Musculoskeletal Medicine, Orthopaedics and Rehabilitation
Describing and diagnosing
Use consistent vocabulary: which tissue, which structure, grade and stability. Ligament injuries are graded I–III (sprain, partial tear, complete tear); muscle strains are graded similarly; fractures are described by site, pattern, displacement, angulation, articular involvement and open/closed status. Tendinopathy is a degenerative, load-related process with disorganised collagen and neovascularisation rather than a primary inflammatory tendinitis - this explains why progressive loading, not rest and NSAIDs alone, is the treatment.
Emergencies not to miss
Compartment syndrome (pain out of proportion, pain on passive stretch, tense compartment - pulses are usually present, so never rely on pulselessness), septic arthritis, open fracture, neurovascular injury, and in the spine cauda equina syndrome or unstable fracture.
Imaging and special tests
Plain radiographs first for suspected fracture; MRI for soft tissue, stress injury and marrow oedema; ultrasound is operator-dependent. Special tests help only when pretest probability is meaningful.
Rehabilitation
Progress through protection and pain control, restore range and neuromuscular control, then strength, power and sport-specific loading. Return to sport requires tissue healing plus sport-specific capacity, psychological readiness and a load-management plan - not merely the absence of pain.
Traps: the Ottawa ankle rules apply to adults aged 18–55 with acute ankle injury; do not apply them to children or pregnant patients, and they guide radiography decisions, not treatment. "Growing pains" are bilateral, nocturnal and benign; unilateral persistent pain in a child needs investigation.
Rule of thumb: pain on passive stretch with a tense compartment means urgent surgical assessment, not a wait-and-X-ray approach.