Musculoskeletal diagnosis in adolescents

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Adolesc Med State Art Rev. 2007 May;18(1):1-10, vii.

Musculoskeletal diagnosis in adolescents.

Patel DR, MD, Greydanus DE.

Department of Pediatrics and Human Development, Michigan State

University College of Human Medicine, Pediatric Residency Program,

Kalamazoo Center for Medical Studies, 1000 Oakland Drive, Kalamazoo,

MI 49008, USA.

Musculoskeletal complaints are a common reason for adolescents to

seek medical attention. It is estimated that musculoskeletal problems

account for up to 20% of visits to primary care practitioners. Many

studies have shown the inadequacies of training of medical students

and primary care residents in musculoskeletal medicine. Also, many

practitioners do not feel comfortable in the management of common

problems in this area.

A general outline for approaching adolescents with musculoskeletal

complaints is presented in this article and is not unlike the

approach to other clinical problems. This outline follows the logical

exploration of the medical history followed by physical examination

and formulation of the appropriate differential diagnosis.

The broad categories of conditions that should be considered in the

differential diagnosis of musculoskeletal symptoms include rheumatic

diseases, chronic pain syndromes, systemic vasculitides, infections,

overuse syndromes, specific orthopedic conditions, metabolic bone

disease, neoplasms of connective tissue and bone, psychosomatic

disorders, peripheral neuropathy, and primary muscle disease.