Musculoskeletal
Musculoskeletal
Notes & Study Aids
the Pre-Three
The Pre-Three Approach to the MSK Patient Exam
The “Pre-Three framework” is a structured method for evaluating musculoskeletal patients that emphasizes safety, triage, and clinical reasoning.
🔹 1. observe
Purpose: Ensure the patient is safe to continue with the exam.
General: bruising, swelling, deformities, asymmetry, bumps, color, scars, etc.
Region specific: For example, at the ankle - Pes Planus (Flat feet), Pes Cavus (High Arches)
🔹 2. Fracture Screen
History or Signs/Symptoms of trauma?
Region specific screenings: For example, at the ankle - Ottawa Civic Hospital
Then
A) Lightly palpate local boney landmarks
B) Percuss local boney landmarks
C) Vibration on local boney landmarks
D) Torsion resisted twisting motion
🔹 3. Active Range of motion
Joint/body part specific - sagittal, coronal, transverse planes
🔹 After Pre-Three
Passive range of motion
Resisted range of motion
Consider diagnostic clusters
Perform orthopedic exams for that region/DDXs
orthopedic exams
Spine: Cervical, Thoracic, Lumbar
Pelvis/Hips
Knee
Ankle
Shoulder
Elbow
Wrist/Hands
resources
Orthopedic Exams: PhysMedU
MSK Anatomy made easy with short, memorable videos: Memorize Medical
