Musculoskeletal Assessment & Trauma Priorities
Combine a structured limb examination with early recognition of threats to life and limb.
Quick revision ↓ Medical Dictionary
01Life before limb
Begin with the trauma primary survey when the mechanism or condition suggests major injury. External deformity can distract from airway compromise, chest injury or concealed haemorrhage. Control immediate threats and call for help while protecting the injured limb; a detailed joint examination must not delay resuscitation.
02History and function
Establish mechanism, energy, timing, pain, weight-bearing ability and previous function. Ask about wounds, numbness, weakness, anticoagulants and relevant medical disease. Low-energy injury can still produce a serious fracture in fragile bone. Record occupation, hand dominance and patient priorities because these influence treatment and rehabilitation.
03Look, feel and move
Expose appropriately, preserve dignity and compare sides when useful. Inspect alignment, swelling, skin and wounds before gentle palpation. Assess movement only when safe; do not force a painful injured joint through range. Examine neighbouring joints and consider referred pain when the apparent site does not explain the findings.
04Neurovascular examination
Document distal perfusion, pulses, sensation and motor function using named nerves where possible. Record findings before and after splinting, reduction or surgery, and repeat if symptoms change. A palpable pulse does not exclude compartment syndrome or every arterial injury. Inability to examine reliably should be documented and escalated.
05Communicate the plan
Explain the suspected injury, uncertainty, analgesia, immobilisation and next investigation. Give specific warnings about increasing pain, numbness, coldness or swelling. Confirm follow-up responsibility and access; a fracture-clinic request alone does not ensure that the patient can obtain timely care.
High-Yield Revision
- A distracting deformity must not delay the primary survey.
- Record neurovascular findings before and after intervention.
- A pulse does not exclude every limb-threatening problem.
Common Pitfalls
- Forcing movement in an unstable painful injury.
- Writing neurovascularly intact without an adequate examination.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.