Clinical Geriatrics

In this issue of Clinical Geriatrics, we publish the first of a two-part article entitled “Essentials of the Musculoskeletal Exam.” The first part focuses on aspects relating to the musculature; the second part will be published in the December issue and will focus on the associated nervous system. Musculoskeletal problems are frequently encountered when caring for the mature adult, and the better we are able to identify specific problems in need of further diagnostic testing, the better we will be able to serve our patients and the health care system.

Everyday I am reminded of just how precious the value of a patient’s history and physical examination is in uncovering a diagnosis and helping guide further testing. While there is clearly a role for technology—and all agree that our diagnostic acumen has greatly improved since CT, MRI, and similar testing has become more readily available—these tests are not without cost to the health care system and have their own limitations. They are not a substitute for one’s own evaluation using physical examination skills.

A thorough history and physical examination is always the “right” place to start. Unfortunately, many parts of the physical examination are becoming less commonplace; testing often is the first rather than the last aspect of one’s work-up. Perhaps this is more common in recent years, as tests have become less invasive and less taxing on the physician’s busy schedule. A thorough physical exam does indeed take time, but it provides invaluable information and insight that often cannot be detected by a scan or test. Another problem is that newer physicians may not have developed the same degree of confidence in their physical examination skills as physicians did in years past when fewer options were available to assist in making the proper diagnosis. Certain aspects of the physical exam may also have long been forgotten from lack of use, despite mastery earlier in one’s career.

I hope that you will read these articles as a way of refreshing your physical examination skills, at least as they relate to the musculoskeletal exam. Perhaps they also will stimulate you to re-read one of the physical diagnosis texts that may have gathered dust on your bookshelf, and help you to appreciate and use your own diagnostic skills and abilities.

Send comments to Dr. Gambert at medwards@hmpcommunications.com.