Skip to main content

Advertisement

SpringerLink
Log in

The rheumatology physical examination: making clinical anatomy relevant

  • Review Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

To review the importance of physical examination in the diagnostic process of musculoskeletal conditions vis-a-vis the development of sensitive and powerful technologies such as MRI and high-resolution ultrasound. Because the physical examination of the musculoskeletal system is an exercise of applied clinical anatomy, the authors tested, in one-to-one practical examinations, the basal knowledge of musculoskeletal anatomy of rheumatology trainees, rheumatologists, and other professionals of musculoskeletal medicine. The results of the authors’ surveys were disappointing, with a correct response rate of 50 to 60% depending on the locales. To correct this deficit, the authors gave many active-learning, case-centered seminars throughout the Americas and some overseas that may have fostered an interest in the study of clinical anatomy. There was an increased interaction between anatomy departments and clinicians, and that daily use of clinical anatomy would make anatomy relevant, improve clinical skills, and probably reduce the overall costs of the health care system.

Key Points

• Knowledge of musculoskeletal anatomy is the basic diagnostic tool in the regional pain syndromes

• Knowledge of musculoskeletal anatomy helps understand the musculoskeletal involvement in the regional and systemic rheumatic disorders

• An active-learning methodology was used since 2006 to review the anatomy that is relevant for rheumatology trainees and practitioners of musculoskeletal medicine

• A skilled, anatomy-based physical examination and a well-thought diagnostic hypothesis could reduce the use of expensive technologies that, being too sensitive, may lead the unaware clinician astray

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Zaman J, Verghese A, Elder A (2016) The value of physical examination: a new conceptual framework. South Med J 109:754–757

    Article  Google Scholar 

  2. Neviaser RJ (2000) Glenohumeral motion in patients with rotator cuff tears: a comparison of asymptomatic and symptomatic shoulders. J Shoulder Elb Surg 9:6–11

    Article  Google Scholar 

  3. Iagnocco A, Filippucci E, Sakellariou G, Ceccarelli F, Di Geso L, Carli L, Riente L, Delle Sedie A, Valesini G (2013) Ultrasound imaging for the rheumatologist XLIV. Ultrasound of the shoulder in healthy individuals. Clin Exp Rheumatol 31:165–171

    PubMed  Google Scholar 

  4. Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S (1990) Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72:1178–1184

    Article  CAS  Google Scholar 

  5. Panush RS (2011) Why rheumatology and the care of patients with rheumatic diseases are important, interesting, and exciting. Rheumatologist 5:65–72

    Google Scholar 

  6. Kalish RA, Canoso JJ (2007) Clinical anatomy: an unmet agenda in rheumatology training (Editorial). J Rheumatol 34:1208–1211

    PubMed  Google Scholar 

  7. Iagnocco A, Naredo E, Bijlsma JW (2013) Becoming a musculoskeletal ultrasonographer. Best Pract Res Clin Rheumatol 27:271–281

    Article  Google Scholar 

  8. Cannella AC, Kissin EY, Torralba KD, Higgs JB, Kaeley GS (2014) Evolution of musculoskeletal ultrasound in the United States: implementation and practice in rheumatology. Arthritis Care Res (Hoboken) 66:7–13

    Article  Google Scholar 

  9. Bandinelli F, Bijlsma JW, Ramiro MS, Pia E, Goekoop-Ruiterman YP, Sivera F, Molto Revilla A, Marinescu C, Rimar D, Norkuviene E, Mayer M, Duarte Marques CC, da Silva JA, Cutolo M (2011) Rheumatology education in Europe: results of a survey of young rheumatologists. Clin Exp Rheumatol 29:843–845

    PubMed  Google Scholar 

  10. Blake T, Marais D, Hassell AB, Stevenson K, Paskins Z (2017) Getting back to the dissecting room: an evaluation of an innovative course in musculoskeletal anatomy for UK-based rheumatology training. Musculoskeletal Care 15:405–412

    Article  Google Scholar 

  11. 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 (Hoboken) 66:270–276

    Article  Google Scholar 

  12. Torralba KD, Villaseñor-Ovies P, Evelyn CM, Koolaee RM, Kalish RA (2015) Teaching of clinical anatomy in rheumatology: a review of methodologies. Clin Rheumatol 34:1157–1163

    Article  Google Scholar 

  13. Kalish RA, Canoso JJ (2012) Development of the seminar. Reumatol Clin 8(Suppl 2):10–12

    Article  Google Scholar 

  14. Michael J (2006) Where’s the evidence that active learning works? Adv Physiol Educ 30:159–167

    Article  Google Scholar 

  15. Taylor DCM, Hamdy H (2013) Adult learning theories: implications for learning and teaching in medical education: AMEE guide no. 83. Med Teacher 35(11):e1561–e1572

    Article  Google Scholar 

  16. Saavedra MÁ, Navarro-Zarza JE, Alvarez-Nemegyei J, Canoso JJ, Kalish RA, Villaseñor-Ovies P, Hernández-Díaz C (2015) Self-assessed efficacy of a clinical musculoskeletal anatomy workshop: a preliminary survey. Reumatol Clin 11:224–226

    Article  Google Scholar 

  17. 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 35:1299–1306

    Article  CAS  Google Scholar 

  18. Canoso JJ (2011) Clinical anatomy: a basic discipline for the rheumatologist [Spanish]. Reumatol Clin 7:215–216

    Article  Google Scholar 

  19. 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 35:3025–3030

    Article  Google Scholar 

  20. Hernández-Díaz C, Alvarez-Nemegyei J, Navarro-Zarza JE, Villaseñor-Ovies P, Kalish RA, Canoso JJ, Vargas A, Chiapas-Gasca K, Biundo JJ, de Toro Santos FJ, McGonagle D, Carette S, Saavedra MÁ (2017) A survey of anatomical items relevant to the practice of rheumatology: pelvis, lower extremity, and gait. Clin Rheumatol 36:2813–2819

    Article  Google Scholar 

  21. Millender LH, Nalebuff EA, Holdsworth DE (1973) Posterior interosseous nerve syndrome secondary to rheumatoid synovitis. J Bone Joint Surg Am 55:375–377

    Article  CAS  Google Scholar 

  22. Shah KN, Hodax JD, Katarincic JA (2016) Evaluating a flexor tendon laceration with the tenodesis effect. J Pediatr 176:214–214.e1

    Article  Google Scholar 

  23. Waldman S (2007) Atlas of pain management injection techniques. Saunders Elsevier, Philadelphia

    Google Scholar 

  24. Koran LM (1975) The reliability of clinical methods, data and judgments (second of two parts). N Engl J Med 293(14):695–701

    Article  CAS  Google Scholar 

  25. Koran LM (1975) The reliability of clinical methods, data and judgments (first of two parts). N Engl J Med 293:642–646

    Article  CAS  Google Scholar 

  26. Canoso JJ (2012) Should rheumatologists palpate the breast? Letter J Rheumatol 39:1296

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hospital General de Tijuana, Tijuana, Baja California, Mexico

    Pablo Villaseñor-Ovies

  2. Hospital Angeles Tijuana, Tijuana, Baja California, Mexico

    Pablo Villaseñor-Ovies

  3. Universidad Autónoma de Baja California, Tijuana, Baja California, Mexico

    Pablo Villaseñor-Ovies

  4. Hospital General Dr. Raymundo Abarca Alarcón, Chilpancingo, Guerrero, Mexico

    José Eduardo Navarro-Zarza

  5. ABC Medical Center, Mexico City, Mexico

    Juan J. Canoso

  6. Tufts University School of Medicine, Boston, MA, USA

    Juan J. Canoso

Authors
  1. Pablo Villaseñor-Ovies
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. José Eduardo Navarro-Zarza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juan J. Canoso
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pablo Villaseñor-Ovies.

Ethics declarations

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Synopsis

Knowledge of musculoskeletal structure and function is essential in the practice of rheumatology. The authors describe an active learning, case-centered teaching methodology they have used in musculoskeletal clinical anatomy seminars since 2006. These seminars, with an optimal participant to instructor ratio of 10 to one, are based on case discussions and the cross-examination of participants and instructors. Pre-seminar surveys have consistently revealed a minimal recollection of the musculoskeletal anatomy as taught in medical school. There is no proof of the long-term efficacy of the method. However, the consistency of encouraging participants’ comments and the many invitations to replicate the seminars at regional and national rheumatologic meetings indicate a favorable perception of the method. Indeed, the short-term efficacy of the method was shown in three studies.

Part of the Topical Collection entitled ‘Empowering Medical Education to Transform: Learnings from an international perspective’

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Villaseñor-Ovies, P., Navarro-Zarza, J.E. & Canoso, J.J. The rheumatology physical examination: making clinical anatomy relevant. Clin Rheumatol 39, 651–657 (2020). https://doi.org/10.1007/s10067-019-04725-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-019-04725-9

Keywords

Search

Navigation