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Differential diagnosis

Explore clinical features, underlying structures, and differential diagnosis in inert and contractile tissues. Learn about capsular patterns and diagnostic techniques for bone, muscle, tendon, and other structures in musculoskeletal evaluation.

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Differential diagnosis

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  1. Differential diagnosis Mazyad Alotaibi

  2. Differential diagnosis • What are the clinical features • What structures could refer to the area -underlying structures -structures above -structures below • Differential diagnosis and clinical reasoning

  3. Inert Tissue • Bone, cartilage, ligament, bursa, fascia, neural tissue • Test by passive stretching or by squeezing

  4. Contractile Tissue • Muscle, musculo-tendinous junction, body of tendon, teno-osseus junction, bone at insertion of tendon • Test by isometric contraction or by passive stretching

  5. Capsular Pattern • When a joint is irritated by trauma, disease or degeneration, the inflamed capsule contracts, producing a loss of range in a set proportion. • This is known as a capsular pattern. • Each joint has its own capsular pattern.

  6. Differential diagnosis • Eg. 1 Pain on resisted LR & passive MR Contractile tissue at fault LR – infraspinatus & teres minor Localise further by palpation • Eg. 2 Active -  ROM LR, Flex, MR Contractile or inert Passive -  ROM LR, Flex, MR Inert structure, capsular pattern  capsulitis

  7. Eg. 3 • Active = Full ROM, painful arc on abd Contractile (deltoid, supra. Sp) or Inert (capsule, bursa) • Passive = Full ROM, painful arc on abs Contractile – not working contractile unit & not putting it on stretch Inert – non-capsular pattern – not capsulitis - bursa; squeezing bursa in sub-acromial space Clinical diagnosis = sub-acromial bursitis

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