The Best Way To Prepare For Your MSK Placement

Introduce yourself

Before starting your placement, it is important to contact your clinical educator to find out more about the environment you will be working in. You can contact them via email or phone, but it’s preferable to speak to them on the phone or in a virtual meeting if possible as it helps establish a more profound relationship with your educator. You should ask questions about the type of conditions you will be seeing, the nature of referrals that are received by the department (self-referrals, general practitioners, orthopaedic) and the local ancillary services available for example, hydrotherapy, mental health, weight loss, persistent pain, etc. It is also useful to inform your educator about your learning needs or any adjustments you need so that a clear plan can be set in place as early as possible to alleviate any stress.

Master your subjective & objective assessments

It’s important to learn your subjective and objective assessments thoroughly without needing any prompts as you do not have to constantly think about what question to ask next or what test to do whilst you are with a patient. Developing a systematic structure for both the subjective and objective assessment that works for you and that you can remember is crucial. A systematic structure allows you to have a clear plan in mind, making it easier to collect the necessary information and perform necessary tests without having to constantly stop and think about what comes next. This not only saves time but also helps you to be more confident in your approach, which is important when dealing with patients who may be anxious or in distress.

In addition to practising your objective assessment, you will also want to be comfortable with completing a neurological assessment as this will come up frequently during your MSK placement. A neurological assessment involves the upper limb and lower limb myotomes and dermatomes. So, how can you master neurological assessments?

• Review anatomy: Before practising dermatome and myotome testing, it is important to have a good understanding of the relevant anatomy. Review the location of nerves and muscles in the body and their corresponding dermatomes and myotomes

• Practice with a friend: Find a friend to practice with, such as a fellow healthcare professional or a willing family member. Have them lie down and practice testing each dermatome and myotome, comparing your results with each other where appropriate

• Use diagrams and models: Use diagrams and models to study the location of nerves and muscles and their corresponding dermatomes and myotomes. You can also use anatomical models to practice the techniques if your university gives you access to such models

• Attend workshops or training sessions: Look for workshops or training sessions offered by university student societies or ask your lecturers to organise a group one-off session. These sessions can provide valuable hands-on experience and guidance from experienced practitioners

Preparation makes everything easier

An incredibly high-yield tip during your MSK placement is to read the notes of the patients you are seeing the day before the scheduled appointment. When you review the notes, it can be useful to make a note of anything you do not know much about which can be their presenting complaint, the condition, investigations such as blood tests or imaging and any relevant past medical history. Once you make a note of this, you can then read about the topic to fill any gaps in your knowledge and help you plan what you intend to ask, assess or advise during the appointment the following day. It is important to note that patient confidentiality must be upheld so avoid taking pictures of patients’ notes with your personal mobile phone or including the names of patients on a separate piece of paper.

If you want to be even more prepared, once you understand the topic you did not initially know much about, you can also read the latest evidence on that given topic which can further refine the questions you might ask the patient during the subjective assessment or the tests you may perform during the objective assessment. Furthermore, understanding the latest evidence on a given topic will exponentially improve your clinical reasoning and really impress your clinical educator when you discuss your assessment and management plan with them.

Know the basics of anatomy

It is not necessary to learn everything about anatomy before starting your placement but it is important to learn the anatomical structures that are likely to be affected. As a minimum, we recommend learning the key muscles, bones, nerves, and blood supply for each joint. If you are unsure about which anatomical structures you need to learn, you can work backwards to figure this out by focussing on the common MSK conditions you will likely see – we’ll illustrate this using MSK hand conditions as an example. If we consider carpometacarpal osteoarthritis, the clinically relevant anatomy you will need to know are the carpal bones of the hand, thenar and hypothenar muscles and the actions of these muscles. To give another example, if we consider carpal tunnel syndrome, you will need to learn the motor and sensory supply of the hand. Once you have a sound understanding of clinically relevant anatomy, you can then ensure that you remember everything you have just read by using the AcePhysio spaced learning question bank which gives you realistic MSK clinical scenarios and puts all the theory you have learnt into practice.

For red flag questions: the more the better

Once you learn the clinically relevant anatomy for each joint, you will also need to be aware of and be able to recognise sinister pathologies for each joint. When asking red flag questions to rule in or rule out red flag pathologies, it’s paramount that you ask more probing questions in a respectful manner if the patient’s response is even slightly concerning or vague. For example, if a patient with neck pain has difficulty holding objects and has bilateral arm pain, you will want to ask more questions to determine if it is a true cervical myelopathy that requires urgent medical intervention. For example, in the case of cervical myelopathy, you will want to ask the patient if they sustained any trauma to the neck (eg. a fall from a height) when they first noticed the reduced grip strength and if their grip strength has continued to deteriorate.

In conclusion, these tips can help you prepare for your MSK musculoskeletal physio student placement. If you need any tailored advice about how to prepare for your MSK placement or you have any challenges during your placement, please feel free to get in touch with us and we will work with you to give you advice and find practical solutions!