Overview of the clinical assessment of musculoskeletal symptoms in adults

For advice on the clinical assessment of musculoskeletal symptoms in children and adolescents, see the separate paediatric assessment topic Clinical assessment of musculoskeletal symptoms in children and adolescents.

This topic offers clinicians an approach to the assessment of adults with new onset of musculoskeletal symptoms, concentrating on clinical assessment and supportive investigations. The advice here then leads into the topic on Approach to suspected inflammatory arthritis, where patterns of disease are used to help refine the potential diagnoses, and help direct the appropriate pathway for investigation and early management.

Musculoskeletal symptoms are very common in primary care, contributing to about 1 in 5 patient encounters with general practitioners in AustraliaBritt, 2015. Inflammatory rheumatological conditions are uncommon. The majority of musculoskeletal presentations to general practitioners involve management for longstanding complaints, particularly osteoarthritis, low back complaints, common injuries and limb conditions.

Inflammatory rheumatological conditions may include inflammatory arthritis (eg rheumatoid arthritis), inflammatory connective tissue disease (eg systemic lupus erythematosus [SLE]) and systemic vasculitides (eg giant cell arteritis). The diagnosis of inflammatory rheumatological conditions can be complex and lengthy. Arthritis is a common symptom of many inflammatory rheumatological conditions and until the diagnosis is confirmed, specialists often refer to early presentations as ‘suspected inflammatory arthritis’.

When a person presents with new onset of unprovoked musculoskeletal symptoms, they should be assessed for any alerting features (‘red flags’) of potentially serious pathology; see Serious rheumatological conditions requiring urgent management and their alerting features (‘red flags’) in adults for examples. Early diagnosis of potentially serious inflammatory rheumatological conditions (eg rheumatoid arthritis) may avert or minimise permanent joint damage and disability. This involves prompt referral to a specialist and early initiation of treatment.

Investigations for suspected inflammatory arthritis, including blood investigations and imaging, play a limited role in diagnosis, because often they are not necessary to make a diagnosis and rarely do they confirm a suspected diagnosis.

For advice on assessing people with back or neck pain, see the separate topic on Assessment of back and neck pain.

For advice on assessing people with noninflammatory limb conditions (eg muscle strain, ligament sprain and tendinopathy), see Overview of limb conditions.