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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, 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

fatigue • fever • generalized weakness • nvoluntary 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 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

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