Musculoskeletal disorders: distinguish tissue, mechanism and function
The musculoskeletal system supports the body and allows movement. Its disorders can involve bone, joints, muscles and the tissues connecting them. Learning which structure is involved is a more useful first step than treating every painful movement as the same problem.
Different tissues contribute to the same movement
Structures of the body working together allow movement. bones provide support and leverage. Muscles create forces that allow movement. Tendons attach muscles to bones. Ligaments connect bones within joints. Cartilage provides low-friction surfaces for joints. Since these structures work together, however, an injury to one is fundamentally different from an injury to another. A patient's report of pain near a joint does not specify which tissue is injured.
Identify a common activity, e.g., lifting a cup and describe all the structures involved in completing that activity. Next, assume one of those components has been injured and document how your previous actions would change based upon the injured component. This exercise illustrates why identifying the source of a patient's complaint (symptom) and identifying the specific tissue injured are two distinct forms of information. Additionally, this exercise assists students in associating an anatomically named component with a practical activity rather than simply memorizing the anatomical name in isolation.
An injury and an inflammatory condition are different explanations
Musculoskeletal disorders may result from an acute injury, repetitive use of a joints or related tissues, or be a component of an inflammatory disease process or another systemic disease process. However, the nature of changes over time matters. Sudden events generally suggest one type of question while gradual changes indicate another type of question. However, the timing alone does not determine the cause. Multiple tissues and mechanisms may contribute to the development of the patient's symptoms.
As an example, document the patient's onset date, the activity that resulted in their complaint and what happened to them subsequent to developing their complaint. Document the history of how their complaint developed and the changes that occurred subsequently to developing their complaint. Do not conflate the history of how their complaint developed (the sequence of events) with a possible explanation for their complaint (cause). If a patient develops complaints related to activity, it is not automatically assumed that they have caused damage due to "overuse." The health care provider requires additional clinical data including physical examination findings and results of applicable investigations prior to formulating either a diagnostic or management plan for the patient.
Function adds information that a pain score cannot supply alone
Assessments may evaluate movement, strength, sensation, functional status and the individual's objectives in addition to pain scores and other symptoms. Depending on the question, selected imaging studies or laboratory studies may be helpful. An imaging study describes anatomy; it does not provide direct evidence regarding whether a person is capable of performing all aspects of their occupation, sleeping well or managing daily household chores.
Compare a radiographic abnormality with a functional limitation statement such as being unable to use stairs. Both provide unique types of information; however, they are not equivalent. For purposes of review, outline what each type of measure demonstrates and what continues to be unknown. Avoid treating a single radiographic study result as sufficient information about the entire individual and avoid making assumptions about similar radiographs resulting in the need for identical care strategies.
Support should match the identified problem and the person
Care may include education, rehabilitation, medicines, practical changes or procedures when indicated. The combination depends on the condition. Rehabilitation plans for injuries to some structures may be inappropriate for others. Personal recommendations should follow assessment, particularly if symptoms are severe, changing or significantly affecting daily function.
When designing a teaching program connect each suggested intervention with its rationale. Does this intervention address symptoms, restore impaired function, protect healing tissue or treat an underlying disease process? Describe how progress will be monitored. While these rationales can overlap, stating them individually clarifies the logic behind recommending an intervention and suggests that there is no single treatment strategy that applies universally to musculoskeletal symptoms.
Check your understanding
A short quiz, with an explanation after each answer.
What connects muscle to bone?
Return to the section you found hardest and explain its example without looking at the page. Check the explanation, then repeat the quiz later. Being able to describe the reasoning is more useful than remembering the position of a correct answer.