Musculoskeletal Health (MS)

  • Musculoskeletal presentations are common in general practice(1), affecting patients of all ages and significantly impacting quality of life and daily functioning. From acute injuries and mechanical back pain to chronic conditions such as osteoarthritis, inflammatory arthritis, and osteoporosis, GPs are often the first point of contact for assessment, diagnosis, and ongoing management. Effective care requires a combination of clinical reasoning, focused examination skills, and a holistic understanding of the patient’s physical, psychological, and social context. GPs also play a key role in early identification of red flag symptoms, appropriate use of imaging, and timely referral to physiotherapy or specialist services. As Ireland’s population ages and the burden of chronic musculoskeletal conditions increases, general practice is central to delivering coordinated, evidence-based, and patient-centred musculoskeletal care. This chapter outlines the essential skills and knowledge needed to confidently manage musculoskeletal health in the community setting. 

    • MS1. Demonstrate the ability to take a detailed history and a careful physical examination of the musculoskeletal system to aid diagnosis of musculoskeletal issues.
    • MS2. Demonstrate competence in managing common musculoskeletal conditions across all ages.
    • MS3. Consider the psychological, social and emotional impact of musculoskeletal conditions and communicate effectively with the patient to mitigate some of this impact.
    • MS4. Identify and respond appropriately to red flag musculoskeletal symptoms (Eg severe neurological deficits, signs of cauda equina syndrome, fractures, symptoms of inflammatory arthritis, signs of cancer or infection).
    • MS5. Recognise yellow flags relating to musculoskeletal issues for effective management in General Practice.
    • MS6. Apply the principles of acute MSK injury treatment including POLICE protocol.
    • MS7. Utilise evidence-based decision making for selecting both pharmacological and non-pharmacological treatment modalities for musculoskeletal presentations including patient education, physiotherapy, medication, joint injections and surgery.
    • MS8. Prescribe specific exercise regimens and modified activities to manage common musculoskeletal conditions.
    • MS9. Encourage exercise regimens, weight management and osteoporosis prevention strategies to reduce the risk of musculoskeletal conditions.
    • MS10. Effectively coordinate care for musculoskeletal conditions by making timely referrals, collaborating with multidisciplinary teams, and adhering to national referral guidelines and treatment thresholds.
    • MS11. Consider the indications for imaging relating to musculoskeletal presentations, acknowledging the limitations of imaging and considering test accuracy and cost effectiveness.
    • MS12. Recognise and address accessibility issues in healthcare settings, advocating for improvements to ensure inclusive care for all patients.
    • MS13. Understand the role of complementary therapies (such as acupuncture or massage therapy) in managing musculoskeletal pain, evaluating their benefits, risks, and appropriate integration with conventional treatments.
    • MS14. Consider the risks and benefits of various analgesia (including paracetamol, NSAIDs, opioids and gabapentinoids) considering factors such as patient adherence, side effects, shared prescribing and patient concerns.
    • MS15. Develop an understanding of medications used for rheumatological conditions including risks and benefits.

    For each problem or disease, consider the following areas within the general context of primary care:  

    • The natural history of the condition, including whether acute or chronic
    • The incidence and prevalence, including in different demographic groups
    • Typical and atypical presentations
    • Recognition of normal variations throughout life
    • Risk factors, including lifestyle, socio-economic and genetic factors
    • Diagnostic features and differential diagnosis
    • Recognition of ‘alarm’ or ‘red flag’ features
    • Appropriate and relevant investigations
    • Interpretation of test results
    • Management, including initial and continuing care, chronic disease monitoring and emergency care
    • Patient and carer information and education
    • Prognosis

    Signs, Symptoms & Presentations

    • Falls
    • Relating to the following Joints: Back, Neck, Jaw, Hip, Knee, Ankle, Foot, Shoulder, Elbow, Wrist, Hand
      • Joint Pain
      • Joint Redness
      • Joint Stiffness
      • Joint Swelling
    • Lumps and Deformities of Bone, Joints or Soft Tissue
    • Muscle Pain
    • Muscle Weakness
    • Trauma

    Common and Important Conditions

    • Adhesive Capsulitis
    • Bone Cancers
    • Bursitis
    • Carpal Tunnel Syndrome
    • Cauda Equina
    • Cervical Spine Disorders
    • Chronic Pain
    • Crystal Arthropathies including Gout
    • Disc Disease
    • Dislocations
    • Dupuytren’s Contracture
    • Fractures
    • Inflammatory Arthropathies (sero positive and sero negative)
    • Lymphoedema
    • Mechanical Back Pain
    • Osteoarthritis
    • Osteomyelitis
    • Osteoporosis
    • Plantar Fasciitis
    • Polymyalgia Rheumatica
    • Septic Arthritis
    • Soft Tissue Trauma
    • Spinal Malignancy
    • Tendonitis
  • Wherever possible learning resources included here are peer reviewed and externally maintained. This is to ensure that trainees have access to quality assured information that is kept up to date.

    Self-Directed Learning

    Blended Learning Resources (Education Platform)

    Diagnosing and Managing Low Back Pain in General Practice

    Best-practice Management of OA in Primary Care

    Workplace Based Learning

    Musculoskeletal health is ideally suited to hands-on learning in the clinical setting. In both general practice and hospital rotations, there are daily opportunities to assess and manage musculoskeletal complaints, from acute sprains and joint pain to chronic back issues and inflammatory conditions. Workplace-based learning allows you to refine your history-taking and examination techniques, practice joint assessments, and develop confidence in recognising red flags and differentiating between mechanical and inflammatory causes. Observing procedures such as joint injections or attending physiotherapy sessions can also enhance your understanding of treatment options and multidisciplinary care. Reflecting on real cases and receiving feedback from supervisors helps integrate practical skills with clinical judgement in a way that is both immediate and relevant.

    Day Release

    Day release sessions provide a supportive environment to deepen your understanding of musculoskeletal presentations through case-based discussions and practical workshops. These sessions allow trainees to review common conditions like back pain, osteoarthritis, and tendonitis, as well as more complex issues such as inflammatory arthritis or unexplained joint swelling. Practicing examination techniques, reviewing imaging reports, and discussing management plans in small groups fosters confidence and encourages critical thinking. Sharing cases with peers from other practices also broadens your exposure to different presentations and management strategies, helping you to build a well-rounded and evidence-based approach to musculoskeletal care.

    Registrar Tutorials

    Registrar tutorials offer focused, one-to-one opportunities to explore musculoskeletal health in greater depth. You can use these sessions to work through recent cases, refine your examination skills, and discuss the management of both acute and chronic musculoskeletal conditions. Whether it’s reviewing how to approach a patient with shoulder pain, discussing when to refer for imaging or rheumatology input, or practicing a musculoskeletal system examination, tutorials allow for tailored feedback and guidance. They also provide space to explore the broader context of musculoskeletal health, including the impact on mental health, work, and mobility, and how to support patients through lifestyle advice, rehabilitation, and long-term care planning.

  • Entrustable Professional Activities (EPAs) underpin workplace-based assessment in this curriculum. Each EPA represents an integrated clinical task that General Practitioners must perform safely and independently, assessed through direct or indirect observation in real clinical settings.

    The curriculum and EPA framework are closely aligned: the curriculum defines the required knowledge, skills, and professional behaviours, while EPAs assess their application in practice. Together, they create a coherent approach to developing and demonstrating readiness for independent clinical work.

    The examples show how specific activities within general practice & chapters of the curriculum align with particular EPAs.

    EPA 9: Manage the care of adults, including older people with acute presentations

    A patient presenting with acute lower back pain and bilateral leg weakness provides an opportunity to demonstrate EPA 9. If the GP Trainer observes the consultation and examination, including assessment for red flags such as cauda equina syndrome, a PIP-C and PIP-P can be used to provide feedback on focused musculoskeletal and neurological assessment, safe triage, and urgent referral. A succinct case entry could be: “assessment of acute back pain with red flag symptoms.” Reflection should explore differential diagnosis, clear explanation of urgency and referral rationale, and empathetic communication to reduce anxiety.

    Core Knowledge Test (CKT)

    • Management of Gout

    • Management of methotrexate therapy

    • Differential Diagnosis of Low Back Pain

    Clinical Competency Test (CCT)

    • A patient presenting with knee pain.
    • A patient presenting with shoulder pain.
    • A patient with a new diagnosis of rheumatoid arthritis. 

    Disclaimer: The examples provided within this section are intended to be indicative only and are included to illustrate how elements of the curriculum may be assessed in the Clinical Competency Test (CCT).

    Examination questions in the CCT test the ability of candidates to integrate knowledge, skills, and professional behaviours across multiple curriculum areas to address the challenges posed by the question.

    The indicative content should therefore be used solely as a general guide as to some of the topics that may be introduced. Actual examination questions will assess a greater depth and complexity of understanding than the illustrative examples provided.

    Please note that a number of CCT questions will require candidates to undertake a physical examination of the simulated patient. In some circumstances, for example in the case of an intimate examination, candidates may be required to display their examination skills through use of a manikin or other device.

  • 1.    Keavy R. The prevalence of musculoskeletal presentations in general practice: an epidemiological study. Br J Gen Pract [Internet]. 2020 June 1 [cited 2025 Aug 19];70(suppl 1). Available from: https://bjgp.org/content/70/suppl_1/bjgp20X711497