THE PROPER EVALUATION OF MUSCULOSKELETAL COMPLAINTS
in the United States of America
William Min
University of Medicine and Dentistry of New Jersey (UMDNJ)
Newark
New Jersey
U.S.A.
Introduction
Primary care physicians and general orthopaedic physicians examine and diagnose numerous cases
of musculoskeletal complaints in the United States annually. The diagnosis of possible oncogenic
causes related to the complaint has become an important issue during the delivery of proper health
care measures in light of increasing health care costs. The techniques and tools available to the
physician for proper diagnosis are evaluated and weighted for their efficacy and appropriateness.
Method
Proper methods evaluated for efficacy and appropriateness were reviewed from the following
sources:
Orthopaedic physicians
Primary care physicians
Orthopaedic journal reviews.
Results
With the onset of advanced methods in imaging, the initial diagnosis made by history and physical
examination is either supported or refuted. These methods, which include the traditional plain
radiographs, nuclear magnetic resonance imaging (MRI), computed tomography scans (CT), bone
scans, and ultrasound, vary in their effectiveness and costs in determining the possible oncogenic
problems that cause musculoskeletal complaints. Also, blood tests are tools that aid in the
diagnosis. Referral to an orthopaedic oncologist for a suspected oncogenic pathology aids in further
confirmation of the initial diagnosis made by the primary care physician or orthopaedic physician.
Conclusion
While history and physical examination, imaging methods, and blood tests are tools that the
primary care physician and orthopaedic physician have at their disposal, cost considerations must
be factored along with the appropriateness and efficacy of the diagnostic tool. The referral to the
orthopaedic oncologist remains the most efficacious and cost-efficient method to diagnose the
possible oncogenic causes of a musculoskeletal complaint.
Literature:
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2. Campbell CJ. Benign Tumors of Bone. Proc Natl Cancer Conf 1964; 5: 345-358
3. Mankin HJ. Advances in Diagnosis and Treatment of Bone Tumors. N Engl J Med 1979; 300:
543-545.
4. Presant CA, Russell WO, Alexander RW, Fu YS. Soft-tissue and Bone Sarcoma Histopathology
Peer Review: The Frequency of Disagreement in Diagnosis and the Need for Second Pathology
Opinions: The Southeastern Cancer Study Group Experience. J Clin Oncol 1986; 4: 1658-1661.
5. Springfield DS, Enneking WF, Neff JR, Makley JT. Principles of Tumor Management. Instr Course
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Acknowledgements:
I wish to thank Dr. Joseph Benevenia, Orthopaedic Surgeon and Associate Professor at the
University Hospital of UMDNJ for his guidance and insight into this program; my friends at the New
Jersey Medical School of UMDNJ for their help; and my family for their endless guidance and
support.
Summer School Participant:
William Min, M.S.
3 Devonshire Court
Morris Township, NJ 07960
U.S.A.
e-mail: william.min@umdnj.edu