Musculoskeletal Injuries and Disorders PDF

Musculoskeletal Injuries and Prof. Ibrahim Al-Adham Disorders Dr.Dania Alhyari  Introduction Musculoskeletal pain arises from the muscles, bones, joints, and connective tissue. The development of musculoskeletal pain can be acute, such a...

Musculoskeletal Injuries and Prof. Ibrahim Al-Adham Disorders Dr.Dania Alhyari  Introduction Musculoskeletal pain arises from the muscles, bones, joints, and connective tissue. The development of musculoskeletal pain can be acute, such as sport injuries (e.g., tendonitis, sprains, and strains), or it can stem from the exacerbation of a condition (e.g., osteoarthritis). Acute pain is typically defined as pain lasting less than 4 weeks. Pain lasting at least 3 months is considered chronic pain and may arise from degenerative joint disease, osteoarthritis, or chronic tendonitis (e.g., carpal tunnel)  Pathophysiology of Musculoskeletal Injuries and Disorders The musculoskeletal system includes the muscles, tendons, ligaments, cartilage, and bones. Muscles are attached to bones by tendons, and ligaments connect bone to bone. Tendons and ligaments normally have limited ability to stretch and twist. Because of their tensile strength, tendons and ligaments rarely rupture unless subjected to intense forces, but they may become damaged when hyper- extended or overused. Synovial bursae are fluid filled sacs located between joint spaces to provide lubrication and cushioning. Cartilage functions as protective pads between bones in joints and in the vertebral column. Muscle injuries can be categorized as – Delayed-onset muscle soreness (e.g., Overexertion), – Myalgia, – Strains, – Tendonitis, – Bursitis, and Sprains  Overexertion Overexertion or repeated unaccustomed eccentric muscle contraction is associated with delayed-onset (8 hours or more) muscle soreness, which can last for days, usually peaking at 24-48 hours. This pain reflects muscle damage that was presumably initiated by force generated in the muscle fibers; the pain is thought to be induced by inflammation, acidosis, muscle spasms, and/or microlesions. Prolonged tonic contraction produced by exercise, tension, or poor posture and by body mechanics can also produce muscle pain. Overexertion is common in individuals who do not exercise regularly but then begin an exercise regimen at a level of high intensity.  Myalgia Myalgia, or muscle pain, can result from: – Systemic infections (e.g., influenza, coxsackievirus, measles, and other illnesses) – Chronic disorders (e.g., fibromyalgia and polymyalgia rheumatica) – Medications (e.g., some cholesterol lowering agents such as HMG-CoA reductase inhibitors) Abuse of alcohol may precipitate acute alcoholic myopathy. Bone and muscle pain related to a vitamin D deficiency (osteomalacia) may also occur.  Strains Strains are a result of an injury to a muscle or a tendon. A strain can be caused by an acute injury, or with prolonged overuse, a strain can become a chronic condition. The movements that cause a strain involve twisting or pulling. Tendons can become strained when their stretch capacity is exceeded (e.g., hyperextension injury of an arm or leg). The strain injury is caused by eccentric contraction of the muscle while the muscle is lengthening. A tear of the muscle or tendon can also occur.  Tendonitis Tendonitis is the inflammation of a tendon, which results from acute injury or from chronic repetitive movements of a body part. An example of an overuse injury is carpal tunnel syndrome, a condition characterized by tingling or numbness of the first digits of the hand caused by repetitive use of the hands and wrists. Tendon sheaths become inflamed and constrict the median nerve as it passes through a narrow channel between the wrist bones. Tendonitis can also commonly occur in the Achilles tendon, which connects the calf muscle to the heel.  Tendonitis Common terms that describe sports related tendonitis from overuse include tennis or golfer’s elbow, swimmer’s shoulder, and jumper’s knee. In sports related overuse injuries, contributing factors for tendonitis can include increased age, poor technique, improper conditioning, exercise of prolonged intensity or duration, and poorly designed equipment for specific activities (e.g., poor cushioning of athletic shoes). Finally, certain medications (e.g., fluoroquinolone antimicrobials) are associated with the development of tendonitis or tendon rupture and carry a boxed warning.  Bursitis Bursitis is a common cause of localized pain, tenderness, and swelling, which is worsened by any movement of the structure adjacent to the bursa, in the joint. Bursitis generally results from an acute injury to the joint or over-repetitive joint action. When pain is accompanied by the presence of a puncture site (possibly from intra-articular injection), an adjacent source of infection, or severe inflammation, an infectious cause should be suspected and ruled out before recommending self- treatment.  Sprains Sprains are the most common problem with ligaments. Sprains are graded by their characteristics, with:- ❖ Grade I sprains resulting from excessive stretching, ❖ Grade II sprains resulting from a partial tear, and ❖ Grade III sprains involving a complete tear of the tissue. Grade II and III sprains typically result in moderate- severe pain, loss of function of the affected limb, and an inability to bear weight. Tears and ruptures are more common in ligaments than in tendons. Sprains commonly occur during physical activity.  Low back pain Low back pain is the fifth most likely reason for a physician visit; Main risk factors for the development of low back pain include sedentary lifestyle - ‫ نمط حياة مستقر خالي من النشاط‬- (particularly one disrupted by bursts of activity), poor posture, improper shoes, excessive body weight, poor mattress and sleeping posture, and improper technique when lifting heavy objects. Most patients recover within a few days to a few weeks, even without treatment; if pain persists for more than 3 months, it is classified as chronic low back pain. Other causes of low back pain include congenital anomalies, osteoarthritis, vertebral fractures and compressions, spinal tuberculosis, and referred pain from diseased kidneys, pancreas, liver, or prostate.  Osteoarthritis Osteoarthritis is characterized by a gradual softening and destruction of the cartilage between bones. Cartilage and bone are destroyed in the joint spaces and regenerated, causing a rearrangement of the synovial architecture. Often referred to as “degenerative joint disease,” osteoarthritis is caused by genetic, metabolic, and environmental factors. Heavy physical activity, repetitive movement, and lifting of heavy weights may aggravate this condition, whereas light- moderate activity does not and is generally helpful  Comparison of Musculoskeletal Disorders Myalgia Tendonitis Bursitis Sprain Strain Osteoarthritis Location Muscles of Tendon Inflammation Stretching or Hyperextensio Weight the body locations of the bursae tearing of a n of a muscle bearing joints, around joint within joints; ligament or tendon knees, hips, areas common within a joint low back, locations hands include knee, shoulder, big toe  Comparison of Musculoskeletal Disorders Myalgia Tendonitis Bursitis Sprain Strain Osteoarthritis Signs Possible Warmth, Warmth, Swelling, Swelling, Non-inflammatory swelling (rare) swelling, edema, bruising bruising joints, narrowing of erythema erythema, joint space, and possible restructuring of crepitus bone and cartilage resulting in joint deformities), possible joint swelling  Comparison of Musculoskeletal Disorders Myalgia Tendonitis Bursitis Sprain Strain Osteoarthritis Symptoms Dull, constant Mildsevere Constant pain Initial severe Initial severe Dull joint pain ache (sharp pain generally that worsens pain pain with relieved pain relatively occurring after with followed by continued pain by rest; joint rare); use; loss of movement pain, upon stiffness weakness and range of or application particularly movement