MSK, Touch and Personhood

Unit 2

This unit challenges learners to explore the care of the peripheral nervous, musculoskeletal (MSK), and integumentary systems through the integration and application of biomedical sciences and osteopathic clinical skills. Development of the learner’s identity as an osteopathic physician continues with this study of structure and function and how alterations of these systems may affect the person’s identity and cause suffering. The unit utilizes the osteopathic, holistic approach of observation and touch to engage students in the art of clinical examination, diagnosis and treatment. Using case-based learning in small groups, students analyze peripheral nervous, MSK, and integumentary diseases and disorders. The cases emphasize underlying cellular and molecular pathophysiologic processes, inflammatory and infectious causes, and the intervention and management of diseases and disorders of the neuromusculoskeletal and integumentary systems while recognizing the psychosocial impact. The analysis of these systems also focuses on health promotion and disease prevention that are important to a high quality of life. In early patient simulations, learners will gather patient history and conduct physical examinations of these systems.


Observation of skin, posture and gait are a window into the patient’s state of health. The skin is the first line of defense, and visual observation is the first impression and place to begin the physical examination. Deep to the skin, the fascia, muscles and bones compose a structural framework for physical interaction with the environment. The musculoskeletal system not only permits locomotion, but also is essential for protection of vital organs, breathing, digestion, fluid circulation, blood cell production, acid-base balance, fat and mineral storage. Musculoskeletal wellness is an important factor in a patient’s quality of life.

Conditions of the skin, muscle, bone and fascia are prevalent and their impact is pervasive. They are the most common cause of severe long-term pain, physical disability, psychosocial status and they affect hundreds of millions of people around the world.1 At any one time, 30% of American adults are affected by joint pain, swelling, or limitation of movement.2 Musculoskeletal conditions are a diverse group with regard to pathophysiology but are linked anatomically and by their association with pain and impaired physical function3. Up to a third of patients in primary care have at least one skin problem.4 This unit emphasizes the psychosocial impact, cellular and molecular pathophysiologic processes, inflammatory and infectious causes, and the intervention and management of diseases of the integument and neuro-musculoskeletal system. ​



1Woolf, A. D., Erwin, J., & March, L. (2012). The need to address the burden of musculoskeletal conditions. Best Practice & Research Clinical Rheumatology, 26(2), 183-224. doi:10.1016/j.berh.2012.03.005

2Barbour KE, Helmick CG, Theis KA, Murphy LB, Hootman JM, Brady TJ, et al. Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation — United States, 2010–2012.  Morb Mortal Wkly Rep.2013;62(44):869-873. PubMed PMID: 2419666

3Selected patient and provider characteristics for ambulatory care visits to physician offices and hospital outpatient and emergency departments Centers for Disease Control and Prevention… - United states, 2008

4A. Lowell, C.W. Froelich, D.G. Faderman, R.S. Kirsner. Dermatology in primary care: Prevalence and patient disposition. J Am Acad Dermatol, 45 (2001), pp. 250–255