Musculoskeletal System and Orthopedics Medical Checkup

Musculoskeletal diseases are a broad category of conditions that impact the structures vital to movement and support in the human body. These diseases can be present at birth or develop as a result of injury or disease and encompass disorders that can affect the bones, joints, muscles, tendons, ligaments, and nerves, each of which playing a critical role in maintaining the body’s structural integrity and facilitating movement.

The Musculoskeletal System

Spine (or vertebral column)

• The spine consists of a series of vertebrae (bones) stacked on top of each other, providing the body with structural support and a framework. It also protects the spinal cord, enables a wide range of movements, and serves as an attachment point for muscles, ligaments, and tendons.
• The spine is divided into several regions, including the cervical (neck), thoracic (mid-back), lumbar (lower back), sacral, and coccygeal (tailbone) regions, each contributing to its overall function. As a central structure in the musculoskeletal system, the spine is a key focus in both orthopedic care and musculoskeletal health.

Bones

• Bones form the solid structure of the body, safeguarding internal organs, anchoring muscles, and storing calcium. They are crucial for support and movement, allowing the body to maintain posture and engage in physical activity.
• Common musculoskeletal diseases affecting the bones include osteoporosis, fractures, bone infections, bone cancers and congenital disorders like osteogenesis imperfecta.

Joints

• Joints are the connections between bones that enable movement and flexibility in the body. They are cushioned by cartilage and stabilized by ligaments, allowing for smooth and controlled motion while preventing bones from rubbing against each other.
• Common conditions affecting the joints include arthritis, bursitis, and dislocations, where bones are forced out of their normal positions.

Muscles

• Muscles are responsible for movement by contracting and relaxing, which moves the bones and joints. They also help maintain posture, generate heat, and contribute to bodily functions such as breathing and circulation.
• Common diseases affecting muscles include muscular dystrophies, myositis, and muscle strains or tears.

Tendons

• Tendons are strong, fibrous tissues that connect muscles to bones, transmitting the force needed for movement. They play a crucial role in enabling the body to perform actions like lifting, pushing, and pulling.
• Tendon-related disorders include tendinitis, tendon ruptures, and tenosynovitis.

Ligaments

• Ligaments are flexible, fibrous bands that connect bones at joints, providing stability and limiting excessive movement to prevent injury. They are essential for maintaining joint integrity during physical activities.
• Common ligament conditions include sprains, ligament tears, and ligament laxity.

Key Components of a Musculoskeletal Medical Checkup

Diagnosing musculoskeletal diseases requires a combination of clinical evaluation, laboratory tests, and imaging studies to accurately identify the specific condition and its severity. In Cuba, this process usually starts with a thorough medical history, where details about symptoms like joint pain, stiffness, swelling, and the duration and pattern of these symptoms are collected.

Medical History

Diagnosis of musculoskeletal disease typically begins with a medical history review:

• Symptom Inquiry:
  • When symptoms first appeared and whether they developed suddenly or gradually.
  • Determine the duration and pattern of symptoms.
  • Identifying the exact location of pain or discomfort.
  • Understanding whether the pain is sharp, dull, constant, or intermittent
  • Inquire about the presence of systemic symptoms like fatigue, fever, or weight loss.
• Family History:
  • Evaluate any family history with similar conditions.
• Risk Factors Investigation:
  • Past Injuries or surgeries in the affected area
  • Presence of chronic conditions (such as diabetes).
  • Current and past medications review.
  • Patient’s level of physical activity, occupation and lifestyle habits.

Physical Examination

Physical examination is carried out to provide direct assessment of the affected area, helping to identify specific abnormalities.

• Inspection: Examines the affected area for swelling, redness, deformities, or asymmetry.
• Palpation: By feeling the affected area, the provider can assess tenderness, warmth, or abnormal masses.
• Range of Motion: The patient is asked to move the affected joint or muscle to evaluate its range of motion, flexibility, and whether the movement causes pain.
• Muscle Strength Testing: Muscle strength is assessed for endurance and potential weaknesses or imbalances
• Structural Abnormalities: Identifies physical signs such as joint misalignment, muscle atrophy, or ligament laxity.
• Special Tests: Specific tests are performed to identify certain conditions, such as the Lachman test for ligament injuries or Phalen’s test for carpal tunnel syndrome.
• Assessment of Overall Physical Health: Evaluates posture, gait, and alignment as well as identifying broader issues that might be contributing to musculoskeletal problems.

Laboratory Tests

Laboratory testing helps identify inflammatory markers, detect autoimmune conditions, and monitor disease progression. It also aids in ruling out other potential causes of musculoskeletal symptoms, ensuring accurate diagnosis and effective treatment planning.

• Inflammatory Markers: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to detect inflammation.
• Autoimmune Tests: Rheumatoid factor (RF), anti-CCP antibodies, and antinuclear antibodies (ANA) to diagnose autoimmune diseases like rheumatoid arthritis and lupus.
• Metabolic Tests: Calcium, phosphate, vitamin D, and parathyroid hormone (PTH) levels to assess bone metabolism and diagnose conditions like osteoporosis.
• Muscle Enzymes: Creatine kinase (CK) to detect muscle damage in conditions like myositis.
• Uric Acid Levels: To diagnose gout and other crystal-induced arthropathies.
• Infection Tests: White blood cell counts and blood/joint fluid cultures to identify infections like septic arthritis or osteomyelitis.

Imaging Studies

Imaging studies provide detailed visualizations of bones, joints, and soft tissues, allowing for the detection of fractures, structural abnormalities, and degenerative changes that are not visible through physical examination alone.

• X-Rays: Used to visualize bone structures, X-rays can detect fractures, dislocations, and degenerative changes like arthritis.
• MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, including muscles, tendons, ligaments, and intervertebral discs. It’s useful for diagnosing conditions like herniated discs or torn ligaments.
• CT Scan (Computed Tomography): Offers a more detailed view of bones and joints than X-rays and is often used when fractures are complex.
• Ultrasound: Utilized to assess soft tissue structures, including muscles and tendons, and to guide injections or aspirations.
• Bone Scans: Used to detect bone abnormalities like infections, fractures, or tumors.

Electrodiagnostic Testing

Electrodiagnostic testing measure electrical activity and identifies nerve damage or dysfunction.

• EMG (Electromyography): Measures the electrical activity of muscles and helps diagnose conditions like nerve compression or muscle diseases.
• Nerve Conduction Studies: Evaluate the speed and strength of electrical signals traveling through nerves to detect nerve damage. 

Biopsy

In certain cases, a biopsy of bone, muscle, or joint tissue may be necessary to diagnose conditions like cancer, infections, or inflammatory diseases.