Occupational medical prophylaxis for the musculoskeletal system: A function-oriented system for physical examination of the locomotor system in occupational medicine (fokus(C))

This paper presents a function-oriented system for physical examination of the locomotor system, named fokus(C) (Funktionsorientierte Koerperliche Untersuchungssystematik, also available on DVD). fokus(C) has been developed with a view to its relevance for occupational medical practice and does not aim primarily to provide a precise diagnosis. Decisive for an occupational medical assessment of disorders of the musculoskeletal system is rather information about functional disorders and any impairment of performance or mobility which they can cause. The division of the physical examination into a rapid screening phase and a subsequent more intensive functional diagnostic phase has proved its practicability in many years of day-to-day use. Here, in contrast to the very extensive measures recommended for orthopaedic and manual diagnosis, for reasons of efficiency and usability of the system in routine occupational medical examinations the examination is structured according to the findings. So it is reduced to that which is most necessary and feasible.Problems with the locomotor system play an important role in the day-to-day work of the occupational physician, in particular with respect to the physical capacity and fitness for work of employees. For the occupational physician, the medical assessment is much more straightforward if the physical examination concentrates systematically on functions rather than on structures and radiologic evidence, and is combined with a well-targeted (pain) anamnesis [1-3]. Many years of practical experience and the limited time allowed for occupational medical examinations speak for a systematic subdivision of the physical examination into a screening phase and, based on the results of this, a subsequent functional diagnostic phase [4]. Depending on the nature of the medical problem or on whether one part of the body is subject to particular strain, these examinations may be carried out as part of a total physical examination or may be