Think about the joints
Pediatric Rheumatology volume 9, Article number: P116 (2011)
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
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)
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.