Musculoskeletal Injuries and Conditions: Assessment and Management

Contents

Abbreviations

Preface

Acknowledgments

1. APPROACH TO THE PATIENT WITH A MUSCULOSKELETAL PROBLEM

History and Physical Examination

Chief Complaint

Neurological Impairment

Other History

Past Medical History (Limited to MSK Problems)

Review of Systems

Other MSK Symptoms

Physical Examination

Provocative Test

Clinically Oriented Anatomy

Tendon and Ligament

Muscle and Fascia

Bursa

Bone and Joint

Nervous System

Biomechanics

Introduction

Clinical Application

Gait Cycle

Gait Dysfunction

Workup

MSK Imaging

Radiographs

Advanced Imaging

Scanning Protocol Modified From AIUM Protocol

Other Workup: Laboratory Investigation

Treatment

Patient Education

Pharmacologic Management

Local Intervention

Physical and Occupational Therapy

Orthoses

Treatment Based on Different Anatomical Pathologies

References

2. NECK

Epidemiology of Neck Pain

Neck Pain in the General Population

Neck Pain in Athletes

Neck Pain at Work

Differential Diagnosis

Unusual Causes of Neck Pain

Neurological Symptoms Associated With Neck Pain

Anatomy

Regional Anatomy

Spine Complex (Bone and Joint)

Ligament

Nerve: Root and Plexus

Muscle

Fascia

Blood Supply

Biomechanics

Physical Examination

Inspection

Palpation

Neurologic Examination and Special Examination

Diagnostic Studies

Plain Radiographs

MRI

Point-of-Care Ultrasonagraphy

CT Scan

Electromyography (EMG)

Treatment

Nonoperative Management

Surgery

Nerve and Spinal Cord Pathology

Cervical Radiculopathy

Noncompressive Radiculopathy

C5 (Nerve Root) Palsy

Greater Occipital Neuralgia

Supraclavicular Nerve Entrapment Syndrome

Cervical Myelopathy

Cervical Cord Neurapraxia

Ossification of Posterior Longitudinal Ligament (OPLL)

Syringomyelia

Chiari Malformation

Drop Head Syndrome

Bone and Joint Pathology

Cervical Facet Pathology

Whiplash-Associated Injury

Degenerative Disc Disease

Rheumatoid Arthritis

Cervical Spine Disorder in Down Syndrome

Klippel–Feil Anomaly

Fracture

Metastatic Cervical Spine Tumor

Muscle and Ligament Pathology

Cervical Strain/Sprain

Myofascial Pain Syndrome

References

3. SHOULDER

Epidemiology of Shoulder Pain

Shoulder Pain in the General Population

Shoulder Pain in Athletes

Shoulder Pain at Work

Differential Diagnosis

Musculoskeletal (MSK) Causes of Shoulder Pain Based on Location

Neuropathic Causes of Shoulder Pain

Extrinsic Causes of Shoulder Pain

Neurological Symptoms

Snapping Shoulder

Shoulder Instability

Anatomy

Bone, Joint, and Ligament

Nerve

Bursa

Muscle

Biomechanics

Shoulder Movement

Subacromial Impingement

Subcoracoid Impingement: Roller Wringer Effect

Suprascapular Nerve Traction With Scapula Position

Biomechanics of Throwing

Shoulder Stability

Physical Examination

Inspection

Palpation

Range of Motion

Strength of Rotator Cuff Muscles

Special Tests

Diagnostic Studies

Plain Radiographs

Point-of-Care Ultrasonography

MRI/MRA

CT Scan

Treatment

Nonoperative Management

Surgery

Tendon and Bursa Pathology

Impingement Syndrome

Rotator Cuff Tendinopathy and Tear

Calcific Tendinopathy

Biceps Long-Head Tendon Pathologies

Pectoralis Muscle Strain and Tear

Joint and Bone Pathology

AC Joint Sprain and Injury

AC Osteoarthritis

Distal Clavicle Osteolysis

Glenohumeral Joint Pathologies

Shoulder Osteoarthritis

Shoulder Instability

Multidirectional Instability

SLAP (Superior Labral Anteroposterior) Lesion

Bennett Lesion

Rheumatologic Disease

Infectious Pathology

Osteonecrosis of the Humeral Head

Little League Shoulder

Sternoclavicular (SC) Sprain/Injury

SC Osteoarthritis

Fracture

Neuropathy and Vascular Dysfunction

Brachial Amyotrophy (Parsonage Turner Syndrome)

Cervical Radiculopathy

Stinger Syndrome (Burner)

Thoracic Outlet Syndrome (TOS)

Effort Thrombosis (Paget–Schroetter Syndrome)

Axillary Artery Occlusion

Suprascapular Neuropathy

Quadrilateral Space Syndrome

References

4. ELBOW

Epidemiology of Elbow Pain

Elbow Pain in the General Population

Elbow Pain in Athletes

Elbow Pain at Work

Differential Diagnosis

Elbow Instability

Snapping Elbow

Stiffness

Anatomy

Bone and Joint

Ligament

Nerve

Muscle

Biomechanics

Kinetic and Kinematics

Elbow Stability

Elbow Function in ADL

Physical Examination

Inspection

Palpation

Range of Motion

Special Tests

Diagnostic Studies

Plain Radiographs

Point-of-Care Ultrasonography

MRI/MRA

CT Scan

Treatment

Nonoperative Management

Surgery

Tendon, Ligament, and Bursa Pathology

Lateral Epicondylitis

Lateral Collateral Ligament Sprain

Medial Epicondylitis

Little League Elbow

Ulnar Collateral Ligament (UCL) Injury

Valgus Extension Overload Syndrome (Posteromedial Impingement)

Distal Biceps Tendinopathy/Tear

Bicipitoradial Bursitis

Triceps Tendinopathy and Tear

Olecranon Bursitis

Bone and Joint Pathology

Osteoarthritis

Osteochondritis Dissecans of the Elbow (Capitellum)

Posterior Impingement of the Elbow

Rheumatoid Arthritis

Myositis Ossificans

Fracture

Elbow Dislocation

Neuropathy

Ulnar Neuropathy

Radial Tunnel Syndrome

Posterior Antebrachial Cutaneous Neuropathy

Median Neuropathy at Elbow

Other Nerves

References

5. WRIST AND HAND

Epidemiology of Wrist and Hand Pain

Wrist and Hand Pain in the General Population

Wrist and Hand Pain in Athletes

Wrist and Hand Pain at Work

Differential Diagnosis

MSK Causes of Wrist and Hand Pain Based on Location

Neuropathic Causes of Wrist and Hand Pain

Differential Diagnosis of Finger/Wrist Drop

Snapping

Anatomy

Bone, Joint, and Ligament

Nerve

Muscle

No Man’s Land

Biomechanics

Forearm Movement and RU Joint

ROM of Wrist and Hand

Proximal Carpal Movements

Wrist Stability

Biomechanics of Hand

Physical Examination

Inspection

Palpation

Special Tests of Wrist and Hand

Special Examination of Hand (Finger)

Diagnostic Studies

Plain Radiographs

Point-of-Care Ultrasonography

MRI/MRA

CT Scan

Electromyography (EMG)

Treatment

Nonoperative Management

Surgery

Tendon and Ligament Pathology

Wrist Extensor Tendon Disorders

Wrist Flexor Tendon Disorders

Trigger Fingers

Retinacular Cyst

Dupuytren’s Disease

Gamekeeper’s (Skier’s) Thumb and Stener’s Lesion

Finger Sprain and Strain

Volar Plate Injury

Central Slip Extensor Injury

Nerve Entrapment Syndrome

Carpal Tunnel Syndrome (CTS)

Anterior Interosseous Neuropathy

Ulnar Neuropathy at Wrist

Superficial Radial Neuropathy

Bone and Joint Pathology

First Carpometacarpal (CMC) Osteoarthritis (Trapeziometacarpal)

Osteoarthritis of the Wrist

Pisotriquetral (PT) Arthritis/Instability

Rheumatoid Arthritis of the Wrist and Hand

Ligament Sprain and Instability

Ganglion Cyst

Carpal Boss

Tumor

Fracture

Other Pathology

Hypothenar Hammer Syndrome

References

6. BACK

Epidemiology of Back Pain

Back Pain in the General Population

Back Pain in Children

Back Pain in Athletes

Back Pain at Work

Differential Diagnosis

Working Definition of Low Back

Differential Diagnosis Based on Mode of Onset

Classification and Differential Diagnosis of Spine Deformity

Differential Diagnosis of Severe Back Spasm

Differential Diagnoses of Bowel and Bladder Dysfunction Related to Spine Pathologies

Differential Diagnosis of Chest Wall Pain

Differential Diagnosis of Buttock Pain

Anatomy

Bone and Joint

Nerve

Artery

Muscle

Biomechanics

Lumbar Spine Biomechanics

Physical Examination

Inspection

Palpation

Neurological and Other Examination

Red Flags

Diagnostic Studies

Plain Radiographs

CT Scan

MRI

Serologic Tests

Electromyography (EMG)

Treatment

Nonoperative Management

Surgery

Back Pain

Nerve and Spinal Cord Pathology

Bone and Joint Pathology

Muscle and Ligament Pathology

Chest Wall Pain

Bone and Joint Pathology

Nerve Pathologies

Muscle Strain

Buttock Pain

Bone and Joint Pathology

Tendon and Bursa Pathology

Ischiogluteal Bursitis

Neuropathy

Miscellaneous Pathology

References

7. HIP AND THIGH

Epidemiology of Hip Pain

Hip Pain in the General Population

Hip Pain in Children

Hip Pain in Athletes

Hip Pain at Work

Differential Diagnosis

Differential Diagnosis of Hip Pain Based on Location

Snapping Hip (Coxa Saltans)

Differential Diagnosis of Groin Mass

Differential Diagnosis of Hip Instability

Anatomy

Bone and Joint

Ligament

Nerve

Muscle

Biomechanics

Kinematic and Kinetic

Hip Stability

Physical Examination

Inspection

Palpation

Range of Motion

Special Examination

Diagnostic Studies

Plain Radiographs

Point-of-Care Ultrasonography

MRI/MRA

Treatment

Nonoperative Management

Surgery

Joint and Bone Pathology

OA of Hip

Labral Tear

Femoroacetabular Impingement

Avascular Necrosis of Hip

Stress Fracture

Osteitis Pubis

Avulsion Fracture and Apophyseal Injuries

Hip Pointer

Hip Dislocation

Tumor or Tumorlike Lesion

Bursitis and Tendinopathy

Lateral Hip

Groin

Neuropathy

Lateral Femoral Cutaneous Nerve

Anterior Femoral Cutaneous Neuralgia

Obturator Neuropathy

Border Nerve Syndrome (Ilioinguinal, Iliohypogastric, and Genitofemoral Nerves)

Posterior Femoral Cutaneous Neuropathy

Other Pathology

Myositis Ossificans

Transient Osteoporosis

Pediatric Hip Pathology

Individual Conditions

Transient Synovitis or Irritable Hip

References

8. KNEE

Epidemiology of Knee Pain

Knee Pain in the General Population

Knee Pain in Athletes

Knee Pain at Work

Differential Diagnosis

MSK (Musculoskeletal) Causes of Knee Pain Based on Location

Neuropathic Causes of Knee and Leg Pain

Differential Diagnosis of Knee Swelling

Differential Diagnosis of Subjective Knee Instability

Differential Diagnosis of Painful Knee Snapping

Anatomy

Bone and Joint

Ligament and Meniscus

Nerve

Biomechanics

Kinematic and Kinetic

Knee Stability

Physical Examination

Inspection

Palpation

Range of Motion

Special Examination

Diagnostic Studies

Plain Radiographs

Point-of-Care Ultrasonography

MRI

MR and CT Arthrography

Management

Nonoperative Management

Surgery

Intra-Articular Structures

Bone and Joint Pathology

Inflammatory Arthropathy

Osteochondritis Dissecans

Spontaneous Osteonecrosis of the Knee

Proximal Tibiofibular Sprain and Instability

Meniscus Pathology

Ligament Injury

Plica Syndrome

Extra-Articular Structures (Bursa, Tendon, Ligament Pathology)

Medial Knee Pathology

Lateral Knee Pathology

Anterior Knee Pathology

Posterior Knee Pathology

Neuropathy

Saphenous Neuropathy; Gonalgia Paresthetica

Peroneal Neuropathy

References

9. LEG

Epidemiology of Leg Pain

Leg Pain in the General Population

Leg Pain in Athletes

Differential Diagnosis

Differential Diagnoses Based on Location of Pain

Differential Diagnosis of Calf Pain and Cramps

Differential Diagnosis of Leg Swelling

Differential Diagnosis of Atrophy and Pseudohypertrophy

Differential Diagnosis of Common Tibial Deformity

Other History to Ask

Anatomy

Cross-Sectional Anatomy

Bones

Muscles

Physical Examination

Inspection

Palpation

Neurological Examination

Evaluation of Foot for Pes Planus (Overpronation) and Pes Cavus (With Supination)

Diagnostic Studies

Plain Radiographs

MRI

Point-of-Care Ultrasonography (US)

CT Scan

Vascular Study and Other Tests

Treatment

Nonoperative Management

Musculoskeletal Pathology

Medial Tibial Stress Syndrome

Chronic Exertional Compartment Syndrome (CECS)

Stress Fracture (of Tibia)

Medial Gastrocnemius Tear

Plantaris Tendon and Soleus Muscle Tear

Neuropathy

Superficial Peroneal Neuropathy

Tibial Neuropathy—Soleal Sling Syndrome

Saphenous Neuritis

Lateral Sural Cutaneous Neuropathy

Vascular Pathology

Arterial Disease

Venous Disease

Other Pathology

Restless Legs Syndrome

Statin Myopathy

References

10. ANKLE ANKLE AND FOOT

Epidemiology of Ankle and Foot Pain

Foot and Ankle Pain in the General Population

Foot and Ankle Pain in Athletes

Foot and Ankle Pain at Work

Differential Diagnosis

Musculoskeletal (MSK) Causes of Foot and Ankle Pain Based on Location

Differential Diagnosis of MSK Hindfoot and Ankle Pain

Differential Diagnosis of MSK Midfoot Pain

Differential Diagnosis of MSK Forefoot Pain

Neuropathic Causes of Foot and Ankle Pain Based on Location

Other Causes of Severe (Disabling) Foot Pain

Common Causes of Pes Cavus (High Arch Foot)

Differential Diagnosis of Pes Planus (Flat Foot, Normal up to 6 Years)

Differential Diagnosis of Ankle Equinus

Differential Diagnosis of Ankle Instability

Differential Diagnosis of Snapping Ankle

Lateralization of Pain

Differential Diagnosis of Neuropathic Ankle and Foot Pain

Anatomy

Bone and Joint

Ligament

Retinaculum

Nerve

Muscle

Biomechanics

Kinetic and Kinematic

Ankle and Foot in Gait

Foot Alignment and Deformity

Physical Examination

Inspection

Palpation

Range of Motion

Special Tests

Diagnostic Studies

Plain Radiographs

Point-of-Care Ultrasonography

MRI

CT Scan

Treatment

Nonoperative Management

Surgery

Ankle and Hindfoot

Ligament, Tendon, and Bursa Pathology

Bone and Joint

Forefoot, Midfoot, and Toes

Common Medial Forefoot and Toe Pathologies

Toe Deformity and Fracture

Common Skin Lesion

Common Midfoot Pathologies

Neuropathy

Tarsal Tunnel Syndrome (Tibial Nerve Entrapment Neuropathy at Ankle)

Baxter’s Neuropathy (Inferior Calcaneal Neuropathy, 1st Branch of Lateral Plantar Neuropathy)

Jogger’s Foot (Medial Plantar Neuropathy)

Morton’s Interdigital Neuralgia

Anterior Tarsal Tunnel Syndrome (Deep Peroneal Nerve Entrapment Neuropathy)

Superficial Peroneal Nerve Entrapment Syndrome

Saphenous Mononeuropathy

Sural Mononeuropathy

Medial Hallucal Neuropathy

References

11. OTHER PAIN SYNDROMES

Epidemiology

Epidemiology of Widespread Pain

Epidemiology of Cancer Pain

Epidemiology of Common Neuropathic Pain Conditions

Differential Diagnosis

Generalized Musculoskeletal Pain

Differential Diagnosis of Diffuse Neuropathic Pain

Physical Examination

Examination for Neuropathic Pain

Diagnostic Studies

Serologic Tests

Electrodiagnosis

Other Diagnostic Tests

Imaging Tests

Generalized Musculoskeletal Pain

Fibromyalgia

Polymyalgia Rheumatica (PMR)

Chronic Fatigue Syndrome

Pain Related to Cancer

Bony Pain Related to Tumor

Muscle and Soft Tissue Pain

Joint Disorders/Synovitis (Neoplastic or Paraneoplastic)

Neuropathic Pain Related to Tumor

Paraneoplastic Peripheral Neuropathy

Radiation Plexopathy

Leptomeningeal Metastasis

Polyradiculopathy

Chronic Radiation Myelopathy

Neuropathic Pain

Central Poststroke Pain Syndrome (Thalamic Pain)

Spinal Cord Injury–Related Pain Syndrome

Complex Regional Pain Syndrome

Small Fiber Neuropathy

Erythromelalgia

References

Index