GALS ASSESSMENT - GAIT

 The GALS assessment is a quick and simple musculoskeletal screening tool used in primary care settings to identify abnormalities and assess the general musculoskeletal health of a patient. GALS stands for Gait, Arms, Legs, and Spine. 

1. Gait

   - Observation: Assess the patient's walking pattern.

   - Normal Findings: Steady and coordinated gait without limping or abnormalities.

   - Abnormalities: Antalgic gait, steppage gait, or any observable asymmetry.

2. Arms

   - Inspection and Palpation: Examine the upper limbs for deformities, swelling, or muscle wasting.

   - Range of Motion:Check for limitations in shoulder, elbow, and wrist movements.

   - Normal Findings: Symmetrical appearance and full range of motion in the upper limbs.

   - Abnormalities : Joint deformities, muscle atrophy, or limited range of motion.

3. Legs

   - Inspection and Palpation: Examine the lower limbs for deformities, swelling, or muscle wasting.

   - Range of Motion: Check for limitations in hip, knee, and ankle movements.

   - Normal Findings: Symmetrical appearance and full range of motion in the lower limbs.

   - Abnormalities: Joint deformities, muscle atrophy, or limited range of motion.

4. Spine:

   - Inspection: Observe the spine for any curvature or deformities.

   - Range of Motion Assess forward flexion, extension, lateral flexion, and rotation of the spine.

   - Normal Findings: Straight and aligned spine with normal range of motion.

   - Abnormalities: Scoliosis, kyphosis, Lordosis or limited range of motion.

IN THIS SESSION, GAIT IS BEEN DISCUSSED IN DETAIL

GAIT

1. Normal Gait:  A regular walk for healthy individuals involves factors like step length, width, speed, arm movement, heel-to-toe motion, and smooth weight transfer. These factors work together for a balanced walking pattern. Any deviations could suggest health issues which requires clinical assessment.

2. Antalgic Gait: Altered walking due to pain; for example, a patient limping after a recent ankle sprain.

3. Trendelenburg Gait: Swaying of the trunk caused by weak hip abductor muscles; seen in conditions like hip arthritis. 

Clinical Case: A patient with hip osteoarthritis presenting with a noticeable sway to one side during walking.

4. Ataxic Gait: Unsteady walk due to poor coordination; observed in conditions affecting the cerebellum, such as cerebellar ataxia.

Clinical Case: A person with multiple sclerosis experiencing difficulty maintaining balance and coordination while walking.

5. Spastic Gait: Stiff, jerky movements due to increased muscle tone; seen in conditions like cerebral palsy. Clinical Case: A child with cerebral palsy demonstrating a stiff and exaggerated walking pattern.

6. Scissors Gait: Legs cross or hit each other during walking; common in conditions like cerebral palsy or spastic paraplegia. 

Clinical Case: An individual with spastic paraplegia exhibiting a scissoring gait.

7. Parkinsonian Gait: Shuffling steps, reduced arm swing, and a forward-leaning posture; typical in Parkinson's disease. 

Clinical Case: An elderly patient with Parkinson's disease demonstrating a shuffling walk and reduced arm movement.

8. High Stepping Gait: Lifting the foot higher than normal; seen in conditions affecting the dorsal columns of the spinal cord.

 Clinical Case: A person with spinal cord injury showing a high-stepping gait due to reduced sensory feedback.

9. Cerebellar Gait: Uncoordinated and staggering walk; associated with cerebellar disorders like multiple sclerosis. 

Clinical Case: A patient with cerebellar ataxia displaying a wide-based and unsteady gait.

10. Waddling Gait: A swaying motion resembling a duck's walk; seen in conditions causing hip muscle weakness, such as muscular dystrophy. 

Clinical Case: A child with muscular dystrophy presenting with a waddling gait.

11. Myopathic Gait: Weakness and difficulty with certain movements due to muscle disorders; observed in patients with myasthenia gravis. 

Clinical Case: A person with myasthenia gravis showing muscle weakness and a compromised gait.

12. Hemiplegic Gait: Walking pattern affected on one side due to paralysis or weakness; common after a stroke.

 Clinical Case: A stroke survivor with weakness on one side displaying a hemiplegic gait.

13. Dystonic Gait: Dystonic gait refers to an abnormal walking pattern caused by dystonia, a neurological movement disorder. It's characterized by involuntary muscle contractions, leading to twisting or repetitive movements while walking.

14. Equine Gait: Walk resembling a horse's gait; often observed in neurological conditions like Friedreich's ataxia.

 Clinical Case: A patient with Friedreich's ataxia exhibiting a high-stepping and uncoordinated equine gait.

15. Scissor-wheel Gait: Combination of scissor and circumduction movements; seen in certain neuromuscular conditions like cerebral palsy.

 Clinical Case: A child with cerebral palsy displaying a scissor-wheel gait pattern.

16. Festinating Gait: Small, rapid steps with increasing speed; common in Parkinson's disease. 

Clinical Case: A person with Parkinson's disease showing festination characterized by progressively faster and shorter steps.

17. Apraxic Gait: Difficulty initiating or coordinating movements during walking; seen in conditions affecting motor planning, such as apraxia. 

Clinical Case: A patient with apraxia struggling with initiating and coordinating steps while walking.

18. Footdrop Gait: Difficulty lifting the front part of the foot; causing a dragging or slapping gait; observed in conditions like peripheral neuropathy. 

Clinical Case: A person with peripheral neuropathy displaying a footdrop gait with difficulty in dorsiflexing the foot.

19. Steppage Gait: High-stepping walk due to weakness or paralysis of the muscles that lift the foot; seen in conditions like foot drop. 

Clinical Case: A patient with foot drop demonstrating a steppage gait characterized by exaggerated lifting of the foot.

20. Toe-Walking Gait: Walking on the toes without the heel touching the ground; common in children but may persist in conditions like cerebral palsy.

 Clinical Case: A child with cerebral palsy exhibiting a persistent toe-walking gait.

MUSCULOSKELETAL SYSTEM EXAMINATION - BASICS

 Signs of Inflammation?

The cardinal signs of inflammation are redness, swelling, heat, pain, and loss of function. These symptoms are the body's natural response to injury or infection, aiming to protect and repair the affected tissue.

In the musculoskeletal system, inflammation can occur due to various reasons, such as trauma, infection, or autoimmune disorders. For example, repetitive stress on joints, like in the case of osteoarthritis, can lead to inflammation in the joints. Additionally, injuries to muscles, ligaments, or tendons can trigger an inflammatory response in the musculoskeletal system.

Let's consider a scenario of rheumatoid arthritis, an autoimmune disorder affecting the musculoskeletal system. In this case, the immune system mistakenly attacks the joints, leading to inflammation, pain, and eventually joint damage. The patient may experience joint swelling, warmth, stiffness, and decreased range of motion.

Tendon? Tendonitis?

A tendon is a fibrous connective tissue that attaches muscle to bone, facilitating the transmission of force from muscle contraction to bone movement. Tendons play a crucial role in the musculoskeletal system, enabling joint stability and movement.

Tendonitis, on the other hand, refers to the inflammation of a tendon. This condition is often caused by overuse, repetitive motion, or strain on the tendon, leading to irritation and inflammation. It can affect any tendon in the body.

Causes of Tendonitis:

1. Overuse: Repetitive activities or excessive strain on a particular tendon can lead to inflammation.

2. Age: Tendons become less flexible with age, increasing the risk of tendonitis.

3. Injury: Direct trauma or sudden impact can damage tendons, causing inflammation.

4. Poor Technique: Incorrect body mechanics or poor technique during physical activities can contribute to tendonitis.

Examples of Tendonitis:

1. Tennis Elbow (Lateral Epicondylitis): Inflammation of the tendons on the outer side of the elbow, often caused by repetitive wrist and arm movements.

2. Achilles Tendonitis: Inflammation of the Achilles tendon, typically resulting from overuse, improper footwear, or sudden increases in physical activity.

Proper rest, ice, compression, and elevation (R.I.C.E.), along with anti-inflammatory medications, are common treatments for tendonitis. 

Ligament? Sprain? 

A ligament is a tough, fibrous band of connective tissue that connects bone to bone, providing stability to joints. Ligaments play a crucial role in maintaining the structural integrity of joints and preventing excessive movement.

A ligament injury, commonly known as a sprain, occurs when there is damage to a ligament. This can range from mild stretching to a complete tear of the ligament fibers. Ligament injuries are often categorized into three grades based on the severity of the damage.

Causes of Ligament Injuries:

1. Trauma: Sudden impact or force on a joint, such as a fall or collision, can cause ligament injuries.

2. Overstretching:Excessive joint movement, especially beyond its normal range, can lead to ligament sprains.

3. Twisting: Rapid or forceful twisting of a joint can result in ligament damage.

Examples of Ligament Injuries:

1. Anterior Cruciate Ligament (ACL) Injury:Commonly occurring in the knee, ACL injuries often result from sudden stops, changes in direction, or impact that cause the ligament to tear.

2. Ankle Sprain: Ligament injuries in the ankle are frequent, often caused by twisting the foot, uneven surfaces, or awkward landings.

Treatment for ligament injuries varies based on severity but may include rest, ice, compression, and elevation (R.I.C.E.), as well as physical therapy and, in some cases, surgical intervention for more severe tears. 

Bursae? Bursitis?

Bursae are small, fluid-filled sacs located throughout the body near joints. They act as cushions between bones, tendons, and muscles, reducing friction and allowing smooth movement of these structures.

Bursitis is the inflammation of a bursa, leading to pain and swelling in the affected area. This condition can occur when the bursa becomes irritated or damaged, often due to repetitive movements or excessive pressure on the joint.

Causes of Bursitis:

1. Repetitive Motion: Continuous, repetitive movements or activities that put strain on a particular joint can lead to bursitis.

2. Joint Overuse: Excessive use of a joint, especially in occupations or activities that involve repetitive motions, may contribute to bursitis.

3. Trauma: Direct impact or trauma to a joint can cause inflammation of the associated bursa.

Examples of Bursitis:

1. Trochanteric Bursitis: Inflammation of the bursa located on the outside of the hip, often caused by activities involving repetitive hip movements or direct trauma.

2. Subacromial Bursitis: Inflammation of the bursa beneath the shoulder blade, commonly associated with shoulder overuse or repetitive overhead arm movements.

Treatment for bursitis usually involves rest, ice, anti-inflammatory medications, and, in some cases, physical therapy. Avoiding activities that exacerbate the condition is also recommended. Severe cases may require aspiration of the bursa fluid or, rarely, surgical intervention.

Joint Crepitus?  

Joint crepitus refers to the audible or palpable sensation of grinding, popping, or crackling within a joint during movement. It can occur for various reasons related to changes within the joint structures.

Causes of Joint Crepitus:

1. Osteoarthritis: Degeneration of joint cartilage can lead to bones rubbing against each other, causing crepitus.

2. Rheumatoid Arthritis: Inflammatory arthritis can result in joint damage and crepitus.

3. Meniscus Tears: Tears in the meniscus, particularly in the knee, can cause popping or crunching sounds.

4. Tendinitis: Inflammation of tendons around a joint may contribute to crepitus.

5. Normal Aging: Wear and tear on joints over time can lead to crepitus, especially in weight-bearing joints.

Instrument used for checking Range of Motion (ROM)?

The instrument commonly used for measuring Range of Motion (ROM) in joints is a goniometer. It helps assess the extent of movement at a specific joint, aiding in physical examinations and rehabilitation processes.

MUSCULO SKELETAL SYSTEM EXAMINATION - BASICS

SIGNS AND SYMPTOMS OF MUSCULO SKELETAL SYSTEM DISORDERS INCLUDE: 

1. Pain: Persistent or acute pain in muscles, joints, or bones.

2. Stiffness: Difficulty in movement or flexibility.

3. Swelling: Inflammation or swelling around joints.

4. Weakness: Reduced strength in muscles.

5. Limited Range of Motion: Difficulty moving a joint through its full range.

6. Deformities: Changes in the normal shape or alignment of bones or joints.

Signs and symptoms of musculoskeletal system disorders in detail

PAIN

Pain is a complex and subjective experience. Its characteristics include:

1. Intensity: The degree of pain, ranging from mild to severe.

2. Duration: How long the pain persists—acute (short-term) or chronic (long-term).

3. Quality: Descriptive terms such as sharp, throbbing, burning, or aching.

4. Location: Specific area or areas where the pain is felt.

5. Timing: Continuous, intermittent, or triggered by certain activities.

6. Radiation: Whether the pain spreads or is localized to a specific area.

7. Aggravating/Alleviating Factors: Activities or conditions that worsen or relieve the pain.

8. Emotional Component:The impact of pain on emotional well-being.

9. Pain Threshold: The level of stimulus required to perceive pain varies among individuals.

10. Tolerance: An individual's ability to endure pain without it becoming overwhelming.

In other words:

 Feature of pain in the SOCRATES  mnemonics

      

1. Site:

   Refers to the specific location where pain is experienced.

    Application to Disorders

      - Osteoarthritis:Weight-bearing joints (knees, hips).

      - Rheumatoid Arthritis: Symmetrical involvement, smaller joints.

      - Fibromyalgia: Widespread, muscles, tendons, ligaments.

      - Gout: Often affects the big toe initially.

2. Onset:

   Describes how the pain began, whether suddenly or gradually.

Application to Disorders:

      - Ankylosing Spondylitis: Gradual onset, morning stiffness.

      - Carpal Tunnel Syndrome: Gradual onset, often at night.

      - Dupuytren's Contracture: Gradual onset, often in middle age.

      - Rotator Cuff Tear: Gradual onset, related to repetitive movements.

3. Character:

   Describes the nature or quality of the pain.

   Application to Disorders:

      - Gout: Intense, throbbing pain.

      - Plantar Fasciitis: Sharp, stabbing pain, especially in the morning.

      - Tendinitis: Localized pain, tenderness.

      - TMJ Dysfunction: Jaw pain, clicking or popping sounds.

4. Radiation:

   -  Indicates whether the pain spreads from the initial site.

   Application to Disorders:

      - Sciatica: Pain radiates down the leg.

      - Cubital Tunnel Syndrome: Radiation along the ulnar nerve.

      - Herniated Disc: Sharp, shooting pain along the sciatic nerve.

5. Associated Complaints:

   - Describes additional symptoms accompanying the pain.

   - Application to Disorders:

      - Fibromyalgia: Fatigue, sleep disturbances.

      - Systemic Lupus Erythematosus (Lupus): Skin rashes, fatigue.

      - Bunions:Changes in foot structure.

6. Timings:

    Refers to the timing pattern of pain.

   - Application to Disorders:

      - Temporomandibular Joint Dysfunction (TMJ): Chronic, worsens with jaw movement.

      - Bursitis: Variable timing, depending on the cause.

      - Dupuytren's Contracture: Chronic, progressively impacting hand function.

7. Exacerbating/Relieving Factors:

   Identifies factors that worsen or alleviate the pain.

   Application to Disorders:

      - Plantar Fasciitis : Aggravated by prolonged standing, relieved by rest and stretching.

      - Rotator Cuff Tear: Aggravated by overhead activities, relieved by rest and exercises.

      - Carpal Tunnel Syndrome: Aggravated by repetitive hand use, relieved by rest or splinting.

      - Tendinitis: Aggravated by repetitive movements, relieved by rest and ice.

8. Severity:

   Measures the intensity or degree of pain.

   Application to Disorders:

      - Herniated Disc: Severity can range from mild to severe, impacting daily activities.

      - Gout: Severe during acute attacks.

      - Systemic Lupus Erythematosus (Lupus): Variable, affecting different organs.

      - Bunions: Mild to moderate, impacting daily activities.

 SOCRATES framework to describe the pain characteristics in different musculoskeletal disorders:

1. Osteoarthritis:

   - Site:Weight-bearing joints (e.g., knees, hips).

   - Onset: Gradual onset, often with age.

   - Character: Initially intermittent, worsens with activity, becomes constant in advanced stages.

   - Radiation: Typically localized to the affected joint.

   - Association: Stiffness, reduced range of motion.

   - Timings: May occur during or after weight-bearing activities.

   - Exacerbating/Relieving factors: Aggravated by prolonged activity, relieved by rest.

   - Severity: Mild to severe, progressing over time.

2. Rheumatoid Arthritis:

   - Site: Symmetrical involvement, smaller joints (e.g., fingers, wrists).

   - Onset: Insidious onset, morning stiffness.

   - Character: Persistent joint pain, swelling, and warmth.

   -  Radiation:May affect multiple joints.

   - Association: Systemic symptoms, fatigue.

   - Timings: More pronounced in the morning.

   - Exacerbating/Relieving factors: Morning stiffness improved with movement, exacerbated by rest.

   - Severity: Variable, can lead to joint deformities.

3. Fibromyalgia:

   - Site: Widespread, muscles, tendons, ligaments.

   - Onset: Chronic, variable intensity.

   - Character: Diffuse, chronic, often accompanied by tenderness.

   - Radiation: Throughout the body.

   - Association: Fatigue, sleep disturbances.

   - Timings: Chronic and fluctuating.

   - Exacerbating/Relieving factors: Aggravated by stress, improved with gentle exercise.

   - Severity: Variable, impacting quality of life.

4. Gout:

   - Site: Often affects the big toe initially.

   - Onset: Sudden onset, acute attacks.

   - Character: Intense, throbbing pain, often at night.

   - Radiation: Localized to the affected joint.

   - Association: Swelling, redness.

   - Timings: Acute attacks with symptom-free intervals.

   - Exacerbating/Relieving factors: Aggravated by alcohol, rich foods; relieved by anti-inflammatory medications.

   - Severity: Severe during acute attacks.

5. Ankylosing Spondylitis:

   - Site: Primarily spine and sacroiliac joints.

   - Onset: Gradual onset, morning stiffness.

   - Character: Chronic back pain, stiffness.

   - Radiation: May involve buttocks or hips.

   - Association: Reduced spinal mobility.

   - Timings: Morning stiffness lasting more than 30 minutes.

   - Exacerbating/Relieving factors: Improved with exercise, worsened with inactivity.

   - Severity: Can lead to spinal fusion.

6. Carpal Tunnel Syndrome:

   - Site: Wrist and hand.

   - Onset: Gradual onset, often at night.

   - Character:Numbness, tingling, and pain in fingers.

   - Radiation:Along the median nerve.

   - Association:Hand weakness.

   - Timings: Often more pronounced at night.

   - Exacerbating/Relieving factors: Aggravated by repetitive hand use, relieved by rest or splinting.

   - Severity: Can affect hand function.

7. Tendinitis:

   - Site: Affected tendon (e.g., shoulder, elbow, Achilles).

   - Onset: Gradual onset, often due to overuse.

   - Character: Localized pain, tenderness.

   - Radiation: Along the course of the affected tendon.

   - Association: Swelling and decreased range of motion.

   - Timings:Variable, may improve with rest.

   - Exacerbating/Relieving factors: Aggravated by repetitive movements, relieved by rest and ice.

   - Severity: Mild to moderate, depending on the extent of inflammation.

8. Herniated Disc (Sciatica):

   - Site: Lower back, radiating down the leg.

   - Onset: Sudden onset or gradual.

   - Character: Sharp, shooting pain along the sciatic nerve.

   - Radiation: Down the leg, following the nerve pathway.

   - Association: Numbness, tingling.

   - Timings: Variable, may improve with conservative measures.

   - Exacerbating/Relieving factors: Aggravated by certain positions, relieved by rest, and physical therapy.

   - Severity: Can range from mild to severe, impacting daily activities.

9. Bursitis:

   - Site: Bursae near joints.

   - Onset:Can be acute or chronic.

   - Character: Localized pain, swelling.

   - Radiation: Often limited to the affected joint.

   - Association: Tenderness over the bursa.

   - Timings:Variable, depending on the cause.

   - Exacerbating/Relieving factors: Aggravated by pressure or movement, relieved by rest and anti-inflammatory measures.

   - Severity: Mild to moderate, depending on the extent of inflammation.

10. Muscle Strains:

    - Site: Specific muscles affected by overuse or injury.

    - Onset: Acute, often related to physical activity.

    - Character: Localized pain, soreness.

    - Radiation: Along the muscle fibers.

    - Association:Swelling, tenderness.

    - Timings: Variable, may improve with rest.

    - Exacerbating/Relieving factors: Aggravated by movement, relieved by rest, ice, and gentle stretching.

    - Severity:Mild to moderate, depending on the extent of muscle damage.

11. Systemic Lupus Erythematosus (Lupus):

    - Site:Various joints and tissues.

    - Onset: Variable, often insidious.

    - Character: Joint pain, swelling, and inflammation.

    - Radiation: Multiple joints may be involved.

    - Association:Skin rashes, fatigue.

    - Timings: Can be chronic with flares.

    - Exacerbating/Relieving factors: Flares triggered by stress, sunlight; improved with

STIFFNESS

Stiffness in the musculoskeletal system disorders refers to a sensation of reduced flexibility or difficulty moving a joint or muscle. Characteristics of stiffness in these disorders include:

1. Limited Range of Motion: Stiffness often results in a decreased ability to move a joint through its normal range.

2. Discomfort or Resistance: There may be a feeling of resistance or discomfort when attempting to move the affected joint or muscle.

3. Morning Stiffness: Many musculoskeletal conditions, such as arthritis, exhibit stiffness that is more pronounced in the morning and improves with movement throughout the day.

4. Gradual Onset or Sudden: Stiffness can develop gradually over time in chronic conditions or suddenly following an injury.

5. Associated Pain: Stiffness is frequently accompanied by pain, either at rest or during movement.

6. Impact on Function: Stiffness can affect daily activities and functionality, making it challenging to perform tasks that involve joint or muscle movement.

7. Response to Activity or Rest: Stiffness may improve or worsen with specific activities or rest, providing diagnostic insights.

8. Morning Rigidity: Some conditions, such as rheumatoid arthritis, may cause prolonged morning stiffness lasting more than an hour.

SWELLING

Swelling in musculoskeletal system disorders is characterized by various features:

1. Location: Swelling may be localized to a specific joint, muscle, or soft tissue area, providing clues to the underlying issue.

2. Appearance: Swollen areas can exhibit redness, warmth, and changes in skin texture.

3. Pain: Swelling is often accompanied by pain, which can range from mild discomfort to severe and may affect mobility.

4. Range of Motion Limitation: Swelling can restrict the normal movement of joints, leading to stiffness and reduced flexibility.

5. Gradual Onset or Sudden: Swelling may develop slowly over time in chronic conditions or suddenly in response to acute injuries.

6. Palpation:  May be assessed through touch, feeling for areas of increased tissue thickness or fluid accumulation.

7. Systemic Symptoms: In some cases, musculoskeletal disorders causing swelling may be associated with systemic symptoms like fever or fatigue.

8. Response to Treatment: Monitoring how swelling responds to rest, ice, compression, and elevation (R.I.C.E.) or other treatments helps in diagnosis and management.

WEAKNESS

Weakness in musculoskeletal system disorders refers to a reduction in the strength of muscles, often resulting in difficulties performing everyday activities. Characteristics of weakness in these disorders include:

1. Reduced Muscle Strength: Obvious loss of power in specific muscle groups, affecting grip, movement, or weight-bearing ability.

2. Fatigue: Weakness may be accompanied by a sense of fatigue or tiredness, even with minimal exertion.

3. Difficulty with Tasks: Challenges in performing tasks that require muscle strength, such as lifting objects, walking, or climbing stairs.

4. Atrophy: Visible or palpable wasting of muscle tissue due to disuse or damage.

5. Unsteady Gait: Weakness in leg muscles can lead to an unsteady or shuffling gait.

6. Difficulty Rising from a Seated Position: Weakness in the lower limbs may make it difficult to stand up from a sitting position.

7. Joint Instability: Weakness around joints can contribute to instability and an increased risk of falls.

8. Asymmetry: Weakness may affect one side of the body more than the other, causing asymmetry in strength.

9. Progressive Weakness: Some musculoskeletal disorders, such as muscular dystrophy, may involve progressive weakening over time.

10. Systemic Weakness: Weakness can be a symptom of systemic conditions affecting multiple muscle groups, such as certain autoimmune disorders.

DEFORMITIES

Deformities in musculoskeletal system disorders involve abnormal changes in the shape or alignment of bones, joints, or soft tissues.

1. Kyphosis: Excessive outward curvature of the spine, leading to a hunched or rounded back.

2. Lordosis: Inward curvature of the spine, often exaggerated in the lower back.

3. Scoliosis: Lateral curvature of the spine, resulting in a twisting or asymmetrical shape.

4. Genu Varum (Bowlegs): Outward curvature of the legs, causing knees to be apart.

5. Genu Valgum (Knock-knees): Inward curvature of the legs, causing knees to touch.

6. Clubfoot: Twisting or pointing inward of the foot.

7. Dupuytren's Contracture: Abnormal shortening of the hand's connective tissue, causing fingers to bend.

8. Joint Dislocation: Displacement of a joint from its normal position.

9. Bunions: Bony bump at the base of the big toe, causing deviation towards smaller toes.

10. Achondroplasia: Genetic disorder causing dwarfism due to abnormal bone growth.

11. Hip Dysplasia: Abnormal development of the hip joint, leading to instability.

12. Osteoarthritis Deformans: Joint deformities associated with osteoarthritis.

13. Rheumatoid Arthritis Nodules: Small, firm bumps under the skin around joints.

14. Ankylosing Spondylitis:  Inflammatory arthritis affecting the spine, causing stiffness and fusion.

15. Cleft Hand or Foot: Splitting of the hand or foot due to incomplete development.

16. Camptodactyly: Fixed flexion deformity of the fingers at the proximal interphalangeal joint.

17. Pectus Excavatum:Sunken or caved-in appearance of the chest.

18. Pectus Carinatum: Forward protrusion of the chest.

19. Torticollis: Involuntary contraction of neck muscles, causing the head to tilt.

20. Talipes Equinovarus (Clubfoot): Abnormal positioning of the foot, turning it inward and downward.

Diagnostic tests for musculoskeletal disorders may include:

1. X-rays: Imaging to assess bone structure and detect abnormalities.

2. MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, joints, and bones.

3. CT Scan (Computed Tomography): Cross-sectional imaging for detailed views of bones.

4. Blood Tests: To check for inflammation, autoimmune disorders, or specific markers related to musculoskeletal conditions.

5. Bone Density Tests (DEXA Scan): Measures bone density to diagnose conditions like osteoporosis.

6. Ultrasound: Examines soft tissues and joint structures using sound waves.

7. Arthroscopy: Direct visualization of the inside of a joint using a small camera.