5. Patient Presentations Related to the Musculoskeletal System
Patient presentations span all relevant age categories, special populations, and varied clinical settings.
5.1 |
Postural Abnormalities and Spinal Deformities |
5.2 |
Back Pain and Somatic Dysfunction of the Pelvis, Sacrum, and Lumbar and Thoracic Spine |
5.3 |
Neck Pain and Somatic Dysfunction of the Cervical Spine |
5.4 |
Gait Disturbances |
5.5 |
Joint Pain, Stiffness, and Swelling |
5.6 |
Muscle Symptoms |
5.7 |
Chest Wall Pain and Somatic Dysfunction of the Ribs |
5.8 |
Head, Orofacial, and Temporomandibular Joint Pain and Somatic Dysfunction of the Head |
5.9 |
Pain and Somatic Dysfunction of the Extremities |
5.10 |
Musculoskeletal Trauma, Fractures, and Dislocations |
5.11 |
Sciatica and Radicular Symptoms |
5.12 |
Musculoskeletal Masses |
5.13 |
Somatic Manifestations of Systemic Disease |
5.14 |
Viscerosomatic and Related Reflexes |
5.15 |
Physical Exam Findings Related to the Musculoskeletal System |
5.16 |
Laboratory Test Findings and Diagnostic Imaging Related to the Musculoskeletal System |
The Guide to clinical presentations in this category may include, but is not limited to, the following ways in which patients present for osteopathic medical care:
ankle injuries and conditions, including sprains, Achilles tendinosis • ankylosing spondylitis, Reiter syndrome, degenerative disc disease, spinal stenosis • apophysitis, calcaneal or tibialis • articular somatic dysfunction and counterstrain tender points • benign arthralgias of childhood • benign hypermobility • bursitis • cauda equina syndrome • cervical spine segmental somatic dysfunction (ie, occipitoatlantal, C1, C2-7) • cervical spondylosis, cervical disc herniation, whiplash syndromes • Chapman reflexes • costochondritis • counterstrain tender points • cranial somatic dysfunction • crush injuries, compartment syndrome • cysts and tumors, bone and musculoskeletal • dermatomyositis • drug-induced myopathies • early-morning stiffness • Ehlers-Danlos syndrome • elbowhumero-ulnar, radioulnar, and radiohumeral somatic dysfunction • entrapment neuropathies • extremity somatic dysfunction • fascial symptoms • fasciitis, iliotibial band syndrome • fibromyalgia, chronic fatigue syndrome • foot deformities, somatic dysfunctions of the foot– talocalcaneal, tarsotalar, tarsometatarsal, metatarsophalangeal • fracture care, fracture healing, stress fracture • genu varus/valgus, severe physiologic bowing, Blount disease, intoeing, metatarsus adductus, medial (internal) tibial torsion, femoral anteversion (medial femoral torsion), developmental dysplasia of the hip • giant cell arteritis • gout and pseudogout • hemarthrosis • herniated intervertebral discs, spinal stenosis • humeral (lateral and medial) epicondylitis • idiopathic inflammatory myopathies (eg, polymyositis) • infectious joint pain, septic arthritis • inflammatory joint pain (eg, monoarticular, oligoarticular, polyarticular) • intra-articular conditions (eg, osteoarthritis, Baker cyst, ganglion cyst, adhesive capsulitis, Charcot joint) • kyphosis, adult and juvenile • Lhermitte phenomenon or sign • ligamentous injury • lordosis • lumbar somatic dysfunction • Lyme disease • mallet finger • Marfan syndrome • meniscal injury • metabolic bone diseases • muscle conditions, including spasm, myalgia, atrophy, soreness, myositis, and muscular dystrophies • musculoskeletal pelvic pain/pelvic floor myalgia • myelopathy • myofascial pain syndrome and trigger points • myositis, tendon rupture, complex regional pain syndrome, patellofemoral syndrome • necrotizing fasciitis • Osgood-Schlatter disease • osteomalacia and related conditions, such as rickets, hip dysplasia, slipped capital femoral epiphysis, Legg-Calve-Perthe’s disease • osteomyelitis • osteopenia and osteoporosis • Paget disease • pain, acute, chronic, or referred, with or without red flag signs or symptoms – back, neck, upper and lower extremity, joint • patellofemoral syndrome (chondromalacia patellae) • pediatric fractures (eg, Salter-Harris physeal fracture classification) • pelvic somatic dysfunction • piriformis syndrome • plantar fasciitis • polymyalgia rheumatica • postural considerations • psoas syndrome • psoriatic arthritis • radiculopathy • reactive arthritis • reflex mechanisms (eg, viscerosomatic and viscerovisceral) • rheumatoid arthritis, juvenile rheumatoid arthritis • rib conditions – counterstrain tender points, somatic dysfunction • sacral somatic dysfunction • scoliosis • short leg syndrome • shoulder dysfunctions-dislocation, rotator cuff injury, labral injury (eg, superior labral tear from anterior to posterior [SLAP] lesion), adhesive capsulitis (frozen shoulder) • somatic dysfunctions of the shoulder-glenohumeral, sternoclavicular, acromioclavicular, scapulothoracic joints • Sjögren disease, scleroderma • soft tissue and bone cysts, tumors, and other bone lesions • somatic dysfunctions of the abdomen/viscera • somatic dysfunctions of hip and knee (eg, patellofemoral glide, tibiofemoral and tibiofibular) • somatic dysfunctions of the hand, metacarpophalangeal and interphalangeal • somatovisceral and somatosomatic reflexes • spina bifida • spinal fractures • spondylitis • spondyloarthropathies • spondylolisthesis • spondylolysis • spondylosis • sprains and strains, dislocations • suspicious and accidental fractures, including pathologic and fragility fractures • systemic lupus erythematosis • temporomandibular joint dysfunction • tendonopathies (eg, impingement syndromes, tendon rupture, enthesitis, tenosynovitis) • thoracic outlet syndrome • thoracic somatic dysfunction • tibiotalar effusion • torticollis • transient synovitis • trigger finger • true and apparent leg-length discrepancy • weakness, tingling, or numbness in the arms, legs, and/or feet, unilateral or bilateral • wrist-radiocarpal, and carpocarpal somatic dysfunction
CONSTITUTIONAL SIGNS AND SYMPTOMS
fatigue • fever • generalized weakness • nvoluntary weight loss • malaise • night sweats • pallor
PHYSICAL EXAM FINDINGS
active and passive range of motion testing • Adson test • anterior and posterior drawer signs (knee and ankle) • Apley compression and distraction tests • asymmetry, joint, regional, and segmental range of motion testing • Barlow test, Ortolani test • Bouchard and Heberden nodes • bounce home test • boutonniere and swan neck deformities • cervical compression test • cervical distraction test • empty-can supraspinatus test • Finkelstein test • gait abnormalities • Hawkins impingement sign, drop-arm test • Homan sign • Hoover test • layer-by-layer palpation • McMurray test • Muscle-strength grading • Neer impingement sign • Ottawa ankle rules for ankle injury radiography • Patrick or Fabere test • Phalen maneuver, Tinel sign • rubor, calor • shoulder apprehension test, Apley scratch test • straight-leg raising test • stress testing of the ankle • talar anterior drawer sign • talar tilt test • tenderness • Thomas test • tissue texture abnormalities • Trendelenburg test
LABORATORY TEST FINDINGS AND DIAGNOSTIC IMAGING
antinuclear antibody tests • autoantibody tests • computed tomography imaging • c-reactive protein • dual-energy x-ray absorptiometry scanning • erythrocyte sedimentation rate • magnetic resonance imaging • nuclear medicine imaging • radiography • serum creatine kinase • sonography • synovial fluid evaluation for crystals