The first two parts of my orthopedic evaluation – the specific verbal history and taking orthopedic baselines – give me a significant amount of information diagnostically before arriving at part three (testing). The gathered intel also informs which tests need to be performed and in what order. An important distinction for patients with extremity complaints is determining if the root cause is in the spine or in the extremity. Rastogi and colleagues examined this idea in their study, which identified 5 factors from the evaluation that can help clinicians find the true location of the problem. My order for patient care is: Location, Diagnosis, Direction, Force. The first priority is isolating the location of the problem. I find that many patients have experienced unsuccessful treatment because they weren’t addressing the correct location. The musculoskeletal system is a system, and symptoms can be distant from the source, just like a heart attack can create arm or jaw pain.
Study: “Exploring indicators of extremity pain of spinal source as identified by Mechanical Diagnosis and Therapy (MDT): a secondary analysis of a prospective cohort study,” Rastogi et al, 2022, JOSPT