MSK diagnosis at first contact.
What a first contact diagnosis is
An MSK diagnosis at first contact is the working diagnosis a clinician reaches at the first appointment for a musculoskeletal problem. It comes mostly from the history and the examination, often before any scan, and it decides the first test, the first treatment and whether a specialist is needed.
It is written for GPs, first contact practitioners, MSK physiotherapists and advanced practitioners. It is not written for patients.
Many problems, one short appointment
Several conditions can look alike in the first minutes, imaging is not always available or helpful at that stage, and the clinician rarely hears what the surgeon later found.
That last point matters most. Without the outcome of each referral coming back, it is hard for anyone to know which of their working diagnoses were right.
Five parts of a good working diagnosis
Most likely, and why
The leading diagnosis, with the features of the history and examination that point to it.
What else, and what must not be missed
The alternatives, and the urgent problems to rule out first.
The test, and what would change the plan
The one test that answers the remaining question, and the finding that would change the next step.
The most likely answer, with its reasons
Orwyn asks the safety questions first, then shows the most likely diagnosis with its reasons, the test to request, what to do today, and whether and how urgently a surgeon is needed. It covers the knee first.
Most tools built for MSK triage aim to keep people out of hospital. Orwyn helps the clinician decide when a patient should go in, when they should not, and gives the clinician and the patient a reason to trust the answer.
Orwyn is currently being assessed for an NHS pilot to test its safety, clinical effectiveness and cost effectiveness.
For the knee in detail, see when knee pain needs an X-ray, when an MRI helps at first contact, suspected ACL injury, the locked knee, the hot swollen knee and knee osteoarthritis at first contact.
Where to read more
Musculoskeletal orthopaedic approach to referral optimisation, NHS England.
Our knee reference pages, listed on the resources page.
Surgeon-governed decision support for first-contact MSK clinicians.