

  • Child with muscle joint or limb pain

  • Unwell child with pyrexia

  • Limping child

  • Delay of milestone

  • Clumsy child in the absence of neurological signs

  • Associated conditions/chronic diseases e.g. inflammatory bowel, cystic fibrosis, arthritis, psoriasis

Red Flags (concern about infection, malignancy or NAI)

  • Fever, malaise

  • Bone/joint pain

  • Refractory pain, persistent night sweats

  • In congruency between history and presentations


20 admissions, totalling 49 patients were reviewed.

20 patients had presenting symptoms to advocate the inclusion of musculoskeletal examinations


Only 2 patients had documented musculoskeletal examinations.


Despite the availability of educational training resources there has been little improvement in the inclusion of this musculoskeletal examination in clinical practice.

Whilst this was a small sample it highlights the need for further education at all levels in when and how to perform a musculoskeletal examination.

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Correspondence to ET Mosley.

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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Mosley, E., McMahon, A. Think about the joints. Pediatr Rheumatol 9 (Suppl 1), P116 (2011).

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