The prevalence of complaints involving the musculoskeletal system is considerable. For shoulder complaints, the incidence in GP practices is 14.45 per 1,000 patients (Lamberts, Monitoring Project). The majority of shoulder complaints fall into one of the following three categories: rotator cuff disorders, articular disorders (particularly frozen shoulder) and disorders affecting the acromioclavicular joint (Winkelman). The elbow and wrist are less frequently affected. Jonquiere registered that the diagnosis of lateral epicondylitis was made in 57 of 74 elbow disorder diagnoses.
Although the incidence of complaints involving the musculoskeletal system is high, adequate examination and treatment of these complaints leave a lot to be desired. Therefore, the need for professional development in this field is pressing. The existing discrepancy between the previously mentioned professional need on the one hand and the training currently provided on the other, elicits several questions. Is structured and sufficient attention given to musculoskeletal examinations during the undergraduate medical degree? Is there sufficient knowledge of the (functional) anatomy, kinesiology and pathology in this area? To what degree is the complexity of the research discouraging? Is the lack of consensus between various schools of thought confusing? It is not the intention of the authors to provide well-balanced answers to these questions. Instead we aim to give the reader the opportunity to expand and deepen their knowledge and skills in this field. Although the information provided relates to general practice, we certainly do not wish to limit ourselves to this proffesional group. We feel that medical students, resident physicians, physiotherapists (in training) and posture and movement therapists will also benefit from using this program. When compiling this program, the authors encountered a number of elementary obstacles. The first question was which method, movement or ‘school’ should be adopted as the basis for this program. For a number of reasons, which will be named below, the classical orthopaedic approach was chosen as the basis for this program. We believe that this method most closely relates to the frame of reference of our target groups. Also, the classical orthopaedic method forms the basis for insights and methods that have been developed more recently. Consequently, anyone who is (or aims to be) thoroughly familiar with the principles of classical orthopaedics will have sufficient basic knowledge to extend their knowledge and skills by looking into other schools of thought.
A second dilemma that the authors encountered was created by the wish to offer a didactically responsible method on the one hand (requiring a rigid systematic approach) and, on the other hand, to compile a program that is easy to use and attractively presented. In our opinion the photographic support is a valuable aid. For some (selective) muscle tests, the photo is accompanied by text describing the manner in which the part to be examined should be approached; the text may give more elaborate information if the complexity of the action gives reason for this. When performing these muscle tests you should realise that the method illustrated may not be the only correct way. By adding an asterisk (*) to repeats, we have tried to improve readability. In addition, next to the various structures, the accompanying disorder is often mentioned.
