Chapter 53: Common Musculoskeletal Complaints

The clinical evaluation begins with a structured patient history using standardized frameworks to characterize pain onset, quality, radiation patterns, and associated functional losses, along with specific joint symptoms like clicking or instability. Physical examination requires a methodical approach incorporating visual inspection, palpation, measurement of active and passive range of motion, and strength assessment to differentiate between articular pain originating in joints and nonarticular pain from surrounding soft tissues, helping clinicians narrow diagnostic possibilities efficiently. Recognition of red flag findings such as significant trauma, signs of infection, focal weakness suggesting compartment syndrome, or systemic symptoms is essential for identifying conditions requiring urgent intervention. Diagnostic testing includes laboratory markers like inflammatory markers and synovial fluid analysis, which remains the definitive test for joint infections and crystal arthropathies, alongside imaging modalities selected based on clinical suspicion. Plain radiographs serve as initial screening tools for bone pathology, while MRI excels at revealing soft tissue injuries involving ligaments and tendons, CT scanning provides superior detail of complex fractures, and ultrasound offers a portable, cost-effective alternative for detecting fluid collections and selected structural abnormalities. Management of acute injuries emphasizes the PRICE protocol alongside pharmacologic interventions including nonsteroidal anti-inflammatory drugs and muscle relaxants for symptom control. The chapter addresses region-specific conditions including mechanical neck and back pain with particular emphasis on serious red flags like cauda equina syndrome, shoulder pathology encompassing rotator cuff dysfunction and instability, overuse epicondylar conditions, hip joint and greater trochanteric pain syndromes, knee injuries affecting menisci and cruciate ligaments, and foot and ankle disorders including tendon ruptures and plantar fasciitis. Special considerations for pediatric patients involve unique fracture patterns and growth plate injuries requiring careful management to prevent permanent complications, while geriatric populations require individualized approaches that address osteoporosis-related fracture risk and avoid iatrogenic stiffness from prolonged immobilization.