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10 stations / 101 steps/ 20 script lines

Musculoskeletal examination

Look, feel, move, then the special tests, with the normal ranges said out loud. The back pain classifier turns the pattern questions into the pattern and its treatment.

Timed station Script drill
0 of 101 steps

0/3Characterize

  • Nature: inflammatory (swelling, warmth, erythema, pain and stiffness after rest, morning stiffness over 30 minutes), non-inflammatory (minimal swelling, cool, worse with use, brief morning stiffness), or damage (deformity, crepitus).
  • Mechanical symptoms: clicking, locking, crepitus; distribution (large or small joints, upper or lower, symmetric, axial or peripheral, how many).
  • Location: articular (pain through the whole range), peri-articular (pain on engaging the tendon or ligament), non-articular (unrelated to joint movement).

0/4Extra-articular and beyond

  • Seropositive features: malar rash, nodules, mouth ulcers, alopecia, sicca, conjunctivitis, scleritis, pericarditis, pleuritis, Raynaud phenomenon.
  • Seronegative features: psoriasis, uveitis, conjunctivitis, oral ulcers, urethritis, cervicitis, balanitis, diarrhea or IBD.
  • Constitutional symptoms (fever, chills, weight loss); neurologic symptoms (sensation, numbness, tingling, weakness); family history of autoimmune disease, rheumatoid or osteoarthritis.
  • Function“How is this affecting your grooming, bathing, toileting, transfers, walking, dressing, and your work?”

7 steps left in this station.

Pattern classifier

Which mechanical back pain pattern?

Answer the pattern questions the way the patient did. Unclear answers count as the worst case: leg-dominant, constant.

Where is it worst?

Does it ever fully stop?

Bending forward

Bending backward

Pattern 1

Probably discogenic: back-dominant pain, always worse in flexion, constant or intermittent.

Criteria

  • Back-dominant
  • Always reproduced or increased in flexion
  • Constant or intermittent

Expected examination

Pain reproduced in flexion; neurological examination normal or unrelated. Prone extension positive (PEP) if pain falls within 10 repetitions, negative (PEN) if unchanged or worse.

Treatment

  • Posture: foot stool standing, large lumbar roll sitting, a pillow between the knees at night.
  • PEP: frequent prescribed sessions of unloaded prone passive extensions (the sloppy push-up) plus standing extension if it helped on exam.
  • PEN: scheduled rest positions (Z lie, prone over pillows), then retreat as far as needed (unloaded flexion position, flexion movement, extension position, extension movement) and advance to the PEP programme.
  • No narcotics; OTC analgesia or NSAIDs with mechanical therapy.

Hip range of motion

  • Flexionabout 135 degrees
  • Extensionabout 25 degrees
  • Internal rotationabout 35 degrees
  • External rotationabout 45 degrees
  • Abductionabout 45 degrees
  • Adductionabout 25 degrees

Recall quiz

Which back pain pattern?

Dominance, timing and direction in; the pattern out.

Score 0 / 5Streak 0

Shuffling the deck...

Demonstration videos are embedded from their creators’ own YouTube channels (Geeky Medics and Stanford Medicine 25) and remain theirs; each frame credits the channel and links out to it.