Musculoskeletal System



Musculoskeletal System





9-A. Shoulder Pain

Fracture

Contusion

Acromial-clavicular joint separation or injuries

Rotator cuff tendonitis, rupture or impingement syndrome

Bursitis

Bicipital tendonitis (long head)

Referred pain



  • Diaphragmatic irritation



    • Biliary disease


    • Myocardial infarction, angina, pericarditis


    • Blood or gas in peritoneal or pleural cavity


    • Subphrenic abscess


    • Splenic rupture


    • Neoplasm


    • Lower lobe pleuropulmonary inflammatory disease


  • Apical lung cancer (Pancoast syndrome)


  • Cervical radiculopathy and brachial neuritis

Osteoarthritis

Infectious, rheumatoid, or crystalline arthritis

Arthritis associated with collagen vascular disease

Anterior or posterior shoulder instability

Shoulder-hand syndrome

Neoplasm, primary or metastatic


Local arterial, venous, or lymphatic occlusion

Adhesive capsulitis

Carpal tunnel syndrome

Thoracic outlet syndromes



  • Cervical and first rib syndromes, scalenus anterior syndrome


  • Hyperabduction syndrome


  • Costoclavicular syndrome

Psychogenic pain

Sleep dysesthesias

Postural

Congenital or developmental abnormalities



References

1. Harris R. See Bibliography, 1, pp. 475-504.

2. Mercier L. See Bibliography, 2, pp. 48-74.


9-B. Back Pain

Functional, mechanical causes: postural imbalance



  • Anteroposterior (e.g., pregnancy)


  • Lateral (e.g., scoliosis, unequal leg lengths)

Trauma



  • Lumbar strain or sprain


  • Lumbosacral disc herniation


  • Vertebral fracture (compression or other)


  • Subluxation of facet joints

Osteoarthritis, spondylosis

Rheumatoid arthritis

Fibromyalgia

Polymyalgia rheumatica

Spondylitis, or sacroiliitis, or both



  • Ankylosing spondylitis


  • Colitic (enteropathic) spondylitis


  • Psoriatic arthritis


  • Behçet syndrome, Reiter syndrome


  • Familial Mediterranean fever


  • Syphilis, ochronosis

Spinal stenosis



  • Congenital, degenerative


  • Iatrogenic (after laminectomy, fusion, or chemonucleolysis)


  • Posttraumatic


  • Paget disease


  • Renal osteodystrophy


Spinal or vertebral tumor



  • Benign (e.g., hemangioma, meningioma, osteoid osteoma)


  • Malignant



    • Primary (e.g., multiple myeloma, ependymoma, osteogenic sarcoma)


    • Metastatic



      • Breast, prostate, lung


      • Kidney, thyroid, gastrointestinal tract


      • Non-Hodgkin or Hodgkin lymphoma


      • Leukemic

Infection (e.g., disc space, vertebral osteomyelitis, epidural abscess)



  • Bacteria, Brucella, spirochetes


  • Herpes zoster, parasites


  • Mycobacteria, fungi

Congenital causes



  • Facet hypertrophy, spondylolysis, spondylolisthesis


  • Spina bifida, transitional vertebrae

Hyperparathyroidism

Osteomalacia (e.g., vitamin D-resistant rickets)

Osteoporosis (primary, endocrine, nutritional, or drugs)

Osteogenesis imperfecta

Scheuermann disease (epiphysitis)

Radium poisoning

Referred pain



  • Vascular disease (abdominal aortic aneurysm, Leriche syndrome)


  • Hip pain


  • Pelvic or prostatic inflammation or tumor, endometriosis


  • Retroperitoneal hematoma/tumor, renal vein thrombosis


  • Renal stones, infection, tumor


  • Polycystic kidney disease


  • Abdominal disease (e.g., intestinal, pancreatic, gallbladder)


  • Cardiopulmonary (pulmonary emboli, pneumonia, pleuritis, angina)

Hemoglobinopathies (e.g., sickle cell, myelofibrosis)

Psychoneurotic (hysteria or malingering)



References

1. Harris R. See Bibliography, 2, pp. 118-151.

2. Broder J, Snarski J. Back pain in the elderly. Clin Geriatric Med. 2007;23:271-289.


3. Baker R, Patel D. Lower back pain in the athlete: common conditions and treatment. Prim Care Clin Office Pract. 2005;32:201-229.


9-C. Myalgias

Fibrositis

Connective tissue disease



  • Polymyalgia rheumatica


  • Rheumatoid arthritis


  • Polymyositis, dermatomyositis


  • Lupus erythematosis


  • Polyarteritis nodosa


  • Scleroderma

Systemic infection



  • Viral illnesses [e.g., influenza, Coxsackie virus, rabies, human immunodeficiency virus (HIV)]


  • Dengue fever, poliomyelitis, tularemia


  • Trichinosis, glanders, leptospirosis


  • Typhoid fever, malaria, brucellosis

Rhabdomyolysis (see 9-D)

Drugs (e.g., amphotericin B, chloroquine, oral contraceptives, fibrates)

Hypothyroidism, hyperparathyroidism

Congenital enzyme deficiency [e.g., phosphorylase (McArdle disease), phosphofructokinase]

Polyneuropathy (e.g., Guillain-Barré disease)

Ischemic atherosclerotic disease (e.g., intermittent claudication)



References

1. Goldman L. Chapter 461. See Bibliography, 3.

2. Wortmann RL. Chapter 80. See Bibliography, 1.


9-D. Muscle Weakness


Acute or Subacute1

Electrolyte abnormality



  • Hyperkalemia, hypokalemia


  • Hypercalcemia, hypermagnesemia


  • Hypophosphatemia

Rhabdomyolysis



  • Extreme muscle exertion, prolonged seizures


  • Hyperthermia



  • Extensive crush injury or muscle infarction


  • Influenza


  • Hypokalemia, hypophosphatemia


  • Alcoholic myopathy


  • Snake venoms


  • Industrial toxin ingestion


  • Familial myoglobinuria


  • Metabolic myopathies (e.g., McArdle disease)

Polymyositis, dermatomyositis

Infections



  • Viral (e.g., influenza, Coxsackie virus, rabies, poliomyelitis, herpes zoster)


  • Trichinosis, toxoplasmosis, cysticercosis, schistosomiasis, trypanosomiasis


  • Botulism, diphtheria


  • Leprosy

Peripheral neuropathy (see 10-N)

Thyrotoxicosis

Corticosteroid therapy

Organophosphorous poisoning


Chronic

Progressive muscular dystrophies



  • Oculopharyngeal


  • Duchenne


  • Facioscapulohumeral


  • Limb-girdle


  • Myotonic

Endocrine disorders



  • Hyperthyroidism or hyperthyroidism


  • Hyperparathyroidism


  • Vitamin D deficiency (e.g., vitamin D-deficient rickets)


  • Corticosteroid therapy


  • Cushing syndrome, Addison disease


  • Acromegaly

Connective tissue disease



  • Lupus erythematosus


  • Rheumatoid arthritis


  • Polymyositis, dermatomyositis


  • Sjögren syndrome


  • Mixed connective tissue disease


Alcoholic myopathy

Chronic polymyopathy



  • Glycogen storage diseases (e.g., McArdle disease)


  • Central core disease

Mitochondrial myopathy



  • Lipid metabolism disorders (e.g., carnitine deficiency)


  • Familial periodic paralysis with progressive myopathy

Progressive neural-muscular atrophy



  • Amyotrophic lateral sclerosis


  • Multiple sclerosis


  • Peroneal muscular atrophy (Charcot-Marie-Tooth disease)


  • Chronic peripheral neuropathy [e.g., arsenic, lead, nutritional (see 10-N)]


Intermittent or Transient, or Both

Electrolyte abnormality



  • Hypokalemia, hyperkalemia


  • Hypophosphatemia


  • Hypercalcemia, hypermagnesemia


  • Hyperkalemic from sodium channel disorders


  • Hypokalemic periodic paralysis (calcium channel disorders)

Drugs



  • Aminoglycosides (neomycin, streptomycin, kanamycin or polymyxin B)


  • Steroids


  • Vincristine, zidovudine, cyclosporine


  • Chloroquine, bretylium


  • Clofibrate, statins, niacin

Myasthenia gravis

Eaton-Lambert syndrome

Acute thyrotoxic myopathy

Thyrotoxic periodic paralysis



References

1. Harris R. See Bibliography, 1, pp. 387-391.

2. Goldman L. Chapter 420. See Bibliography, 3.


9-E. Polyarticular Arthritis

Rheumatoid arthritis1

Juvenile rheumatoid arthritis1


Rheumatic fever1

Ankylosing spondylitis1

Collagen vascular diseases



  • Lupus erythematosus1


  • Scleroderma1


  • Polymyositis, dermatomyositis1


  • Mixed connective tissue disease


  • Polyarteritis nodosa (rare)1


  • Henoch-Schönlein purpura (rare)1


  • Wegener granulomatosis (rare)1


  • Other vasculitides (rare; e.g., allergic granulomatosis)1


  • Polymyalgia rheumatica1

Immunologically mediated diseases

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Jun 19, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Musculoskeletal System

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