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Patient Presentations Related to the Musculoskeletal System
Patient presentations span all ages and gender identities, reflecting patients from diverse backgrounds, cultures, and abilities and their reasons for presenting to osteopathic physicians in varied clinical settings.
| 5.1 Postural and Spinal Variations | |
| 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 Variations | |
| 5.5 Joint Pain, Stiffness, and Swelling | |
| 5.6 Muscle Symptoms | |
| 5.7 Chest Wall Pain and Somatic Dysfunction of the Thoracic Region and Ribs | |
| 5.8 Head, Orofacial, and Temporomandibular Joint Pain and Somatic Dysfunction of the Head and Neck | |
| 5.9 Pain and Somatic Dysfunction of the Extremities | |
| 5.10 Musculoskeletal Trauma, Including 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 and Diagnostic Testing Related to the Musculoskeletal System |
Clinical presentations in this category may include, but are not limited to, the following conditions or situations prompting patients to present for osteopathic medical care:
| Bone disorders | apophysitis • Osgood-Schlatter disease • osteitis deformans • osteogenesis imperfecta • osteomalacia • osteopenia • osteoporosis |
| Chronic pain disorders | fibromyalgia • myalgic encephalomyelitis (chronic fatigue syndrome) • myofascial pain syndrome |
| Connective tissue disorders | Ehlers-Danlos syndrome • Marfan syndrome • mixed connective tissue disease • scleroderma • Sjögren syndrome • systemic lupus erythematosus |
| Crystal-induced arthropathies | gout • pseudogout |
| Cysts | bone cysts • ganglion cysts • synovial cysts |
| Degenerative spinal disorders | degenerative disk disease • disk herniation • spinal disk compression • spinal stenosis • spondylolisthesis • spondylolysis • spondylosis |
| Disorders of muscles and muscle compartments | compartment syndrome • dermatomyositis • iliopsoas dysfunction • muscular atrophy • muscular dystrophy • piriformis syndrome • polymyositis • torticollis |
| Fractures and other trauma | compression fracture • crush injury • epiphyseal fracture • labral injury • pathologic fracture • spinal fracture • spiral fracture • stress fracture • whiplash syndrome |
| Infectious and inflammatory arthritis | osteomyelitis • polymyalgia rheumatica • psoriatic arthritis • reactive arthritis • rheumatoid arthritis • septic arthritis • spondylitis |
| Joint disorders | meniscal injury • neuropathic arthropathy • osteoarthritis • synovitis • temporomandibular joint dysfunction |
| Lower extremity disorders | Blount disease • femoral anteversion • genu varus/valgus • hip dysplasia • leg length inequality • Legg-Calvé-Perthes disease • medial tibial torsion • metatarsus adductus • patellar tracking syndrome • patellofemoral syndrome • pes planus • severe physiologic bowing • slipped capital femoral epiphysis • tibiotalar effusion |
| Soft tissue disorders | benign hypermobility • bursitis • costochondritis • iliotibial band syndrome • necrotizing fasciitis • plantar fasciitis |
| Somatic dysfunctions | cranial • cervical • thoracic • lumbar • sacral • pelvic • rib • shoulder • elbow • wrist • hip • knee • foot • abdomen • neuroreflexive mechanisms |
| Spinal abnormalities | kyphosis • lordosis • scoliosis • spina bifida |
| Sprains, strains, and dislocations | ankle sprain • shoulder dislocation |
| Tendon disorders | Achilles tendinitis • enthesitis • impingement syndromes • lateral epicondylitis • medial epicondylitis • Osgood-Schlatter disease • tendon rupture • tenosynovitis |
| Tumors | enchondroma • osteochondroma • sarcoma |
| Upper extremity disorders | adhesive capsulitis • mallet finger • rotator cuff injury • trigger finger • winged scapula |
CONSTITUTIONAL SIGNS AND SYMPTOMS
- anorexia
- chills
- fatigue
- fever
- generalized weakness
- jaundice
- malaise
- night sweats
- unintentional weight loss
PHYSICAL EXAM FINDINGS AND EVALUATIONS
- active and passive range-of-motion testing
- Adam’s forward bend test
- Adson test
- anterior and posterior drawer signs (knee and ankle)
- Apley compression and distraction tests
- asymmetry, joint, regional, and segmental testing
- Barlow maneuver and Ortolani maneuver
- Bouchard and Heberden nodes
- bounce home test
- boutonniere and swan-neck deformities
- cervical compression test
- cervical distraction test
- Chapman reflexes
- Finkelstein test
- gait abnormalities
- Homan sign
- Hoover sign
- layer-by-layer palpation
- Lhermitte sign
- McMurray test
- muscle strength grading
- Ottawa ankle rules
- pallor
- Patrick (FABERE) test
- percussion test
- Phalen maneuver and Tinel sign
- signs of inflammation (e.g., rubor, calor, tumor, dolor)
- shoulder apprehension test, Apley scratch test
- shoulder impingement testing (Hawkins-Kennedy test, drop-arm test, empty-can test, Neer test)
- straight-leg raising test
- stress testing of the ankle
- talar tilt test
- tender points
- tenderness
- Thomas test
- tissue texture abnormalities
- Trendelenburg test
- trigger points
- valgus and varus stress testing
- viscerosomatic/
somatovisceral reflexes
LABORATORY AND DIAGNOSTIC TESTING
- alkaline phosphatase level
- antinuclear antibody testing
- autoantibody testing
- calcium and phosphate levels
- C-reactive protein level
- creatine kinase level
- CT scanning
- DXA scanning
- erythrocyte sedimentation rate
- MRI
- nuclear medicine imaging
- parathyroid hormone level
- radiography
- rheumatoid factor testing
- synovial fluid evaluation
- ultrasonography
- vitamin D level