The musculoskeletal system is a type of organ system that
allows for movement and stability of the body and consists of bones, muscles,
joints, tendons, cartilage, ligaments, bursae (fluid-filled sacs), and other
connective tissue. Complications arising when individual parts of this bodily
system are injured can range from minor discomfort to serious medical
conditions. Symptoms of musculoskeletal disorders (MSDs) can be acute or
chronic and may include inflammation, swelling, pain, fatigue, weakness, joint
noises and stiffness, limited range of motion, and lack of coordination.
The skeletal system serves many important functions,
including providing structure, shape, form, support, and protection for the
body. The skeletal system also allows for bodily movement, produces blood for
the body, and stores minerals. The skeletal system consists of 206 bones that
form a rigid framework as well as protect soft tissues and vital organs of the
body. For example, the brain is protected by the skull which surrounds it and
the heart and lungs are enclosed in the sternum and rib cage.
Bodily movement is made possible by the interaction of the
muscular and skeletal systems. For this reason, they are often grouped together
as the musculoskeletal system. Muscles are connected to bones by tendons. Bones
are connected to each other by ligaments. Where bones meet one another is
called a joint. Muscles that cause movement of a joint are connected to two
different bones. The muscles contract and relax to cause movement. An example
would be the contraction of the biceps and a relaxation of the triceps. This
produces a bend at the elbow. The contraction of the triceps and relaxation of
the biceps produces the effect of straightening the arm.
Muscles are very specialized tissues that have the ability
to contract and to conduct electrical impulses. Muscles are classified
functionally as either voluntary or involuntary and structurally as either
striated or smooth. From this organization, there are three types of muscles:
smooth (involuntary) muscles, striated voluntary (skeletal) muscles, and
striated involuntary (cardiac) muscles.
Red blood cells are produced by the red marrow located in
certain bones, including flat bones such as the hip bone, skull, and
breastbone. An average of 2.6 million red blood cells is produced each second
by the bone marrow to replace those damaged and destroyed by the liver.
Bones also serve as a storage area for minerals such as
calcium and phosphorus. When an excess of these minerals is present in the
blood, a buildup of the mineral will occur within the bones. When the supply of
these minerals within the blood is low, it will be withdrawn from the bones to
replenish the supply.
Arthritis: Arthritis is a disorder that involves joint
inflammation or swelling. More than 100 different diseases fall under the
general category of arthritis. Arthritis conditions affect the joints, the
tissues surrounding the affected joints, and other connective tissues. Common
forms of arthritis include rheumatoid arthritis, osteoarthritis, and
Muscular dystrophy: Muscular dystrophy (MD) is a group of
rare inherited autoimmune muscle diseases in which muscle fibers are unusually
susceptible to damage. Muscles, including primarily voluntary muscles, become
progressively weaker due to muscle damage. In some types of muscular dystrophy,
heart muscles, other involuntary muscles, and other organs are affected.
The most common types of muscular dystrophy have been found
to be due to a genetic deficiency of the muscle protein dystrophin. A cure for
muscular dystrophy has not been found, but medications and therapy can slow the
course of the disease.
Fibromyalgia: Fibromyalgia, also known as fibromyositis or
fibrositis, is a chronic (long-term) condition characterized by widespread,
long-term pain in the muscles, ligaments, and tendons, as well as fatigue and
multiple tender points (places on the body where slight pressure causes pain).
In addition to muscular pain and fatigue, fibromyalgia can also cause sleep
problems, depression, and an inability to think clearly.
Although fibromyalgia affects about four million Americans,
the vast majority of them are women in their mid-30s to late-50s. An estimate
of the prevalence of fibromyalgia is as high as 3-5% of the population in the
United States, or approximately six million people. Fibromyalgia symptoms may
never completely resolve, and their intensity can vary. Although the symptoms
of fibromyalgia may be hard to live with, the condition is not considered
progressive or life-threatening.
Joint stiffness: Joint stiffness is the feeling that motion
of a joint is limited or difficult. Some people with joint stiffness are
capable of moving the joint through its full range of motion, but some
individuals cannot move the joint due to the pain they are experiencing. Joint
stiffness is common with arthritis and usually occurs immediately when rising
after lying or sitting still.
Joint noises: Joint noises, such as creaks and clicks, are
common and harmless in many individuals, but they can also occur with specific
problems of the joints. For example, the base of the knee cap may creak when it
is damaged by osteoarthritis.
Temporomandibular joint disorder: Temporomandibular joint
disorder (TMJD, TMJ, or TMD), or TMJ syndrome, is an umbrella term covering
acute or chronic inflammation of the temporomandibular joint, which connects
the lower jaw to the skull. TMJ can result in significant pain and impairment.
TMJ may require surgical repair.
CAUSES AND RISK
Individuals who are more susceptible to musculoskeletal
problems tend to maintain fixed positions (such as sitting in a chair or
standing), perform repetitive movements of the limbs (such as athletes or
factory workers), overload particular muscle groups, apply pressure on body
parts, and use forceful movements (such as in sports).
Musculoskeletal problems and pain can be caused by damage or
injury to bones, joints, muscles, tendons, ligaments, bursae, or nerves. If no
injury has occurred or if pain persists for more than a few days, then another
cause is often responsible.
Bone pain is usually deep, penetrating, dull, or sharp. It
commonly results from injury. Other less common causes of bone pain include
bone infection (osteomyelitis), vitamin A toxicity, and tumors.
Muscle pain is often less intense than that of bone pain but
can be very unpleasant. For example, a muscle spasm or cramp (a sustained
painful muscle contraction) in the calf is an intense pain that is commonly
called a charley horse. Pain can occur when a muscle is affected by an injury,
an autoimmune reaction (for example, polymyositis or dermatomyositis), loss of
blood flow to the muscle, dehydration and resulting electrolyte imbalances,
infection, or invasion by a tumor.
Tendon and ligament pain is also often less intense than
bone pain. This type of pain is often worse when the affected tendon or
ligament is stretched or moved. Common causes of tendon pain include
tendonitis, tenosynovitis, lateral and medial epicondylitis, and tendon injuries.
Common causes of ligament pain include injuries (sprains).
The exact causes of osteoarthritis and rheumatoid arthritis
remain unknown. Most researchers believe that several factors, including
obesity, age, joint injury or stress, genetics, and muscle weakness, may
contribute to the development of osteoarthritis. Some researchers believe that
cartilage damage may occur when too many enzymes that allow for the natural
breakdown and regeneration of cartilage are released.
Rheumatoid arthritis is considered an autoimmune disorder
because the immune system does not function properly and attacks the body's own
cells. Some researchers believe that this autoimmune process is triggered by an
infection with a virus or bacterium. Heredity may also play a role in the
development of rheumatoid arthritis.
Periarthritis typically occurs after a joint becomes
injured, which causes scarring, thickening, and shrinkage of the joint. It may
also occur after exposure to cold temperatures. Periarthritis typically affects
the shoulder. Individuals who have other types of long-term arthritis that
affect the shoulders have an increased risk of developing periarthritis of the
Gender: Although fibromyalgia may develop in men or women,
statistics indicate that women are seven times more likely to develop the
condition than men. Nine out of 10 fibromyalgia patients are women, and an
estimated 3.4% of American women have the condition. Women's symptoms also tend
to be more severe than men's. Women may be more prone to develop fibromyalgia
Age: Individuals between the ages of 20 and 60 are at the
highest risk of developing fibromyalgia, although it may occur at any age.
Genetic factors: There is some indication that genetic factors
may be involved in the development of fibromyalgia. Studies have shown that
individuals with family members who have fibromyalgia are at a higher risk of
developing it themselves.
Specific lifestyle factors: People who have recently
experienced a traumatic physical or emotional event (such as a divorce, car
accident, or death of a family member) may be at a higher risk of developing
Psychiatric illness: While the majority of individuals with
fibromyalgia report a history of psychiatric symptoms, such as depression or
anxiety, many patients do not. There is no clear evidence that psychiatric
illness causes fibromyalgia.
Aggravating factors: Changes in weather, cold or drafty
environments, infections, allergies, hormonal fluctuations (premenstrual and
menopausal states), stress, depression, and anxiety may all contribute to
Muscular dystrophy refers to a number of diseases that are
caused by genetic mutations that involve progressive weakness, degeneration,
and wasting of muscles. The Duchenne and Becker types of muscular dystrophy
(DBMD) have similar signs and symptoms, are caused by the same genetic mutation
(dystrophin mutation), and occur more frequently in males than in females.
The particular gene that causes DBMD is found on the X
chromosome, and so it is called "X-linked." Females carry two X
chromosomes. Males carry one X chromosome and one Y chromosome. Because males
have only one X chromosome, a male carrying a copy with a DBMD mutation will
have the condition. However, because females have two copies of the X
chromosome, a female can have one copy with a DBMD mutation and one functional
copy. Because the functional copy is usually enough to compensate, a female
with a DBMD mutation usually has few or no symptoms. However, because she can
pass the mutation on to her children, she is called a "carrier."
Each son born to a woman with the dystrophin mutation on one
of her two X chromosomes has a 50% chance of inheriting the mutated gene and
having DBMD. Each of her daughters has a 50% chance of inheriting the mutation
and being a carrier. While most cases of DBMD occur by inheritance from the mother,
in approximately one-third of boys with DBMD, there is a new mutation that
forms in the egg, and so the mother is actually not the carrier of the
Temporomandibular joint disorder:
The cause of most TMJ disorders remains unknown. Some types
of temporomandibular joint (TMJ) disorders appear to be caused by injury to the
joint from a severe blow to the jaw or arthritis. Many behaviors, including
frequently clenching the jaw or grinding the teeth (which may occur during
sleep), poor posture that puts strain on the muscles and bones near the jaw, or
other habits that overwork the jaw muscles (e.g. constantly chewing gum), may
contribute to the development of TMJ disorders. However, further research is
needed to definitively determine if these behaviors cause TMJ disorders.
SIGNS AND SYMPTOMS
Pain is the chief symptom of most musculoskeletal disorders.
The pain may be dull, sharp, radiating, or local and may be mild or severe.
Although pain may be acute (short-lived), as is the case with most injuries, it
may become chronic (ongoing) with illnesses such as rheumatoid arthritis.
Muscle pain is known as myalgia.
Common symptoms of osteoarthritis include joint pain,
swelling and/or stiffness in a joint (especially after use), joint discomfort
before or during a change in the weather, bony lumps on the fingers, and loss
of joint flexibility. The joints that are most often affected by osteoarthritis
include the fingers, spine, and weight-bearing joints, such as the hips,
ankles, feet, and knees.
Rheumatoid arthritis often affects many joints at the same
time, and the severity of symptoms varies among patients. Symptoms, which may
come and go, typically include pain and swelling in the joints (especially in
the hands and feet), generalized aching or stiffness of the joints and muscles
(especially after periods of rest), loss of motion of the affected joints,
weakness in the muscles near the affected joints, low-grade fever, and general
feeling of discomfort. Early in the disease, the joints in the hands, wrists,
feet, and knees are most frequently affected. Over time, arthritis may develop
in the shoulders, elbows, jaw, hips, and neck. In addition to the joints,
rheumatoid arthritis may cause swelling in the tear ducts, salivary glands, the
lining of the heart, the lungs, and occasionally, blood vessels.
Periarthritis causes swelling and pain in the joints. Most
patients develop periarthritis of the shoulder. When the shoulder is affected,
the joint's mobility is significantly or completely reduced and aggressive
treatment is started.
Signs and symptoms of muscular dystrophy vary according to
the type of muscular dystrophy. In general, they may include muscle weakness,
apparent lack of coordination, and progressive crippling, resulting in
contractures of the muscles around the joints and loss of mobility.
The primary symptoms of fibromyalgia include widespread
musculoskeletal pain, severe fatigue (tiredness), and sleep disturbances.
Fibromyalgia may cause pain in the muscles, tendons, or ligaments. The pain is
usually in multiple locations and may be difficult to describe precisely.
Most individuals with fibromyalgia complain of a total body
"ache." Their muscles may feel like they were pulled or overworked or
feel as if they are burning. Other symptoms associated with fibromyalgia
include irritable bowel syndrome (IBS). Symptoms of IBS include fluctuations
between constipation and diarrhea, frequent abdominal pain, abdominal gas, and
nausea. Symptoms of IBS are frequently found in roughly 40 to 70% of
Acid reflux, or gastroesophageal reflux disease (GERD), also
occurs with the same high frequency. Recurrent migraine or tension-type
headaches are seen in about 70% of fibromyalgia patients and can pose a major
problem in coping for this patient group.
Temporomandibular joint disorder (TMJ) causes tremendous
jaw-related face and head pain in one-quarter of fibromyalgia patients.
Other common symptoms of fibromyalgia include premenstrual
syndrome (PMS) and painful periods, chest pain, morning stiffness, cognitive or
memory impairment, numbness and tingling sensations, muscle twitching,
irritable bladder, the feeling of swollen extremities (hands and feet), skin
sensitivities, dry eyes and mouth, dizziness, and impaired coordination.
Fibromyalgia patients are often sensitive to odors, loud noises, bright lights,
and sometimes even the medications they are prescribed.
Temporomandibular joint (TMJ) disorder:
Common symptoms of TMJ disorders include pain and soreness
of the jaw (which may worsen when the individual chews food, talks, or yawns),
pain in and around the ear, facial pain, an uneven bite or change in the way
the lower and upper teeth fit together, jaw muscle stiffness, a clicking sound
or grating sensation when the mouth is opened and closed (sometimes called jaw
clicking), headache, tired facial muscles, and locking of the joint, which may
temporarily limit the movement of the jaw.
It is important to note that jaw clicking affects many
individuals who do not have TMJ disorders. Individuals who do not experience
pain or limited movement of the jaw when the jaw clicks most likely do not have
Depression: Some individuals with musculoskeletal problems
may suffer from depression. This may happen if the musculoskeletal disorder
interferes significantly with the patient's lifestyle, including causing pain.
Individuals should consult their healthcare providers if they experience
feelings of sadness, low self-esteem, loss of pleasure, apathy, and difficulty
functioning for two weeks or longer with no known underlying cause. These may
be signs of depression and suicidal thoughts.
Joint damage: In some cases, musculoskeletal disorders can
lead to severe joint damage. In such cases, surgery, such as a joint
replacement, may be necessary. Individuals should regularly visit their
healthcare providers to monitor their conditions.
Limited mobility: Patients with musculoskeletal disorders
may have limited mobility in their joints. Joint mobility decreases as the
joint becomes more damaged.
A clinician can often diagnose a musculoskeletal disorder
based on symptoms and the results of a physical examination. Laboratory tests,
imaging tests, and other diagnostic procedures are sometimes necessary to help
the clinician make or confirm a diagnosis.
Physical examination: When a person complains of muscle
weakness, the clinician checks muscles for bulk, texture, and tenderness.
Muscles are also checked for twitches and involuntary movements, which may
indicate a nerve disease rather than a muscle disease. Clinicians look for
wasting away of muscle (atrophy), which can result from damage to the muscle or
its nerves or from lack of use, as sometimes occurs with prolonged bed rest.
Clinicians look for muscle enlargement (hypertrophy), which normally occurs
with exercise such as weight lifting. However, when a person is ill,
hypertrophy may result from one muscle working harder to compensate for the
weakness of another. Muscles can also become enlarged when normal muscle tissue
is replaced by abnormal tissue (increasing the size but not the strength of the
muscle), which occurs in certain inherited muscle disorders, such as Duchenne's
Clinicians try to establish which (if any) muscles are weak
as well as the degree of weakness involved. The muscles can be tested
systematically, usually beginning with the face and neck, then the arms, and
finally the legs. Normally, a person should be able to hold the arms extended,
palms up, for one minute without them sagging, turning, or shaking. Downward
drift of the arm with palms turning inward is one sign of weakness. Strength is
tested by pushing or pulling while the clinician pushes and pulls in the
opposite direction. Strength is also tested by having the person perform
certain maneuvers, such as walking on the heels and tiptoes, rising from a
squatting position, or getting up and down from a chair rapidly 10 times. To
assess eye muscle strength, the person is asked to look in all directions; if
double vision develops, one or more eye muscles may be weak.
The clinician tests a joint's range of motion by moving the
limb around a joint while the person is completely relaxed (passive movement).
The clinician will check muscle tone by testing passive movement. Resistance to
such movement (passive resistance) may be decreased when the nerve leading to
the muscle is damaged. Resistance to such movement may be increased when the
spinal cord or brain is damaged. If a person is weak, clinicians also tap the
person's muscle tendon with a rubber hammer to assess reflexes. Reflexes may be
slower than expected when the nerve leading to the muscle is damaged. Reflexes
may be more rapid than expected when the spinal cord or brain is damaged.
Laboratory tests: Laboratory tests are often helpful in
making the diagnosis of a musculoskeletal disorder. A test called an
erythrocyte sedimentation rate (ESR) test measures the rate at which red blood
cells settle to the bottom of a test tube containing blood. The ESR is
increased when inflammation is present. However, because inflammation occurs in
so many conditions, the ESR alone does not establish a diagnosis. The level of
creatine kinase (a normal muscle enzyme that leaks out and is released into the
bloodstream when muscle is damaged) may also be tested. Levels of creatine
kinase are increased when there is widespread and ongoing destruction of
muscle. In rheumatoid arthritis, a blood test to identify rheumatoid factor or
anti-cyclic citrullinated peptide (anti-CCP) antibody is helpful in making the
diagnosis. In systemic lupus erythematosus (lupus), a blood test to identify
autoimmune antibodies (antinuclear antibodies) is helpful in making the
Nerve tests: Nerve conduction studies help determine whether
the nerves supplying the muscles are functioning normally. Nerve conduction
studies, together with electromyography, help indicate whether there is a
problem primarily in the muscles (such as myositis or muscular dystrophy); in
the nervous system, which supplies the muscles (such as a stroke, spinal cord problem,
or polyneuropathy); or with the neuromuscular junction (such as myasthenia
gravis). Electromyography, often performed at the same time as nerve conduction
studies, is a test in which electrical impulses in the muscles are recorded to
help determine how well the impulses from the nerves are reaching the
connection between nerves and muscles (neuromuscular junction).
X-rays: X-rays are most valuable for detecting abnormalities
in bone and are taken to evaluate painful, deformed, or suspected abnormal areas
of bone. Often, X-rays can help to diagnose fractures, tumors, injuries,
infections, and deformities (such as congenital hip dysplasia). Also, X-rays
may be helpful in showing changes that confirm a person has a certain kind of
arthritis (for example, rheumatoid arthritis or osteoarthritis). X-rays do not
show soft tissues such as muscles, bursae, ligaments, tendons, or nerves. To
help determine whether the joint has been damaged by injury, a clinician may
use an ordinary (non-stress) X-ray or one taken with the joint under stress
Arthrography is an X-ray procedure in which a dye is
injected into a joint space to outline the structures, such as ligaments inside
a joint. Arthrography can be used to view torn ligaments and fragmented cartilage
in the joint.
Dual-energy X-ray absorptiometry (DEXA): The most accurate
way to evaluate bone density, which is necessary when screening for or
diagnosing osteoporosis, is with dual-energy X-ray absorptiometry (DEXA). In
this test, low-dose X-rays are used to examine bone density at the lower spine,
hip, wrist, or entire body. Measurements of bone density are very accurate at
these sites. To help differentiate osteoporosis (the most common cause of an
abnormal DEXA scan) from other bone disorders, doctors may need to consider the
person's symptoms, medical conditions, medication use, and certain blood or
urine test results as well as the DEXA results.
Computed tomography (CT) and magnetic resonance imaging
(MRI): Computed tomography (CT) and magnetic resonance imaging (MRI) give much
more detail than conventional X-rays. CT and MRI may be performed to determine
the extent and exact location of musculoskeletal damage. These tests can also
be used to detect fractures that are not visible on X-rays. MRI is especially
valuable for imaging muscles, ligaments, and tendons. MRI can be used if the
cause of pain is thought to be a severe soft-tissue problem (for example,
rupture of a major ligament or tendon or damage to important structures inside
the knee joint). The amount of time a person spends undergoing CT is much less
than for MRI.
Bone scanning: Bone scanning is an imaging procedure that is
occasionally used to diagnose a fracture, particularly if other tests, such as
plain X-rays and CT or MRI, do not reveal the fracture. Bone scanning involves
the use of a radioactive substance (technetium-99m-labeled pyrophosphate) that
is absorbed by any healing bone. The technique can also be used when a bone
infection or a metastasis (from a cancer elsewhere in the body) is suspected.
The radioactive substance is given intravenously and is detected by a
bone-scanning device, creating an image of the bone that can be viewed on a
Joint aspiration: Joint aspiration is used to diagnose
certain joint problems. A needle is inserted into a joint space and fluid
(synovial fluid) is drawn out (aspirated) and examined under a microscope. A
doctor can often make a diagnosis after analyzing the fluid. For example, a
sample of synovial fluid may contain bacteria, which confirms a diagnosis of
infection. Joint aspiration is usually performed in a doctor's office and is
generally quick, easy, and relatively painless. The risk of joint infection is
Arthroscopy: Arthroscopy is a procedure in which a small
(diameter of a pencil) fiber optic scope is inserted into a joint space,
allowing the doctor to look inside the joint and to project the image onto a
television screen. The skin incision is very small. A person receives local,
spinal, or general anesthesia. During arthroscopy, doctors can take a piece of
tissue for analysis (biopsy) and, if necessary, perform surgery to correct the
condition. Disorders commonly found during arthroscopy include inflammation of
the synovium lining a joint (synovitis); ligament, tendon, or cartilage tears;
and loose pieces of bone or cartilage. Such conditions affect people with
arthritis or previous joint injuries, as well as athletes. All of these
conditions can be repaired or removed during arthroscopy. There is a very small
risk of joint infection with this procedure.
General: Musculoskeletal problems are generally managed with
medications that reduce pain and inflammation. In severe cases, surgery may be
necessary to repair damage.
In order to properly manage pain and prevent joint damage,
individuals should take their medications as prescribed by their healthcare
providers. Individuals with musculoskeletal problems should also tell their
healthcare providers if they are taking any other drugs (prescription,
over-the-counter, or dietary supplements) because they may interfere with
Corticosteroids: Corticosteroids, such as prednisone
(Deltasone©) and methylprednisolone (Medrol©), are occasionally used to reduce
inflammation and pain and slow joint damage caused by musculoskeletal problems.
These drugs are generally very effective when used short-term. However, if used
for many months to years, these drugs may become less effective and serious
side effects may develop. Side effects may include easy bruising, thinning of
bones, cataracts, weight gain, a "moon" face, and diabetes.
Corticosteroids are usually prescribed for a certain amount
of time, and then the individual is gradually tapered off the medication.
Individuals should not stop taking corticosteroids suddenly or change their
dosages without first consulting their healthcare providers.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal
anti-inflammatory drugs (NSAIDs) have been used to relieve pain and inflammation
caused by musculoskeletal problems. Commonly used over-the-counter NSAIDs
include ibuprofen (Advil© or Motrin©) and naproxen sodium (Aleve©). Higher
doses of these drugs are also available by prescription. Commonly prescribed
NSAIDs include diclofenac (Cataflam© or Voltaren©), nabumetone (Relafen©), and
ketoprofen (Orudis©). NSAIDs may be taken by mouth, injected into a vein, or
applied to the skin. These medications are generally taken long term to manage
The frequency and severity of side effects vary among
NSAIDs. The most common side effects include nausea, vomiting, diarrhea,
constipation, decreased appetite, rash, dizziness, headache, and drowsiness.
The most serious side effects include kidney failure, liver failure, ulcers,
heart-related problems, and prolonged bleeding after an injury or surgery.
About 15% of patients who receive long-term NSAID treatment develop ulcers in
the stomach or duodenum.
Pain relievers: Over-the-counter (OTC) pain relievers used
in the treatment of musculoskeletal disorders include acetaminophen (Tylenol©).
Prescription pain relievers, including tramadol (Ultram©), have been used to
reduce pain caused by musculoskeletal problems. Although this drug, which is
available by prescription, does not reduce swelling, it has fewer side effects
than NSAIDs. Tramadol is generally taken as a short-term treatment to reduce
symptoms of flare-ups.
Narcotic pain relievers, such as acetaminophen/codeine
(Tylenol with Codeine©), hydrocodone/acetaminophen (Lorcet©, Lortab©, or
Vicodin©), or oxycodone (OxyContin© or Roxicodone©), may be prescribed to treat
severe musculoskeletal pain. However, they do not reduce swelling. These
medications are only used short-term to treat flare-ups. Common side effects
include constipation, drowsiness, dry mouth, and difficulty urinating. Narcotic
pain relievers should be used cautiously because individuals may become
dependent upon them.
Selective COX-2 inhibitors: Celecoxib (Celebrex©) has been
taken by mouth to reduce pain and inflammation caused by musculoskeletal
problems such as osteoarthritis. Celecoxib is currently the only COX-2
inhibitor that is approved by the U.S. Food and Drug Administration (FDA).
Celecoxib is generally taken long-term to manage symptoms.
COX-2 inhibitors have been linked to an increased risk of
serious heart-related side effects, including heart attack and stroke.
Selective COX-2 inhibitors have also been shown to increase the risk of stomach
bleeding, fluid retention, kidney problems, and liver damage. Less serious side
effects may include headache, indigestion, upper respiratory tract infection,
diarrhea, sinus inflammation, stomach pain, and nausea.
Topical pain relievers: Topical pain relievers are creams,
ointments, gels, and sprays that are applied to the skin. Many over-the-counter
(OTC) pain relievers may temporarily help reduce pain caused by osteoarthritis.
Products such as Aspercreme©, Sportscreme©, Icy Hot©, and Ben-Gay© may help
reduce arthritis pain. Capsaicin cream, which is made from the seeds of hot
peppers, may reduce pain in joints that are close to the skin surface, such as
the fingers, knees, and elbows. Lidocaine patches (Lidoderm©) may also be used.
Lidocaine is an anesthetic when applied topically and may decrease pain
associated with musculoskeletal problems.
Antidepressants: Some individuals with musculoskeletal
problems may also suffer from depression. Commonly prescribed anti-depressants
for arthritis patients include amitriptyline, nortriptyline (Aventyl©,
Pamelor©), and trazodone (Desyrel©). These drugs may also help with nerve pain
associated with musculoskeletal disorders. Side effects of antidepressant
medications include drowsiness, fatigue (excessive tiredness), constipation,
dry mouth, and blurred vision.
Lifestyle changes: Many lifestyle changes, including regular
exercise, weight management, and consumption of a healthy diet may help reduce
symptoms of musculoskeletal problems. A healthcare provider may recommend a
physical therapist, nutritionist, or registered dietician to help determine the
best treatment plan for the individual.
Individuals with musculoskeletal problems such as
osteoarthritis or rheumatoid arthritis should wear comfortable footwear that
properly supports their weight. This may reduce the amount of strain put on the
joints during walking.
Individuals with musculoskeletal problems may require canes,
walkers, or other devices to help them get around. If the hands are severely
affected, braces may be beneficial. Individuals should talk to their healthcare
providers about assistive devices that are available.
Individuals with musculoskeletal problems should maintain
good posture. This allows the body's weight to be evenly distributed among
Cool compress or ice pack: Applying a cool compress or ice
pack to the affected joint during a flare-up may help reduce swelling and pain.
Heat: Applying a hot pack to affected joints may help reduce
pain, relax muscles, and increase blood flow to the joint. It may also be an
effective treatment before exercise. Alternatively, individuals may take a hot
shower or bath before or after exercise to help reduce pain.
Fusing bones: If there is serious joint damage, the bones of
a joint, such as the ankle, may be surgically fused together in a procedure
called arthrodesis. This surgery helps increase stability and reduces pain.
However, the joint no longer has any flexibility and cannot bend or move.
Joint replacement surgery: In some cases, individuals with
osteoarthritis suffer from permanent joint damage. In such instances, joint
replacement surgery may be necessary. During the procedure, the damaged joint
is surgically removed, and it is replaced with a plastic or metal device called
a prosthesis. The most commonly replaced joints are the hip and knee, but other
joints, including the elbow, shoulder, finger, or ankle joints can be replaced
Joint replacement surgeries are generally most successful
for large joints, such as the hip or knee. Researchers estimate that hip or
knee replacements last at least 20 years in 80% of patients. After a successful
surgery and several months of rehabilitation, individuals are able to use their
new joints without pain.
As with any major surgery, there are risks associated with
joint replacements. Patients should discuss the potential health risks and
benefits of surgery with their healthcare providers.
Preventing sports injury: Some musculoskeletal problems
associated with injuries may be preventable. Care should be taken in sports and
physical activities to prevent injuries, sprains, and the overuse of joints,
such as in the ankle, wrist, knee, shoulder, and spine. Individuals
participating in sports activities such as football, swimming, gymnastics,
baseball, basketball, tennis, skiing, wrestling, and soccer may be at a greater
risk of developing musculoskeletal problems.
Preventing occupational injury: Any job or activity that
requires a fixed position over a long period of time can cause musculoskeletal
discomfort. Poor job and workplace design appears to contribute to many
reported discomforts. Important methods of preventing such discomfort include
assuming a range of comfortable positions and having adjustable furniture, such
as chairs, tables, and keyboard supports. However, the degree of adjustability
for any furniture and visual display depends on how long and for what purpose
they will be used. Prolonged work in the same position, whether seated or
standing, can cause discomfort. Where possible, movement should be incorporated
into the task to prevent discomfort and fatigue.
It is best to avoid standing still in one place for long
periods of time. The activity of the leg muscles acts as a pump and assists the
veins in returning blood to the heart. Prolonged standing stops this pumping
action and this may cause swelling of the lower extremities. Using a rubber or
padded mat where prolonged standing cannot be avoided is recommended by
healthcare providers. Mats help reduce fatigue and improve comfort. For those
individuals who sit for long periods of time, a well-designed chair is very
Dietary modification: Nutritional changes, along with the
addition of supplements (vitamins, minerals and herbs), may be effective in
reducing symptoms associated with musculoskeletal problems.
It is best to limit caffeine and other stimulants, as well
as alcohol, and to stop smoking. It may also be beneficial to eliminate
potential food allergens, including dairy (milk, cheese and sour cream), eggs,
nuts, shellfish, wheat (gluten), corn, preservatives, and food additives (such
as dyes and fillers). Additionally, it may be helpful to avoid refined foods
such as white breads and pastas and foods with high levels of sugar or refined
sugar, such as donuts, pastries, candy, and soft drinks.
Exercise: Maintaining physical fitness is important to those
suffering from musculoskeletal problems. Those with musculoskeletal problems
who exercise according to their healthcare professional's recommendations tend
to do better, with less symptoms and a slower disease progression, than those
who do not. A daily regimen of exercise can help the person feel better
physically and mentally. Individuals should walk as much as possible, even if
assistance is necessary.
Regular exercise may also help individuals control their
weight and decrease stress on the musculoskeletal system. There are many ways
for people to exercise including gardening, walking, sports activities, and
dancing. Individuals who are beginning an exercise program should choose
activities that fit their levels of strength and endurance. The type of
exercise is not as important as a consistent exercise schedule. Most experts
today agree that burning calories should not be the goal of exercise. Exercise
that causes extreme pain or discomfort is considered by many experts as
unhealthy, and may even cause permanent damage to the body.
Pilates is a body conditioning routine that seeks to build
flexibility, strength, endurance, and coordination without adding muscle bulk.
In addition, pilates may increase circulation and may help to sculpt the body
and strengthen the body's "core" (torso). People who engage in
pilates regularly report that they have better posture, are less prone to
musculoskeletal injury, and experience better overall health.
It is recommended for the patient to consult with their
healthcare providers before beginning any exercise program.
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Natural Standard (www.naturalstandard.com)