Investigations for musculoskeletal problems

Investigation of musculoskeletal (MSK) problems can present challenges to clinicians. There is a lack of definitive tests available and skills are needed to interpret results. There is also the potential to do harm to patients, both in terms of physical harm, for example from ionising radiation, but also by reinforcing worries about physical damage to tissues which can then pose a barrier to improvements.

The investigation of MSK complaints, therefore, need to be carried out carefully and astutely. Relevant and timely follow-ups can be very positive.

Serology

Review 20 patients you have seen in the last year who have had rheumatology serology tests (eg rheumatoid factor, anti-CCP, HLA-B27, ANA/ANF).

Were these patients subsequently referred to see a rheumatologist?

• How much information did the tests add to the clinical picture?
• Did they affect your management of the patient?

X-rays

Consider performing a retrospective review of patients who have had x-rays for knee pain in the past year:

• Was your request in keeping with Royal College of Radiologists (RCR) iRefer guidelines?These can be accessed by all healthcare professionals via e-Learning for Healthcare (e-LfH).
• How will this change your approach in future?

Consider performing a retrospective review of patients who have had x-rays for back pain in the past year:

• Was your request in keeping with RCR guidelines?
• How will this change your approach in future?

Magnetic Resonance Imaging (MRI)

Standards

RCR iRefer guidelines.

Consider performing a retrospective review of patients who have had MRI scans for knee injuries (read code for MRI scan: 56N91):

• Was your request in keeping with RCR guidelines?
• Did your history and examination findings correlate with the MRI report?
• How will this change your approach in future?

Consider performing a retrospective review of patients who have had MRI for back or neck pain (with or without radiculopathy):

• Was your request in keeping with RCR guidelines?
• Did your history and examination findings correlate with the MRI report?
• How will this change your approach in future? How confident do you feel about diagnosing a prolapsed disc without an MRI scan?