Examination skills in the assessment of the musculoskeletal system in children and adolescents

Musculoskeletal symptoms in children and adolescents are common, can be the presenting feature of severe, even life-threatening, disease and may present to different clinical specialities including primary care and secondary care (e.g. paediatrics, orthopaedics, accident and emergency). Accurate diagnosis relies on competent clinical examination skills. It is therefore important that clinicians have competence in basic examination of the paediatric musculoskeletal system. This article reviews the evidence which suggests that competence in basic locomotor examination skills amongst paediatricians is low compared with other body systems, and we discuss the reasons for this. In the absence of an evidence-based validated screening locomotor examination aimed at children and adolescents, we describe a suggested approach.