Regional Musculoskeletal and Neurologic Conditions
Core concepts
Organize by region: cervical, thoracic, lumbar, sacroiliac, upper and lower extremity, plus neurologic presentations such as radiculopathy, myelopathy, and entrapment syndromes. Know typical pain referral patterns, key examination findings, and which findings differentiate mechanical from neurologic causes.
Discriminating findings
Radicular pain follows a dermatomal pattern, may worsen with tension or cough, and often comes with reflex, sensory, or motor change. Mechanical pain is more positional and reproduced by motion testing. Myelopathy signals include gait change, hyperreflexia, and clumsy hands - these are urgent. Sacroiliac presentations show asymmetric landmarks and pain with provocation maneuvers.
Traps
- Labeling any leg pain as sciatica without dermatomal or tension findings.
- Missing myelopathy because the patient's chief complaint is neck pain.
- Treating a peripheral entrapment while ignoring an upstream restriction.
- Assuming normal imaging excludes a mechanical problem, or abnormal imaging proves the source.
Rule of thumb
Before treating, ask whether the findings are mechanical, radicular, or systemic - each answers to a different plan.
Worked example
A patient has lateral leg pain to the dorsum of the foot, positive tension sign, and reduced ankle dorsiflexion strength. That is an L5 radicular pattern, not simple mechanical low back pain, so the plan emphasizes neurologic monitoring and appropriate referral alongside cautious supportive care.