Musculoskeletal Disorders and Sports Medicine: Match Structure to Maneuver
Think anatomy and tissue, not test names
Musculoskeletal questions usually ask whether you can link a structure to a provocation maneuver, then choose the least invasive next step. Shoulder: rotator cuff tendinopathy (painful arc, pain with resisted abduction and external rotation) versus full-thickness tear (drop-arm sign, external-rotation lag) versus adhesive capsulitis (global loss of passive motion, especially external rotation) versus AC arthropathy (point tenderness, pain with cross-body adduction). Knee: ACL (Lachman, pivot shift), meniscus (joint-line tenderness, McMurray), patellofemoral pain (theater sign, pain with resisted quadriceps). Hip: osteoarthritis with groin pain and limited internal rotation. Spine: screen for red flags - fever, cancer history, night pain, bowel or bladder change, saddle anesthesia, progressive deficit - before treating mechanical back pain.
Traps: the Ottawa ankle rules decide imaging, not treatment. Obtain radiographs only with malleolar or midfoot tenderness plus inability to bear weight four steps, and remember the foot rules cover navicular and fifth metatarsal base. Tendinopathy is a load problem, so eccentric or heavy-slow resistance is first line, not rest and repeated steroids, which risk tendon rupture. In acute compartment syndrome, pain with passive stretch and a tense compartment outrank pulses and imaging. Return-to-play decisions hinge on pain-free function and sport-specific loading, not time alone.
Worked example
A 45-year-old tennis player has lateral elbow pain; resisted wrist extension reproduces it and the cervical exam is normal. That is lateral epicondylopathy - manage load with eccentric wrist extensor exercise, and skip imaging.
Rule of thumb
If passive motion is limited, think joint or capsule; if pain arises against resistance with full passive motion, think tendon or muscle.