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The rheumatology physical examination: making clinical anatomy relevant.

  • Villaseñor-Ovies, Pablo1, 2, 3
  • Navarro-Zarza, José Eduardo4
  • Canoso, Juan J5, 6
  • 1 Hospital General de Tijuana, Tijuana, Baja California, Mexico. [email protected] , (Mexico)
  • 2 Hospital Angeles Tijuana, Tijuana, Baja California, Mexico. [email protected] , (Mexico)
  • 3 Universidad Autónoma de Baja California, Tijuana, Baja California, Mexico. [email protected] , (Mexico)
  • 4 Hospital General Dr. Raymundo Abarca Alarcón, Chilpancingo, Guerrero, Mexico. , (Mexico)
  • 5 ABC Medical Center, Mexico City, Mexico. , (Mexico)
  • 6 Tufts University School of Medicine, Boston, MA, USA.
Published Article
Clinical Rheumatology
Publication Date
Aug 24, 2019
DOI: 10.1007/s10067-019-04725-9
PMID: 31446539


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.

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