Self-Care: Musculoskeletal Injuries/Disorders

**What is acute pain?

Pain lasting < 4 weeks

**What is chronic pain?

Pain lasting 3+ months

**What is the location of myalgia?

Muscles of the body

**What are the signs of myalgia?

Possible swelling (rare)

**What are the symptoms of myalgia?

- Dull, constant ache (sharp pain relatively rare)

- Weakness & fatigue of muscles also common

**What is the onset of myalgia?

Varies depending on cause

Trauma = acute

Drug induced = insidious

**What are the modifying factors of myalgia?

- Elimination of cause

- Use of stretching

- Rest

- Heat

- Topical analgesics

- Systemic analgesics

**What is the location of tendonitis?

Tendon locations around joint areas

**What are the signs of tendonitis?

- Warmth

- Swelling

- Erythema

**What are the symptoms of tendonitis?

- Mild to severe pain generally occurring after use

- Loss of range of motion

**What is the onset of tendonitis?

Often gradual, but can develop suddenly

**What are the modifying factors of tendonitis?

- Elimination of cause

- Stretching

- Rest

- Ice

- Topical analgesics

- Systemic analgesics

**What is the location of bursitis?

Inflammation of bursae within joints

Common locations: knee, shoulder, big toe

**What are the signs of bursitis?

- Warmth

- Edema

- Erythema

- Crepitus (possible)

**What are the symptoms of bursitis?

Constant pain that worsens with movement or application of external pressure over the joint

**What is the onset of bursitis?

Acute with injury

Recurs with preciptiant use of joint

**What are the modifying factors of bursitis?

- Joint rest

- Immobilization

- Topical analgesics

- Systemic analgesics

**What is the location of sprains?

Stretching or tearing of ligaments within a joint

**What are the signs of sprains?

- Swelling

- Bruising

**What are the symptoms of sprains?

- Initial severe paid followed by pain, particularly with joint use

- Tenderness

- Reduction in joint stability & function

**What is the onset of sprains?

Acute with injury

**What are the modifying factors of sprains?

- RICE

- Stretching

- Use of protective wraps

- Topical analgesics

- Systemic analgesics

**What is the location of strains?

Hyperextension of a joint that results in overstretching or tearing the muscle or tendon

**What are the signs of strains?

- Swelling

- Bruising

**What are the symptoms of strains?

- Initial severe pain with continued pain upon movement and at rest

- Muscle weakness

- Loss of some function

**What is the onset of strains?

Acute with injury

**What are the modifying factors of strains?

- RICE

- Stretching

- Use of protective wraps

- Topical analgesics

- Systemic analgesics

**What is the location of osteoarthritis?

- Weight-bearing joints

- Knees

- Hips

- Low back

- Hands

**What are the signs of osteoarthritis?

- Noninflammatory joints

- Narrowing of joint space

- Restructuring of bone & cartilage (resulting in joint deformities)

- Possible joint swelling

**What are the symptoms of osteoarthritis?

- Dull joint pain relieved by rest

- Joint stiffness < 20-30 minutes

- Localized symptoms of joint

- Crepitus

**What is the onset of osteoarthritis?

Insidious development over years

**What are the modifying factors of osteoarthritis?

- Continuous exercise (light moderate activity)

- Weight loss

- Heat

- Analgesic medication

- Topical pain relievers

**What are the treatment goals for a patient with musculoskeletal pain?

- Decrease subjective intensity/severity of pain

- Decrease duration of pain when possible

- Restore function of the affected area

- Prevent re-injury and disability

- Prevent acute pain from becoming chronic persistent pain

**What are the exclusions for self-treatment of musculoskeletal pain?

- Severe pain (score > 6)

- Pain that lasts 10+ days

- Pain that continues 7+ days after treatment with a topical analgesic

- increased intensity or change in character of pain

- Pelvic or abdominal pain (other than dysmenorrhea)

- Accompanying N/V, fever, or other signs of systemic infection/disorder

- Visually deformed joint, abnormal movement, weakness in any limb, numbness, or suspected fracture

- Pregnancy

- < 2 years old (FDA)

- Back pain and loss of bowel and/or bladder control

- Arthritis pain that requires use of topical NSAID 21+ days

- Arthritis pain that has not improved after 7 days of using a topical NSAID

**What is the length of treatment and when do you follow up for pain from musculoskeletal injuries/disorders?

RICE therapy & oral/topical analgesics for 7 days, then follow up

May continue oral analgesics prn up to 10 days --> follow up to assess for ADRs and resolution of pain

**What is the length of treatment and when do you follow up for osteoarthritis pain?

Initiate nondrug & drug therapies and follow up in 3 weeks

If pain is not decreased maximize current therapy or add additional agent --> follow up in 3 weeks

If pain is not decreased, titrate dose(s) of present therapy to max tolerated dosages & consider referral for further evaluation

**What are the guidelines for rest in RICE therapy?

Rest injured area and continue until pain is reduced (generally one or two days)

Slings, splints, or crutches can be used if necessary

**What are the guidelines for ice in RICE therapy?

As soon as possible, apply ice to the injured area in 15 to 20 minute increments, at least 3-4 times a day

Continue the ice pack therapy until swelling subsides (usually 1-3 days, depending on the severity of injury)

**What are the guidelines for compression in RICE therapy?

Apply compression to injured area with an elastic support or an elasticized bandage as follows

If ice is also being applied, soak bandage in water to aid the transfer of cold

After removal, wash the used bandage in lukewarm, soapy water; do not scrub it. Rinse the bandage thoroughly and allow to air dry on a flat surface

**What are the guidelines for elevation in RICE therapy?

Elevate the limb or body part with the injured area at or above the level of the heart, to decrease swelling and relieve pain

**What are the counseling points for heat therapy for musculoskeletal pain?

Do not directly apply to skin

Apply for 15-20 minutes, 3-4 times/day

Do not use on inflamed areas because it can intensify vasodilation & exacerbate vascular leakage

Do not use on areas of broken skin or areas with decreased sensation (could lead to skin burn)

**How can TENS work to reduce pain?

It is thought to come from 2 mechanisms:

Alteration of pain transmission

Increase in the production of natural endorphins

**What are the safety concerns associated with TENS therapy?

Avoid placing electrodes on or over throat, chest, head, or carotid arteries as you do not want to over shock or cause deadly spasms from electrodes

**Which patients shouldn't use TENS therapy?

Patients with internal or attached medical devices, pregnant women, and pediatric population

What are epsom salts?

Magnesium sulfate solution

Are epsom salts clinically effective?

There is no scientific evidence supporting clinical effectiveness

For which musculoskeletal injuries/disorders are NSAIDs considered 1st line therapies over acetaminophen?

Osteoarthritis of the hip, hand, and knee

What are the risks of chronic NSAID use?

Leads to more severe and prevalent AEs such as

- Nephropathy

- GI ulcerations and bleeding