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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

fatigue • fever • generalized weakness • involuntary weight loss • malaise • night sweats • pallor

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

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