Neuromusculoskeletal Diagnosis
Core approach
Neuromusculoskeletal diagnosis combines regional inspection, palpation, range of motion, orthopedic provocative tests, neurologic screening, and functional assessment. Localize the lesion by anatomy: dermatomes for sensory findings, myotomes for motor weakness, and deep tendon reflexes for reflex arcs. Distinguish nociceptive mechanical pain from radicular, myelopathic, visceral, and systemic causes.
Concepts to know
Understand upper versus lower motor neuron signs, root versus peripheral nerve patterns, and the difference between radiculopathy and peripheral entrapment. Joint play and end-feel help identify hypomobility or instability. Muscle testing can reveal pain inhibition or true weakness. Provocative tests are rarely diagnostic alone; use clusters and the overall pattern.
Question traps
A positive test is not a diagnosis. Many orthopedic tests have limited specificity. Do not label bilateral or multilevel findings as a single-level lesion without evidence. Watch for red flags such as progressive weakness, bowel or bladder changes, saddle anesthesia, fever, unexplained weight loss, or night pain. Also avoid confusing referred visceral pain with mechanical dysfunction.
Worked example
A patient has dorsiflexion weakness, sensory loss over the dorsum of the foot, and no reflex change. This pattern fits L5 more than S1. S1 typically affects plantar flexion, the lateral foot, and the Achilles reflex. Rule of thumb: let anatomy localize the lesion; do not rely on pain location alone.
Documentation
Record side, level, neuro findings, provocative tests, functional limitations, and response to care. Reassess objectively.