Musculoskeletal Disorders: What You Need to Know

A musculoskeletal disorder can affect many structures: bones, muscles, ligaments, tendons, nerves, or cartilage. With a timely diagnosis, through a combination of a physical exam, laboratory tests, and imaging studies, there can be a favorable outcome.

What is a musculoskeletal disorder?

Musculoskeletal disorders encompass many conditions but are basically related to any disturbance of muscles or skeletal bones. Do you remember studying the human skeleton in school? If so, just realize that anything attached to those skeletal bones is considered musculoskeletal.

Consider these attachments:

• Muscles
• Ligaments, which connect bone to other bones.
• Tendons, which are the thin ends of muscles that attach to bone.
• Nerves, which carry impulses from the brain, and spinal cord to muscles and tendons.
• Cartilage, which is the firm, flexible fibrous tissue that serves many purposes in the body.

What symptoms do I get when I have a musculoskeletal disorder?

Symptoms can vary when you have a musculoskeletal disorder, since any of the above areas can be affected.

Pain is usually the most common symptom, and usually occurs at the affected area. When the pain is felt away from the injured area, it is called ‘referred pain.’ There can be pain before activity (after a period of inactivity), during activity, and post-activity. Most musculoskeletal disorders cause pain in a specific area when a particular action is performed. In more severe injuries, the pain progresses to a burning sensation.

Other symptoms can include decreased range of motion (stiffness), muscle twitching, cramps, or dull aches.

How long does musculoskeletal pain last?

Musculoskeletal pain is categorized into acute, lasting less than 24 hours, and chronic, lasting 24 hours or more. Chronic pain can last anywhere from a few days to several years, or even a lifetime, depending on the condition.

Are musculoskeletal disorders commonly caused in the workplace?

Musculoskeletal disorders are prevalent in the workplace, due to the physical stresses placed on our bodies. These injuries come with high costs to employers, such as lost productivity and hours, short and long-term disability, and worker’s compensation treatment costs.

What activities can be affected by musculoskeletal injuries?

In addition to lost work hours, there can be an inability to perform leisure and recreational activities, leading to psychological consequences such as anxiety and depression.

What are the causes of musculoskeletal disorders?

There are many causes of musculoskeletal pain. Usually, there is an intricate balance within our musculoskeletal anatomy that keeps our normal structure and function.

Trauma, to any body part, is a common cause of musculoskeletal pain. The trauma can be from an auto accident; work-related injury (occupational illness); sports injury; fall, or anything else that interferes with the normal balance of the muscles, bones, joints, tendons, or ligaments.

Overuse injuries, also known as cumulative trauma, occur when a repetitive action causes the damage. These are 'wear and tear’ injuries that result from the overuse of the muscles, tendons, ligaments, joints, or nerves. Cumulative trauma is frequent in a person who has an occupation that involves a repeated pattern of muscular or tendon use.

How does a physician diagnose a musculoskeletal disorder?

Well, a diagnosis comes after a combination of a physical exam, laboratory tests, and imaging studies.

1. The physical exam should focus on areas of tenderness, swelling, spasm, or limited range of motion.
2. Laboratory tests can assist with diagnosing numerous conditions. In addition, these tests can be essential in ruling out some of the more serious conditions that cause musculoskeletal pain.
   1. An erythrocyte sedimentation rate (ESR) test is used to screen for an inflammatory condition.
   2. An antinuclear antibody (ANA) test is used to check for rheumatoid arthritis, Sjogren’s syndrome (a condition that causes dry eyes and mouth), and scleroderma (a connective tissue disorder).
   3. A blood calcium level should be checked: low calcium levels can result in muscle cramps.
   4. The rheumatoid factor (RF) should be checked since it is positive in approximately 80% of patients with rheumatoid arthritis.
3. Imaging studies
   1. Plain X-rays only show bones, but not soft tissues, such as muscles, tendons, cartilage, or ligaments. The plain X-rays are needed to evaluate the underlying bones for serious conditions such as a fracture (break), cancer, bone spurs (prominent bony areas at the ends of the bones), and osteoporosis (thinning of the bones that can cause them to break easier than expected). Cancer from a different organ that has spread to the bone, called metastatic, can appear as ‘punched out’ lesions on x-rays. The punched-out lesions look like raindrops hitting a surface and splashing.
   2. A computed tomography (CT or CAT) scan produces computerized images from different angles, allowing comprehensive three-dimensional viewing. However, even though the CT scan provides viewing of the soft tissues and the bones, it does not yield as much soft tissue details as an MRI (discussed below).
   3. Magnetic Resonance Imaging (MRI) combines magnetic and radio waves to produce computerized three-dimensional images. It is considered the ‘gold standard’ for evaluations of soft tissues and bone.

What medicines can be used to treat musculoskeletal disorders?

Medications of various types can be used to treat musculoskeletal disorders. For pain, there are over the counter (OTC) medicines like acetaminophen (Tylenol), but these must be used cautiously since excessive use can lead to liver disease.

For pain, nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin (Bayer, Ecotrin, Anacin), ibuprofen (Advil, Motrin), or naproxen (Aleve), can also be used, along with a higher dose for anti-inflammatory purposes.

Many prescription NSAIDs are currently being prescribed, including Celebrex, Voltaren (diclofenac), Ansaid, Meloxicam, and many others. Again, caution must be used with all NSAIDs, since there is a risk of gastrointestinal (GI) irritation, which can cause stomach ulcers and bleeding.

Sometimes certain antidepressants can help with muscular or nerve pain, especially in a condition such as fibromyalgia, where there are several areas of muscular soreness.

What else can I do to treat my musculoskeletal disorder?

• Exercise is usually the mainstay treatment for most musculoskeletal diseases after the acute phase of 24 hours. Ideally, one should combine cardiovascular exercise (aerobic exercise) with stretching and weight training (anaerobic exercise). Walking, biking, hiking, and elliptical machines are excellent cardiovascular activities. For those who cannot tolerate the activities mentioned above, water exercises, can prove beneficial, such as lap swimming or water aerobics.
• Physical therapy (PT), and occupational therapy (OT,) can help give direction for specific exercises, treatment, and postural recommendations — especially if there is poor posture, or poor body mechanics (functioning)
• Chiropractic can help when there is a misalignment: Abnormal positioning caused by shortening or lengthening of the muscles along the spine or other areas. A chiropractor can fix this misalignment using an instrument, or their hands.
• Acupuncture has been claimed to help many people.
• Hot and cold therapy can also be effective. The old-fashioned idea was to use ice for the acute injury (first 24 hours), followed by heat; However, every person is different. Some respond better to ice, and some respond better to heat.
• Steroid injections can help with inflammation and pain, depending on the case. The injection can be given intramuscular, usually in the buttocks, or directly into an inflamed joint.
• Lifestyle changes can also help with musculoskeletal issues. Suggestions: See your doctor regularly, eat a healthy diet, avoid tobacco and alcohol, and get enough sleep.