Musculoskeletal

Musculoskeletal

Notes & Study aids

1st - 3 - 1st

The 1st–3–1st Approach to the MSK Patient Exam

The “1st–3–1st framework” is a structured method for evaluating musculoskeletal patients that emphasizes safety, triage, and clinical reasoning.

🔹 First “1st”: Initial Triage

• Purpose: Ensure the patient is safe to continue with the exam.

• Observe: Posture, movement quality, distress.

• Fracture Screen: Rule out red flags for urgent referral.

• Active Range of Motion (AROM): Quick screen for function and pain response.

🔹 The “3” Steps

1. History (Hx): Build a differential diagnosis.

   • General questions: triage for complicating factors (neuro changes, vision, breathing, nausea, headache).

   • Region-specific questions: rule in/out common local conditions.

   • LOC-Q-SMAT framework → Location, Onset, Chronology, Quality, Severity, Modifying factors, Associated symptoms, Treatments tried/goals.

2. Physical Exam (PE): Systematic regional exam to narrow your working diagnosis.

3. Ancillary Studies: Imaging or labs to confirm the suspected diagnosis when appropriate.

🔹 Final “1st”: Working Diagnosis

• Synthesize findings from observation, history, exam, and studies.

• Arrive at a working diagnosis that directs management and referral decisions.

orthopedic exams

Spirometry can distinguish between:

• Obstructive pulmonary disease (increased airway resistance – bronchitis)

  • TLC, FRC, RV may increase because of hyperinflation of lungs

• Restrictive disease (reduced TLC due to disease – tuberculosis) or exposure to environmental agents (fibrosis)

  • VC, TLC, FRC, RV decline because lung expansion is compromised

Simple spirometry can NOT determine/measure:

• RV, FRC, and TLC

Simple spirometry can determine/measure:

• IRV, TV, and ERV
  

  resources

• Orthopedic Exams: PhysMedU

• MSK Anatomy made easy with short, memorable videos: Memorize Medical

MSK Notes