Table 2

The assessment of specific problems (specifically related to urgency, importance, and/or prevalence)

ProblemAction required
Emergencies/red flagsTo know when to immediately refer a patient with a condition that requires urgent specialist management. This requires the ability to identify, characterise, and differentiate through patient inquiry, examination, and limited investigation, within the context of knowledge and outline management of:

  • Open fractures

  • Fractures with nerve or vascular compromise

  • Cauda equina compression

  • Compartment syndrome/vascular compromise

  • Joint infection

  • Soft tissue infection

  • Bone infection

  • Temporal arteritis

Extremity problems: traumaticTo identify, characterise, and differentiate through patient inquiry, examination and limited investigation, within the context of knowledge. This requires the ability to:

  • Take a relevant history in the knowledge of the characteristics of trauma and fracture

  • Identify and characterise, for example, injuries that include fracture of long bones, fracture involving joints, joint dislocations, sprains, and strains

  • Evaluate the energy of the trauma and its impact on type of injury (low energy trauma and fragility fracture, traffic accident and complicated fractures)

Extremity problems: non-traumaticTo identify, characterise, and differentiate through patient inquiry, examination, and limited investigation, within the context of knowledge. This requires the ability to:

  • Take a relevant history in the knowledge of the characteristics of major, non-traumatic extremity problems

    • – Joint disorders (osteoarthritis, rheumatoid arthritis)

    • – Soft tissue disorders (bursitis, tendonitis, tenosynovitis, enthesopathy, and nerve entrapment)

    • – Muscle disorders (congenital, inflammatory, and neurological)

    • – Bone conditions (malignancy and infection)

  • Identify and characterise, for example, conditions that include:

    • – Joint inflammation and/or damage such as osteoarthritis, rheumatoid arthritis

    • – Soft tissue conditions such as bursitis, tendonitis, tenosynovitis, enthesopathy, and nerve entrapment

    • – Muscle conditions such as congenital, inflammatory and neurological

    • – Bone conditions such as malignancy and infection.

Spinal problemsThis requires the ability to:

  • Take a relevant history in the knowledge of the characteristics of the major conditions:

    • – Mechanical neck/back pain (for example, non-specific low back pain, lumbago)

    • – Spinal cord or root entrapment (for example, herniated lumbar disc)

    • – Vertebral fracture of traumatic origin

    • – Vertebral fracture of osteoporotic origin

    • – Inflammatory back pain (for example, ankylosing spondylitis)

    • – Spinal deformity (for example, scoliosis)

    • – Destructive (infectious and tumour related) back pain (for example, tuberculosis, metastasis, certain cancers)

Problem based symptomatic approachTo construct an appropriate differential diagnosis and plan of patient inquiry, examination, limited investigation, and assessment for a patient presenting with:

  • Musculoskeletal injury

  • Joint pain—poly-, mono-, and periarticular

  • Back pain

  • Regional pain or stiffness

  • Generalised pain or stiffness

  • Decrease or loss of motion or weakness

  • Altered sensation

  • Deformity

  • Mass

This should relate to mechanisms of conditions (also considered later in the context of knowledge):

  • Traumatic (for example, low energy as in osteoporosis, occupational injuries, or sports injuries)

  • Vascular/ischaemic (for example, compression or disruption of a vessel)

  • Neurological (for example, compression)

  • Infectious (for example, joint or bone)

  • Degenerative (for example joint or spine)

  • Autoimmune or immune mediated (for example, rheumatoid arthritis)

  • Metabolic/toxic (for example, osteoporosis, gout)

  • Inherited/developmental/congenital (for example, scoliosis)

  • Neoplastic (for example, myeloma)

  • Psychological (for example chronic pain syndromes, fibromyalgia)