Guidance for AMEs on examining the musculoskeletal system
To perform the tasks involved in inspecting, flying and evacuating an aircraft safely and effectively a pilot must be free of pain and have sufficient strength and range of movement in the spine and limbs.
At routine medical examination information on musculoskeletal function is obtained informally by observation of the applicant as they walk, sit, climb onto the examining couch etc. At the initial examination, following musculoskeletal injury or if there is any other reason to suspect impaired function, formal examination is required. This will include, as a minimum, demonstration of a satisfactory range and strength of neck and limb movements, of stability of joints likely to be subjected to prolonged or sudden stress and the absence of pain or side effects of medication likely to affect concentration or judgement.
Neck movement is essential to keep a satisfactory lookout and the initial applicant must show a good range of flexion, extension, lateral flexion and rotation of the cervical spine.
Examination of lumbar spine movements will help to identify painful conditions which might cause distraction in flight. The initial applicant should demonstrate a good range of flexion, extension, lateral flexion and rotation of the lumbar spine.
Putting the hands behind the head and then behind the back tests elbow and shoulder movements and is usually sufficient to demonstrate satisfactory reach. Observing the applicant writing, tying shoe-laces etc may alert the examiner to the need for further examination of manual dexterity.
If the applicant can squat and stand up comfortably without support he or she has demonstrated sufficient range of movement and strength to operate the brake and rudder pedals.
Physical Disability and Aviation Medical Certification
In the aviation environment impairment of the musculoskeletal system may cause difficulty in entry to and exit from an aircraft and safe operation of controls. Restricted mobility may adversely affect ability to read instruments or keep a satisfactory lookout. Applicants for pilot licensing with musculoskeletal disabilities require assessment to ensure they have adequate strength and range of movement, with aids or modifications to controls as appropriate, and that they are not experiencing symptoms or side effects of medication likely to impair judgement and concentration. A medical flight test will be required to assure satisfactory function in the cockpit environment if there is any major physical disability or any minor disability that has the potential to cause difficulty with any control movement or other required in-flight function, access or egress.
Medical Certification following Musculoskeletal Injury
Significant injury warrants an unfit assessment. The doctor responsible for treating the injury should provide full details of damage sustained and treatment provided. The AME must confirm satisfactory functional recovery. The pilot must show a full pain-free range of movement with sufficient strength to carry out the relevant flying tasks.
For example, a pilot returning to flying after a lower limb injury would have to demonstrate hip, knee and ankle mobility and strength sufficient to assist passengers in aircraft evacuation and to operate rudder and brakes in difficult circumstances such as cross-wind landings.