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Think about the joints!
  1. E T Mosley1,
  2. A M McMahon1,2
  1. 1Peadiatric Rheumatology, Sheffield Children's Hospital, Sheffield, UK
  2. 2Paediatric Rheumatology, Leeds Children's Hospital, Leeds, UK


Aim 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 such as malignancy, sepsis, arthritis and non-accidental injury. It has been previously shown that musculoskeletal examination is poorly documented. Musculoskeletal examination has now been included as a station on the RCPCH clinical exam since 2009. Teaching resources on how to perform musculosketal examinations are freely available as are 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 any forms of musculoskeletal examination along side other core systems were reviewed. Standard used for inclusion of musculoskeletal examination:

  • Child with muscle, joint or limb pain

  • Unwell child with fever

  • Limping child

  • Delay of milestone

  • Clumsy child in the absence of neurological signs

  • Associated conditions/chronic diseases for example, inflammatory bowel, cystic fibrosis, arthritis, psoriasis

Red Flags (concern about infection, malignancy or NAI).

  • Fever, malaise, systemic upset

  • Bone/joint pain with fever

  • Refractory pain, persistent night sweats

  • In congruency between history and presentations

Results 48 admissions, totalling 47 patients were reviewed. 23 patients had presenting symptoms to advocate the inclusion of musculoskeletal examinations.

  • Trigger Number

  • fever 17

  • Chronic disease 1

  • Limp/joint pain 1

  • Repeat attendee with fever 1

  • Red flag (excluding fever) 3

Only two patients had documented musculoskeletal examinations.

Conclusions Despite the availability of free training resources and intense efforts of Rheumatologists, and the arthritis research council to highlight the ease with which musculoskeletal examinations are performed, and the need for early recognition of children with potential Rheumatological conditions, there has been little improvement in the inclusion of this clinical examination. While this was a small sample, predominantly patient with fever it highlights the need for further education aimed both medical student and junior doctors, in both when and how to perform a musculoskeletal examination.

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