Clinical Rheumatology

, Volume 36, Issue 12, pp 2813–2819 | Cite as

A survey of anatomical items relevant to the practice of rheumatology: pelvis, lower extremity, and gait

  • Cristina Hernández-Díaz
  • José Alvarez-Nemegyei
  • José Eduardo Navarro-Zarza
  • Pablo Villaseñor-Ovies
  • Robert A. Kalish
  • Juan J. Canoso
  • Angélica Vargas
  • Karla Chiapas-Gasca
  • Joseph J. Biundo
  • Francisco Javier de Toro Santos
  • Dennis McGonagle
  • Simon Carette
  • Miguel Ángel SaavedraEmail author
Original Article


This study aimed to generate a minimum list of structural and functional anatomical items about the pelvis/hip, knee, ankle/foot, gait, and lower limb innervation, which are most relevant to the practice of rheumatology. To determine their perceived relevance to clinical practice, seven members of the Mexican Clinical Anatomy Task Force compiled an initial list of 470 anatomical items. Ten local and international experts according to a 0–10 Likert scale ranked these items. Of the original list, 101 (21.48%) items were considered relevant (global rate >40). These included 36/137 (26.27%) pelvis and hip items, 25/82 (30.48%) knee items, 22/168 (13.98%) ankle/foot items, 11/68 (16.17%) neurologic items, and 7/15 (46.66%) gait-related items. We propose that these 101 anatomical items of the lower extremity, when added to the 115 anatomic items of the upper extremity and spine we previously reported, may represent an approximation to the minimal anatomical knowledge central to the competent practice of rheumatology. The meager representation of ankle and foot items may reflect a lesser emphasis in these anatomical regions during rheumatologic training. Attention to these and related items during rheumatologic training and beyond may sharpen the rheumatologist’s ability in the differential diagnosis of regional pain syndromes as well as strengthen an endangered art: the rheumatologic physical examination.


Clinical anatomy Physical examination Regional pain syndromes Rheumatology education 


Compliance with ethical standards




  1. 1.
    Navarro-Zarza JE, Hernández-Díaz C, Saavedra MA, Alvarez-Nemegyei J, Kalish RA, Canoso JJ, Villaseñor-Ovies P (2014) Preworkshop knowledge of musculoskeletal anatomy of rheumatology fellows and rheumatologists of seven North, Central, and South American countries. Arthritis Care res 66:270–276CrossRefGoogle Scholar
  2. 2.
    Saavedra MA, Villaseñor-Ovies P, Harfush LA, Navarro-Zarza JE, Canoso JJ, Cruz-Domínguez P, Vargas A, Hernández-Díaz C, Chiapas-Gasca K, Camacho-Galindo J, Alvarez-Nemegyei J, Kalish RA (2016) Educational impact of a clinical anatomy workshop on 1st-year orthopedic and rheumatology fellows in Mexico City. Clin Rheumatol 35:1299–1306CrossRefPubMedGoogle Scholar
  3. 3.
    Villaseñor-Ovies P, Navarro-Zarza JE, Saavedra MÁ, Hernández-Díaz C, Canoso JJ, Biundo JJ, Kalish RA, de Toro Santos FJ, McGonagle D, Carette S, Alvarez-Nemegyei J (2016) A survey of anatomical items relevant to the practice of rheumatology: upper extremity, head, neck, spine and general concepts. Clin Rheumatol 35:3025–3030CrossRefPubMedGoogle Scholar
  4. 4.
    Sivera F, Ramiro S, Cikes N, Cutolo M, Dougados M, Gossec L, Kvien TK, Lundberg IE, Mandl P, Moorthy A, Panchal S, da Silva JA, Bijlsma JW, Working Group on Training in Rheumatology (2016) Rheumatology training experience across Europe: analysis of core competences. Arthritis Res Ther 18(1):300CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Sivera F, Ramiro S, Cikes N, Dougados M, Gossec L, Kvien TK, Lundberg IE, Mandl P, Moorthy A, Panchal S, da Silva JA, Bijlsma JW, Working Group on Training in Rheumatology across Europe (2015) Differences and similarities in rheumatology specialty training programs across European countries. Ann Rheum dis 74:1183–1187CrossRefPubMedGoogle Scholar
  6. 6.
    Brown CR Jr, Criscione-Schreiber L, O'Rourke KS, Fuchs HA, Putterman C, Tan Valeriano-Marcet J, Hsieh E, Zirkle S, Bolster MB (2016) What is a rheumatologist and how do we make one? Arthritis Care res 68:1166–1172CrossRefGoogle Scholar
  7. 7.
    Bolster M, Brown C, Criscione-Schreiber LG, Fuchs H, Hsieh E, O'Rourke KS, et al (2015) Core curriculum outline for rheumatology fellowship programs. Am Coll Rheumatol 1–94Google Scholar
  8. 8.
    Pascual-Ramos V, Bernard-Medina GA, Flores-Alvarado DE, Portela-Hernández M, Maldonado-Velázquez MD, Jara-Quezada LJ, Amezcua-Guerra LM, Rubio N, López-Zepeda NE, Álvarez-Hernandez E, Saavedra MÁ, Arce-Salinas CA, Consejo Mexicano de Reumatología (CMR) (2017) The method used to set the pass mark in an objective structured clinical examination defines the performance of candidates for certification as rheumatologists. Reumatol Clin. doi: 10.1016/j.reuma.2016.11.007

Copyright information

© International League of Associations for Rheumatology (ILAR) 2017

Authors and Affiliations

  • Cristina Hernández-Díaz
    • 1
  • José Alvarez-Nemegyei
    • 2
  • José Eduardo Navarro-Zarza
    • 3
    • 4
  • Pablo Villaseñor-Ovies
    • 5
    • 6
  • Robert A. Kalish
    • 7
  • Juan J. Canoso
    • 8
    • 9
  • Angélica Vargas
    • 10
  • Karla Chiapas-Gasca
    • 11
  • Joseph J. Biundo
    • 12
  • Francisco Javier de Toro Santos
    • 13
  • Dennis McGonagle
    • 14
  • Simon Carette
    • 15
    • 16
  • Miguel Ángel Saavedra
    • 17
    Email author
  1. 1.Laboratorio de Ultrasonido Musculoesquelético y ArticularInstituto Nacional de RehabilitaciónMéxicoMexico
  2. 2.Unidad de InvestigaciónHospital Regional de Alta Especialidad de la Península de YucatánMéridaMexico
  3. 3.Hospital General de Chilpancingo Raymundo Abarca AlarcónChilpancingoMexico
  4. 4.Universidad Autónoma de GuerreroAcapulcoMexico
  5. 5.Hospital Ángeles de TijuanaTijuanaMexico
  6. 6.Universidad Autónoma de Baja CaliforniaMexicaliMexico
  7. 7.Tufts Medical CenterBostonUSA
  8. 8.Centro Médico ABCMéxicoMexico
  9. 9.Tufts Medical SchoolBostonUSA
  10. 10.Departamento de ReumatologíaInstituto Nacional de Cardiología Ignacio ChávezMéxicoMexico
  11. 11.Hospital Adolfo López Mateos, ISSSTEMéxicoMexico
  12. 12.Tulane Medical CenterNew OrleansUSA
  13. 13.Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC)Complejo Hospitalario Universitario A Coruña (CHUAC), Sergas, Universidad La Coruña (UDC)CoruñaSpain
  14. 14.UK National Institute for Health Research Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
  15. 15.Division of Rheumatology, Mount Sinai HospitalUniversity Health NetworkTorontoCanada
  16. 16.University of TorontoTorontoCanada
  17. 17.Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La RazaInstituto Mexicano del Seguro SocialMexico CityMexico

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