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 and Achilles tendinitis • ankylosing spondylitis • apophysitis, calcaneal or tibialis • articular somatic dysfunction and counterstrain tender points • benign arthralgias of childhood • benign hypermobility • bursitis • cauda equina syndrome • cervical disk herniation • cervical spine segmental somatic dysfunction (i.e., occipitoatlantal, C1, C2-7) • cervical spondylosis • Chapman reflex points • costochondritis • counterstrain tender points • cranial somatic dysfunction • crush injuries, compartment syndrome • cysts and tumors, bone and musculoskeletal • degenerative disk disease • dermatomyositis • drug-induced myopathies • early-morning stiffness • Ehlers-Danlos syndrome • elbow, humeroulnar, radioulnar, and radiohumeral somatic dysfunction • entrapment neuropathies • extremity somatic dysfunction • fasciitis, iliotibial band syndrome • fibromyalgia, chronic fatigue syndrome • foot deformities, somatic dysfunctions of the foot – talocalcaneal, tarsotalar, tarsometatarsal, metatarsophalangeal • gout and pseudogout • hemarthrosis • herniated intervertebral disks, spinal stenosis • humeral (lateral and medial) epicondylitis • idiopathic inflammatory myopathies (e.g., polymyositis) • infectious joint pain, septic arthritis • inflammatory joint pain (e.g., monoarticular, oligoarticular, polyarticular) • intra-articular conditions (e.g., osteoarthritis, Baker cyst, ganglion cyst, adhesive capsulitis, Charcot joint) • kyphosis, adult and juvenile • leg-length discrepancy • ligamentous injury • lordosis • lower extremity abnormalities (e.g., 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 • lumbar somatic dysfunction • Lyme disease • mallet finger • Marfan syndrome • meniscal injury • muscle conditions, including spasm, myalgia, atrophy, soreness, myositis, and muscular dystrophies • musculoskeletal pelvic pain/pelvic floor myalgia • myelopathy • myofascial pain syndrome and trigger points • necrotizing fasciitis • Osgood-Schlatter disease • osteomalacia and related conditions (e.g., rickets, hip dysplasia, slipped capital femoral epiphysis, Legg-Calvé-Perthes 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 (e.g., 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 (e.g., viscerosomatic, viscerovisceral) • rheumatoid arthritis, juvenile rheumatoid arthritis • rib conditions – counterstrain tender points, somatic dysfunction • sacral somatic dysfunction • scoliosis • shoulder dysfunctions – dislocation, rotator cuff injury, labral injury (e.g., superior labral tear from anterior to posterior [SLAP] lesion), adhesive capsulitis (frozen shoulder) • Sjögren syndrome, scleroderma • soft tissue and bone cysts, tumors, and other bone lesions • somatic dysfunctions of the abdomen/viscera • somatic dysfunctions of the hand (e.g., metacarpophalangeal, interphalangeal) • somatic dysfunctions of the hip and knee (e.g., patellofemoral glide, tibiofemoral and tibiofibular) • somatic dysfunctions of the shoulder – glenohumeral, sternoclavicular, acromioclavicular, scapulothoracic joints • somatovisceral and somatosomatic reflexes • spina bifida • spinal fractures • spinal stenosis • spondylitis • spondyloarthropathies • spondylolisthesis • spondylolysis • spondylosis • sprains and strains, dislocations • stress fractures • suspicious and accidental fractures, including pathologic and fragility fractures • systemic lupus erythematosus • temporomandibular joint dysfunction • tendinopathies (e.g., impingement syndromes, tendon rupture, enthesitis, tenosynovitis) • thoracic outlet syndrome • thoracic somatic dysfunction • tibiotalar effusion • torticollis • transient synovitis • trigger finger • weakness, tingling, or numbness in the arms, legs, and/or feet • whiplash syndromes • wrist – radiocarpal and carpocarpal somatic dysfunction
CONSTITUTIONAL SIGNS AND SYMPTOMS
fatigue • fever • generalized weakness • involuntary 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 testing • Barlow maneuver, Ortolani maneuver • Bouchard and Heberden nodes • bounce home test • boutonniere and swan-neck deformities • cervical compression test • cervical distraction test • empty-can test • Finkelstein test • gait abnormalities • Hawkins impingement sign, drop-arm test • Homan sign • Hoover sign • layer-by-layer palpation • Lhermitte sign • McMurray test • muscle-strength grading • Neer impingement sign • Ottawa ankle rules • Patrick (FABERE) test • Phalen maneuver, Tinel sign • rubor, calor • shoulder apprehension test, Apley scratch test • straight-leg raising test • stress testing of the ankle • talar tilt test • tenderness • Thomas test • tissue texture abnormalities • Trendelenburg test
LABORATORY TEST FINDINGS AND DIAGNOSTIC IMAGING
antinuclear antibody tests • autoantibody tests • C-reactive protein levels • creatine kinase levels • CT scanning • dual-energy x-ray absorptiometry scanning • erythrocyte sedimentation rate • magnetic resonance imaging • nuclear medicine imaging • radiography • synovial fluid evaluation for crystals • ultrasonography