Introduction to musculoskeletal assessment

Having arthritis or another musculoskeletal (MSK condition is one of the biggest contributors to years lived with disability (YLDs). 21% of YLDs in the UK are accounted for by MSK conditions (Global Burden of Disease Collaborative Network, 2024). 

It is estimated that MSK disorders account for approximately 1 in 7 GP consultations (Jordan cardiovascular, gastrointestinal, skin, eyes)? et al. 2010) and every year 1 in 5 adults will consult their GP for an MSK condition. MSK conditions accounted for 1.2 million hospital admissions in England in 2023-24, 7% of the total number (NHS England, 2024).

Clinical assessment skills – history taking and examination – are the key to making an accurate diagnosis and appropriately managing any patient presenting with an MSK issue. This guide aims to introduce you to the methods you might use during the initial clinical assessment. It is not exhaustive or intended to replace direct clinical teaching and experience, but to be used as an aid to learning. 

Initial approach

Before considering a diagnosis, it is useful to try to broadly categorise the symptoms and signs (from the patient’s history and examination) by answering the following key questions:

• Are the symptoms from the joint itself or the soft tissues (tendons/muscles)?
• Is the condition acute or chronic?
• Is the condition inflammatory or non-inflammatory?
• What is the pattern of affected areas/joints?
• What is the impact of the condition on the patient’s life?
• Are other systems involved?

The answers to these questions should enable you to produce a succinct summary of the patient’s condition and would lead you to a narrower differential diagnosis. An example of a patient summary produced using this method might be:

‘This patient has a chronic symmetrical inflammatory polyarthritis, mainly affecting the small joints of the hands and feet, which is causing pain, difficulty with dressing and hygiene, and is limiting their mobility.’