Over 400 skeletal muscles and 200 bones, connected by numerous tendons and joints, allow us to walk upright, turn, bend and stand on our heads. As resilient as our skeletal structure is, it is also susceptible to wear and tear, incorrect loading and various diseases. The right diagnosis is important for prevention and appropriate treatment. Complaints often lead patients to the doctor: constant pulling in the back, cracking of the knee joints when climbing stairs, swelling of the fingers or painful muscle tension.
Problems with the skeletal system, especially the spine and joints, are among the most frequent causes of visits to the doctor and sick leave. The questioning (anamnesis) of the patient about the exact medical history plays an important role. Often the doctor can already deduce from the answers which structures of the musculoskeletal system the complaints originate from and what their triggers may be.
The most important contact person – apart from the general practitioner – is the orthopedist; however, depending on the suspected diagnosis, a visit to a neurologist or internist/rheumatologist, for example, may also be useful. Symptoms that are particularly common and therefore the focus of questioning are pain and dysfunction. Thus, the physician will want to know when these occur (i.e., at what time of day, whether at rest or under what stress), how they manifest themselves, how long they last, what makes them worse and better, and what other complaints plague the patient (e.g., swelling, redness, nerve palsies). Also of interest to the therapist are previous illnesses, accidents and surgeries, family illnesses and medications, occupation, and recreational behavior.
Basic diagnostics
The physical examination is usually performed on the standing, sitting and lying, predominantly undressed patient. Posture and figure already provide initial clues; during the examination (inspection), the physician pays particular attention to body symmetry, the curvature of the spine, and the joints, which may be characteristically deformed in rheumatism, for example, as well as to the musculature, mobility, and malpositions. The inspection also includes checking the gait pattern.
Palpation and percussion, especially of the bony prominences of the spinal column, provide indications of disease foci; muscle tension can also be palpated in this way. The length and circumference of the arms and legs are often also determined. If there is a suspicion of a disease such as rheumatism or gout, various blood tests are performed. These can be used, for example, to determine inflammatory cells and substances that attack the patient’s own immune system (autoantibodies) or to examine hormones that could be triggers for increased bone loss, for example.
