DIAGNOSTIC OF THE

MUSCULOSKELETAL
PROBLEMS
NUR AFIQAH BINTI ABDUL RAHMAN
112016188
PEMBIMBING : dr. Jafri, SpOT
 History taking
1. Identity
2. Chief complain
◦ Pain
Onset, causes, precise location, character, severity, duration, factors that relieve &
aggravate the pain, its variation in day and night
◦ Decrease in function
Due to muscle weakness or fatigue, instability or stiffness of a joint.
◦ Physical appearance
Deformity
- Crooked limb (angulatory deformity)
- Twisted limb (torsosional or rotational deformity)
- Wasted limb (atrophy)
- Short leg (leg length discrepancy )
- Crooked back ( scoliosis)
Abnormal way of walking (limp of abnormal gait )
3. Past history
Previous illnesses, injuries, related treatment (vaccinations, operations)
4. Functional inquiry
Heart disease, diabetes, kidney disease, respiratory conditions
5. Social, economic and work history
6. Family history
Some musculoskeletal conditions can be congenital and acquired.
Physical examination
◦ Look (inspection)
- Skin redness, cyanosis, pigmentation
- Atrophy, hypertrophy, scars of previous injury or operations.
- Deformity, swelling, or lumps.
- Measure any limb shortening
- Compare abnormal limb with the opposite limb
- If the patient is able to walk, ask him to do so, back and forth
◦ Feeling (palpation)
Skin temperature, tenderness, swelling, mass/lump (size, consistency, fluctuation, and
abnormal relationship of bones at their joints (dislocations), joint crepitus, pulse

◦ Move
Active movement ; it may be limited by pain and associated muscle spasm, muscle
weakness, ruptured muscle and tendon, joint stiffness or joint contracture ,
Passive movement ; decrease (s.a.a) or increase due to lax capsule or torn ligament.
Abormal ROM should be recorded.
◦ Listening (Auscultation)
Sounds arising from bones (fracture crepitus), joint (joint crepitus) or muscle action
(snapping tendons)
Special physical test
1. Thomas test - Hip flexion deformity
2. the Tredelenburg test
3. Barlow test or Ortolani test- Instability of the newborn hip
4. Sciatic nerve irritation Lasegue’s test
5. McMurray test-Torn medial meniscus of the knee
◦ Neurological examination
1. Motor system (muscle tone, power, coordination)
2. Sensory system (touch, pain, temperature, position sense, vibration)
3. Reflexes (tendon, abdominal, plantar)
Diagnostic imaging
1. Inspection of a radiograph
◦ General density of the bone – increased or decreased
◦ Local density of bone – increased or decreased
◦ Relationship between bones- dislocation and subluxation
◦ Break in bone continuity – fracture
◦ General contour if a bone – internal or external irregularity
◦ Thickness of articular cartilage – as reflected by the width of the joint space, or more
accurately the cartilage space
◦ Changes on soft tissues- swelling, atrophy
◦ Plain ( conventional ) Tomography
Ex : destructive lesions in bone, fracture, nonunions of fractures or the completeness of
bony union across an area of arthrodesis (joint fusion)
◦ Computed Tomography
- less radiation than conventional tomograms use.
- Detect benign & malignant tumors, pulmonary metastases, osteomyelitis, intervertebral disc
herniation, spinal stenosis and etc
- Useful in imaging of complex fractures of the spine and the joints of the extremities
◦ Ultrasonography (USG)
- Detecting joint effusions, muscle tendon injuries, cartilaginous femoral head and the
acetabulum in newborn infants with suspected congenital dislocation or subluxation of the
hip.
- Differentiate between solid soft tissue lesions and fluid-filled cystic lesions ; popliteal cyst

- Doppler phenomenon using USG is an accurate and noninvasive method of assessing arterial
and venous blood flow in an extremity
◦ Contrast radiography
1. Arthrography
Injection of radiopaque contrast agent or air into the synovial cavity to detect injuries or
other abnormalities of the articular cartilage, fibrocartilaginous menisci, capsule and
ligaments.
2. Myelography
Injection of contrast medium into the subarachnoid space can detect the protrusions of
nucleus pulposus or soft tissue neoplasms extending into the vertebral canal.
3. Discography
Injection of radiopaque contrast agent into suspected abnormal intervertebral discs
under local anesthesia can help in localizing the particular disc that causing symptoms
to patient.
◦ Magnetic Resonance Imaging
-Provides cross-sectional images with higher resolution than CT, and better images of the
brain and spinal cord.
- Most effective diagnostic imaging technique for the demonstration of malignant tumors of
soft tissue and bone, internal derangements of joints (especially knee), rotator cuff tears in
the shoulders, muscle and tendon injuries, intervertebral dics herniations, and early stages
of avascular necrosis of the bone.
◦ Arthroscopy
To evaluate the joint ; intraarticular fracture, meniscus or ligament tear, rheumatic.
For knee, elbow, pelvic and shoulder
Laboratory Investigation
1. Blood : HB, RBC, WBC, LED, blood coagulation, uric acid values, and blood culture
2. Serum : serum calcium, HIV test, mantoux test, Rose test for rheumatoid disease
3. Urine
4. Cerebrospinal fluid
5. Synovial fluid
6. Abnormal fluids (effusions, exudates)
- Gross appearance, culture

7. Body tissues (biopsy)

- Bone marrow is obtained by sternal or iliac puncture (aspiration biopsy)
- Bone & soft tissue specimens are obtained by open operation( open biopsy) or by
withdrawing a small piece of tissue through a hollow cannula ( punch biopsy )
- For dx of musculoskeletal neoplasms.
THANK YOU!