Musculoskeletal Pain Mnemonic – Best USMLE CS mnemonics

Musculoskeletal Pain Mnemonic:

Having trouble remembering all the important questions to ask during your patient encounter? Then try this Musculoskeletal Pain Mnemonic for USMLE Step 2 CS.

Musculoskeletal pain mnemonic - Best USMLE Step 2 CS Mnemonics - Medical Institution


Musculoskeletal pain mnemonic – Best USMLE Step 2 CS Mnemonics – Medical Institution

PHYSICAL EXAMINATION for Musculoskeletal Pain Mnemonic
NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Make sure to use proper draping (don’t forget to tie back patient’s gown). Make sure to explain each physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.

1) Shoulder Pain:

  • Head and neck exam: Checked for bruises, neck movements and signs of head trauma
  • Exam of the arms: Compared both arms in terms of strength, range of motion (shoulder, elbow, wrist), sensation, DTRs, pulses

2) Lower back pain:

  • Back exam:Inspection, palpation, range of motion
  • Extremities: Inspection, palpation of peripheral pulses, hip exam
  • Neuro exam: Motor, DTRs, Babinski sign, Gait (including toe and  heel walking), passive straight leg raising, sensory exam

3) Calf Pain:

  • Extremities: Inspection, palpation; checked for Homans’ sign
  • Joint exam:  Inspection, palpation, range of motion (knee, ankle, hip joint on both sides)
  • Neuro exam: Sensory and motor reflexes (knee, ankle)

4) Heel Pain:

  • Extremities: Palpation of medial calcaneal tuberosity, Achilles tendon, plantar fascia, retrocalcaneal bursa.  Passive range of motion and general strength of ipsilateral knee and hip.  Ankle dorsifl exion and great toe extension and passive range of motion; strength testing of ankle dorsifl exion and plantarflexion
  • Neuro: Checked sensation to light touch for dermatomes of foot and ankle; assessed Achilles tendon reflex
DIFFERENTIAL DIAGNOSIS for Musculoskeletal Pain Mnemonic

1) Shoulder Pain:

  • Shoulder dislocation
  • Rotator cuff tear
  • Clavicular fracture
  • Humeral fracture 
  • Osteoporosis
  • Elder abuse

2) Lower Back Pain:

  • Lumbar muscle strain
  • Disk herniation
  • Lumbar spinal stenosis
  • Metastatic prostate cancer
  • Tumor in the vertebral canal
  • Vertebral compression fracture
  • Multiple Myeloma
  • Malingering 
  • Ankylosing spondylitis

3) Calf Pain:

  • Deep venous thrombosis
  • Cellulitis
  • Myositis
  • Rupture of Baker’s cyst 
  • Hematoma
  • Spasm due to injury or sprain

4) Heel Pain:

  • Plantar fasciitis 
  • Calcaneal stress fracture
  • Achilles tendinitis
  • Retrocalcaneal bursitis
  • Tarsal tunnel syndrome
  • Foreign body
  • Ankle sprain
DIAGNOSTIC WORKUP for Musculoskeletal Pain Mnemonic

1) Shoulder pain:

  • XR of the shoulder and arm
  • MRI—shoulder
  • Bone density scan (DEXA)

2) Lower back pain:

  • Rectal exam
  • XR—Lower spine
  • MRI—Lower spine
  • PSA
  • CBC, calcium, BUN/Cr
  • Serum and urine protein electrophoresis

3) Calf pain:

  • Doppler U/S of the lower extremities
  • D -dimer
  • Hypercoagulability testing
  • CBC with differential
  • CPK and myoglobin level
  • CT venography
  • MRI

4) Heel pain:

  • XR—right ankle
  • Bone scan
  • MRI


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