Occupational physicians are very often confronted with questions as to the fitness of the postural and locomotor systems, especially the spinal column. Occupational medical assessment and advice can be required by patients with acute symptoms, at routine check-ups, by persons who have problems doing certain jobs at work and for expert medical reports as to the fitness of persons with chronic disorders or after operations. Therefore, for occupational medical questions a physical examination must aim primarily to investigate functions and not structures or photographic evidence. It should be structured systematically and according to regions of the body and, together with a specific (pain) anamnesis (see Part 1) should provide a basis for the medical assessment. This paper presents a function-oriented system (Funktions-Orientierte Körperliche Untersuchungs Systematik: fokus©) for physical examination of the locomotor system, developed with a view to its relevance for occupational medical practice. This occupational medical examination of the spinal column and the whole locomotor system does not aim primarily to provide a precise diagnosis. Decisive for an occupational medical assessment of disorders of the muscular and skeletal 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 diagnostics, for reasons of efficiency and usability of the system in routine occupational medical examinations, the measures are chosen according to the situation and so are reduced to that which is most necessary and feasible.
