Table 4

The core knowledge to support diagnosis and management

(A) Basic knowledge
To identify the bones and joints within the articulated human skeleton
To specify the major muscle groups, their function, and their root innervation
To specify major vessels and nerves related to the musculoskeletal problems
To outline the basic physiology, cell biology, and pathology relating to musculoskeletal conditions
  • This includes aging, injury and disease states, and repair of musculoskeletal tissues (bone, cartilage, synovium, muscle, entheses). (Including mechanical, traumatic, metabolic, vascular, degenerative, inflammatory, and immune mediated conditions, neoplastic, inherited, and developmental)

(B) Knowledge of methods for management and treatment
Management strategiesTo be able to describe the strategies available for the management, including rehabilitation, of acute and chronic musculoskeletal disorders (listed above), and for chronic musculoskeletal pain.
  • This includes education, drug treatment, physical treatments, relaxation, self efficacy, psychosocial interventions, social support, referral, and shared care

  • To be familiar with factors that influence adherence to a management plan.

PharmacologyTo know the major indications, adverse effects, drug interactions, and contraindications of drugs commonly used in the management of musculoskeletal conditions
  • Acute and chronic pain management

  • Disease modifying treatment

This includes analgesics, non-steroidal anti-inflammatory drugs, antidepressant drugs in pain management, corticosteroids, hypouricaemic drugs, disease modifying and cytotoxic drugs, treatment for osteoporosis
There should be familiarity with the placebo effect and an awareness of special situations with these drugs, such as pregnancy
Non-surgical treatment for traumaTo be able to describe the principles of reduction, fixation, and immobilisation for fracture and multiple trauma management
  • To know the most common non-operative procedures for fracture and dislocation. This includes closed reduction, the use of external fixation devices such as Plaster of Paris or elastic wraps. Common injuries may include fracture of the wrist or proximal humerus, shoulder dislocation, and ankle sprain

Surgical treatmentTo be able to describe the surgical principles of reduction, fixation, and immobilisation for fracture and multiple trauma management
  • This includes familiarity with the treatment of the most common fractures such as hip, wrist, and ankle fractures

  • To know the most common operative procedures for fracture and dislocation. This includes open reduction, the use of internal and external fixation devices

To know the most common operations for musculoskeletal conditions.
  • Arthroscopy of the knee,

  • Arthroplasty of hip and/or knee

  • Back surgery (discectomy, spinal fusion)

  • Amputation, synovectomy, osteotomy, arthrodesis, and carpal tunnel decompression

To be able to describe the benefits and complications of large joint (hip, knee) replacement surgery
This includes the complications of DVT, infection and loosening, and expected durability of implant
Other proceduresTo know the indications, benefits and risks of:
  • Joint aspiration

  • Injections of joint, soft tissue and spine

RehabilitationTo know the benefits of rehabilitation of musculoskeletal conditions and their effect on outcome of treatment process and total patient function
  • This should be in the context of different musculoskeletal conditions such as amputations, spinal cord injury, trauma, fractures, osteoporosis, osteoarthritis, rheumatoid arthritis, mechanical soft tissue lesions, neck and back pain, disuse atrophy, and deconditioning due to prolonged immobilisation

  • Rehabilitative interventions should include physiotherapy and occupational therapy

  • The different problems of lower versus upper limb amputation should be understood

To know the common orthoses, limb prostheses, and adaptive equipment for individual patients with a musculoskeletal impairment
  • For example, when to use Plaster of Paris, sticks, cane, walker, corset, activities of daily living equipment

PreventionTo know prevention strategies for common musculoskeletal conditions
  • Specific examples might include trauma, fractures, osteoporosis, osteoarthritis, osteoarticular infection, mechanical soft tissue lesions, and neck or back pain

  • Strategies include benefits and risks of lifestyle factors, physical activity, minimising immobility, and avoidance of specific risks for musculoskeletal conditions

(C) Knowledge of methods to assist diagnosis and management
Laboratory assessmentTo demonstrate an appropriate use and interpretation of laboratory investigations for diagnosis and assessment of musculoskeletal conditions
  • Full blood count (haemoglobin/white cells)

  • Acute phase response

    • – Erythrocyte sedimentation rate (ESR)

    • – C reactive protein (CRP)

  • Immunological investigations

    • – Rheumatoid factor

    • – ANA

  • Serum biochemistry, including calcium, alkaline phosphatase, creatine kinase, and albumen

  • Synovial fluid analysis (white cells, glucose, culture, crystals)

ImagingTo demonstrate the appropriate use of imaging for the diagnosis and assessment of musculoskeletal conditions and to be able to interpret reports
  • for example, x ray, CT scan, MRI, bone densitometry, bone scintigraphy, musculoskeletal ultrasound