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Content Objective: Musculoskeletal Pain

By the end of the Family Medicine Clerkship, the medical student will be able to:

  1. Perform a patient-centred interview that includes:
    1. exploration of different causes of mechanical low back pain.
    2. probing for red flags of potentially serious causes.
    3. potential psychosocial risk factors for chronic disability (i.e. “yellow flags.”)
  2. Perform a focused physical exam that distinguishes different causes of mechanical low back pain and identifies signs of potentially serious secondary causes e.g. infection, pathological fracture, non-MSK referred pain.
  3. Propose initial management plan for low back pain that includes:
    1. appropriate and timely investigation of urgent potentially serious secondary causes.
    2. appropriate evidence-informed management of mechanical LBP, including pharmacological and non-pharmacological modalities, return to work, and secondary prevention.
  4. Conduct a history and physical exam so as to:
    1. identify an acute hot joint (and act upon this finding),
    2. differentiate arthritis vs. soft-tissue disorder, and/or
    3. differentiate inflammatory vs. non-inflammatory arthritis
  5. Establish a differential diagnosis for patients presenting with the following joints specifically:
    • Shoulder (dislocated and separated shoulders, fractured clavicle, rotator cuff tendinitis, osteoarthritis, etc.)
    • Elbow (lateral epicondylitis, medial epicondylitis, etc.)
    • Knee (menisical tear, MCL/ACL/PCL tears, dislocated patella, patella-femoral pain, osteoarthritis, etc.)
    • Ankle/Foot (gout, fractures vs. ankle sprains, etc.)
    • Hip (dislocation, fracture, osteoarthritis, etc.)
  6. Identify musculoskeletal clinical scenarios for which investigation is appropriate and describe their inherent limitations.
  7. Propose an initial treatment plan of musculoskeletal pain, including pharmacological and non-pharmacological modalities.

Mandatory Clinical Encounter

  • Back pain

* Where a specific resource is not listed for a particular objective, please refer to recommended general texts/websites. Resources have often been selected from the Clinical Practice Guidelines and Protocols in British Columbia and Alberta’s Towards Optimized Practice Clinical Practice Guidelines. These are often concise summaries of national guidelines.