Musculoskeletal diagnosis in adolescents

Musculoskeletal complaints are a common reason for adolescents to seek medical attention. It is estimated that musculoskeletal problems account for up to 20% of visits to primary care practitioners. Many studies have shown the inadequacies of training of medical students and primary care residents in musculoskeletal medicine. Also, many practitioners do not feel comfortable in the management of common problems in this area. A general outline for approaching adolescents with musculoskeletal complaints is presented in this article and is not unlike the approach to other clinical problems. This outline follows the logical exploration of the medical history followed by physical examination and formulation of the appropriate differential diagnosis. The broad categories of conditions that should be considered in the differential diagnosis of musculoskeletal symptoms include rheumatic diseases, chronic pain syndromes, systemic vasculitides, infections, overuse syndromes, specific orthopedic conditions, metabolic bone disease, neoplasms of connective tissue and bone, psychosomatic disorders, peripheral neuropathy, and primary muscle disease.