Musculoskeletal DDX

What you perceive, may not

always be right…..
 Bone pain & pathologic fractures

• Osteoporosis (fracture) • Multiple myeloma (bone pain,

• Malignancy, primary or fracture)
metastatic (fracture) • Paget’s disease (bone pain)
• Hyperparathyroidism (bone • Leukemia (bone pain)
pain) • Gaucher disease (fracture)
• Hyperthyroidism (osteopenia) • Beta thalassemia (fracture)
• Cushing’s syndrome
(osteopenia)
• Osteogenesis imperfecta
(fracture)
• Osteomalacia or rickets
(bowing and pseudofractures)
 Neck pain

• Acute or chronic cervical • Spinal stenosis

strain/sprain, eg, poor sleeping • Fibromyalgia
posture, whiplash injury • Deep neck infection, eg,
• Osteoarthritis, eg, cervical Ludwig’s angina
spondylosis on x-ray • Thyroiditis
• Herniated disk (discogenic
• Shoulder disorder
neck pain)
• Subarachnoid hemorrhage
• Rheumatoid arthritis
• Thoracic outlet syndrome
• Ankylosing spondylitis
• Temporal (giant cell) arteritis
• Compression fracture
• Cervicobrachial syndrome
• Osteomyelitis
• Cervicalgia
• Meningitis
• Torticolis
• Migraine
• Metastatic cancer
 Neck stiffness

• Meningitis
• Cervical arthritis, eg,
osteoarthritis, rheumatoid
arthritis
• Cervical strain, eg, poor
sleeping posture,
whiplash injury
• Fibromyalgia
• Polymyalgia rheumatica
• Hypertonicity
• Torticolis
 Shoulder pain

• Rotator cuff tendinitis • Avascular necrosis

("impingement") or tear • Polymyalgia rheumatica
• Subacromial bursitis • Fibromyalgia
• Biceps tendinitis • Thoracic outlet syndrome
• Osteoarthritis (acromioclavicular • Brachial plexus neuropathy
joint; rare in glenohumeral joint) • Referred pain from gallbladder,
• Frozen shoulder (adhesive heart, diaphragm, Pancoast tumor
capsulitis) • Metastatic or primary tumor
• Acromioclavicular (AC) separation
• Neck disorder, eg, osteoarthritis,
herniated disk, tumor
• Rheumatoid or septic arthritis
• Calcific tendinitis
• Shoulder dislocation or fracture
 Elbow pain

• Epicondylitis, lateral ("tennis

elbow") or medial ("golf
elbow")
• Olecranon bursitis
• Arthritis, eg, rheumatoid
arthritis, gout, osteoarthritis,
septic arthritis
• Fracture
• Tendinitis of distal insertion of
biceps
• Ulnar nerve entrapment at
elbow
• Avascular necrosis
• Metastatic or primary tumor
 Wrist pain
• Sprain
• Area of first CMC joint:
osteoarthritis, DeQuervain’s
tenosynovitis, scaphoid
fracture (snuffbox pain)
• Carpal tunnel syndrome
• Pronator teres syndrome
(median nerve entrapment at
level of pronator teres)
• Lunate fracture or dislocation
• Colles (distal radius) fracture
• Triangular fibrocartilage
complex (TFCC) injury
• Arthritis, eg, rheumatoid
arthritis, osteoarthritis, reactive
arthritis (Reiter’s syndrome),
psoriatic arthritis, gout or
pseudogout, septic arthritis
• Dorsal ganglion (may be
ventral)
• Superficial radial neuropathy
(cheiralgia paresthetica or
handcuff neuropathy)
 Low back pain
• Muscular strain/sprain
• Osteoarthritis – spondylosis w or
w/o myelopathy
• Herniated disk
• Spinal stenosis
• Sciatica
• Sacroiliitis, eg, ankylosing
spondylitis
• Rheumatoid arthritis
• Metastatic cancer
• Compression fracture, eg,
osteoporosis, multiple myeloma
• Osteomyelitis or epidural abscess
• Cauda equina tumor
• Ischial bursitis
• Piriformis syndrome
• Polymyalgia rheumatica
• Abdominal Aortic aneurysm
• Duodenal ulcer
• Kidney stones or pyelonephritis
• Pancreatitis
• Prostatitis
• Lumbago
• Postlaminectomy syndrome
• Radiculopathy
 Hip pain
• Hip joint arthritis, eg,
osteoarthritis, rheumatoid
arthritis, septic arthritis, gout
• Trochanteric bursitis
• Hip fracture
• Sciatica
• Sacroiliitis, eg, ankylosing
spondylitis
• Lumbar facet joint
degenerative arthritis
• Lumbar disk herniation
• Ischial bursitis
• Piriformis syndrome
• Iliopsoas bursitis
• Claudication (arterial
insufficiency)
• Polymyalgia rheumatica
• Fibromyalgia
• Meralgia paresthetica
(compression of lateral femoral
cutaneous nerve; anterolateral
thigh pain)
• Avascular necrosis
• Hip dislocation
• ISD
 Knee pain
• Patellofemoral syndrome
• Iliotibial band syndrome
• Patellar tendinitis
• Anserine bursitis
• Meniscus tear (medial > lateral)
• Medial or lateral collateral
ligament strain or tear
• Cruciate ligament tear (anterior >
posterior)
• Prepatellar bursitis
• Baker’s (popliteal) cyst
• ISD
• Septic joint, eg, gonococcal
• Arthritis, eg, osteoarthritis,
rheumatoid arthritis, gout,
pseudogout, septic arthritis,
reactive arthritis (Reiter’s
syndrome)
• Medial plica syndrome
• Osgood-Schlatter disease
•
Osteochondritis dissecans
• Neuropathic arthropathy (Charcot
joint)
• Tumor, eg, osteosarcoma
• Referred pain from hip, eg,
avascular necrosis
• Referred pain from back, eg,
sciatica
• Fracture
 Knee effusion
• Trauma, eg, fracture, ligament or
meniscal injury, overuse
• Infection, eg, gonococcal,
Staphylococcus aureus, Lyme
disease, tuberculosis
• Gout or pseudogout
• Seronegative
spondyloarthropathy, eg, reactive
arthritis (Reiter’s syndrome)
• Rheumatoid arthritis
• Osteoarthritis or inflammatory
osteoarthritis
• Hemarthrosis due to bleeding
disorder
• Malignant or benign tumor
 Calf pain

• Muscular strain • Vasculitis, eg, polyarteritis

• Baker’s (popliteal) cyst nodosa, thromboangiitis
• Deep vein thrombosis obliterans (Buerger’s disease)
• Spinal stenosis
• Claudication (arterial
insufficiency) (pseudoclaudication; usually
back and thigh pain)
• Superficia thrombophlebitis
• Varicose veins
• Achilles tendon rupture
• Myositis, eg, polymyositis,
dermatomyositis
 Ankle Pain

• Ankle sprain, eg, anterior

talofibular ligament
• Fibular fracture
• Tibial avulsion fracture
• Arthritis, eg, gout,
rheumatoid arthritis
• Posterior tibial tendinitis
(pain posterior to medial
malleolus)
• Peroneal tendonitis (pain at
lateral malleolus)
• Neuropathic arthropathy
(Charcot joint)
• Avascular necrosis
 Heel pain

• Plantar fasciitis
• Enthesopathy due to seronegative spondyloarthropathy (eg,
ankylosing spondylitis)
• Achilles tendinitis
• Pre-achilles bursitis
• Metatarsal stress fracture
• Heel pad syndrome (traumatic irritation of fat tisses)
• Retrocalcaneal bursitis
• Tarsal tunnel syndrome
• Large bony heel spur
• Calcaneal stress fracture (runners)
• Genital herpes simplex (referred pain from sacral ganglion)
 Foot pain
• Ingrown toenail
• Bunions, corns, calluses, warts
• Plantar fasciitis
• Morton's neuroma
• Metatarsalgia, eg, rheumatoid
arthritis
• Pes planus (flatfoot)
• Bursitis of first
metatarsophalangeal (MTP) joint
(inflamed bunion)
• Metatarsal stress fracture
• Arthritis, eg, gout, psoriatic
arthritis, rheumatoid arthritis,
osteoarthritis
• Poorly fitting shoes
• Lumbar disk herniation
• Achilles tendinitis
• Retrocalcaneal bursitis
• Tarsal tunnel syndrome
• Peripheral neuropathy, eg,
diabetes mellitus, alcoholism
• Arterial insufficiency
• Diabetic or arterial insufficiency
ulcer with or without osteomyelitis
• Polyarteritis nodosa,
thromboangiitis obliterans
(Buerger's disease), Raynaud's
syndrome
• Erythromelalgia