Is musculoskeletal history and examination so different in paediatrics?
Musculoskeletal (MSK) complaints in children and adolescents are common. The differential diagnosis is broad and based predominantly on clinical assessment. The skills both for eliciting history and for examination require understanding of the child/young person's specific emotional and cognitive developmental stage; interpretation of the findings requires knowledge of normal (and abnormal) motor and musculoskeletal growth and development. We specifically describe the different approach, unique skills and knowledge required by all clinicians who assess children and adolescents with MSK complaints; children and adolescents are not 'just little adults'. We emphasize the importance of clinical competence in ensuring that patients with juvenile idiopathic arthritis are diagnosed early and referral to specialist centres is not delayed with consequential suboptimal management and outcome. There is evidence that physician clinical skills in MSK assessment are inadequate, probably as a result of systemic deficiencies in the education process. Current and proposed solutions are discussed.
Musculoskeletal Research Group, Medical School, University of Newcastle, Framlington Place, Catherine Cookson Building, NE2 4HH Newcastle, UK. h.e.foster@ncl.ac.uk
Helen E
HE
Foster
David A
DA
Cabral
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008487:Medical History Taking; D009140:Musculoskeletal Diseases / Q000175:diagnosis; D010147:Pain Measurement; D010372:Pediatrics / Q000592:standards* / Q000639:trends; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016059:Range of Motion, Articular / Q000502:physiology; D012017:Referral and Consultation / Q000592:standards* / Q000639:trends; D012216:Rheumatic Diseases / Q000175:diagnosis*; D012219:Rheumatology / Q000592:standards / Q000639:trends