Wk 2 MSK Disorders

Musculoskeletal (MSK) Injuries

  • Presented by Dr. Kam Capoccia & Dr. Melissa Mattison

  • Self-Care Therapeutics 2025

Case Study: Lou Louis-Self

  • Profile: 15-year-old male high school wrestler

  • Condition: Self-described hamstring pull

  • Assessment Tool: QuEST SCHOLAR-MAC

  • Recommendation Approach:

    • Quickly assess the patient

    • Determine if the patient is appropriate for self-care

    • Suggest appropriate self-care strategies

    • Communicate effectively with the patient

QuEST/SCHOLAR-MAC Assessment

  • Symptoms: Identify main and associated symptoms

  • Characteristics: Describe the nature of symptoms

  • History: Investigate prior occurrences or treatments

  • Onset: Determine when the issue began

  • Location: Identify where the problem exists

  • Aggravating Factors: Discover what exacerbates the condition

  • Remitting Factors: Identify what alleviates the symptoms

  • Medications: Review all medications (prescription, non-prescription, herbal)

  • Allergies: Note any known allergies and reactions

  • Conditions: Consider other underlying medical conditions

Treatment Recommendations

  • Approaches: Select the best recommendation

    • A. RICE: Rest, Ice, Compression, Elevation

    • B. RACE: Recover Actively, Compression, Elevation

    • C. MEAT: Movement, Exercise, Analgesics, Treatment

    • D. PEACE & LOVE: Protection, Elevation, Avoid anti-inflammatories, Compression, Elevation, Load Optimism, Vascularization, Exercise

  • Objectives:

    • Understand clinical presentations of MSK injuries

    • Differentiate strains, sprains, and osteoarthritis

    • Discuss non-pharmacologic and pharmacologic treatment options

Overview of MSK Injuries

  • Components of MSK System: Muscles, tendons, ligaments, cartilage, bones

  • Pain Sources: Muscles, bones, joints, connective tissue

  • Types of Pain: Can be acute or chronic

  • Economic Impact: Costs the U.S. economy $60 billion annually

  • Osteoarthritis Statistics: 27 million diagnosed; projected 67 million by 2030

Pathophysiology of MSK Injuries

  • System Composition: Muscles, tendons, ligaments, cartilage, bones

  • Injury Mechanisms: Tendons and ligaments may damage but rarely rupture

  • Protective Structures: Bursae (fluid-filled sacs), cartilage (pads)

  • Pain Mechanism: Stimuli to pain receptors in muscles and fascia due to overuse or injury

Specific Conditions

Sprain

  • Definition: Stretching or tearing of a ligament

  • Symptoms:

    • Swelling, bruising

    • Initial severe pain, followed by tenderness and reduced joint stability

  • Onset: Acute with injury

  • Treatment: Protective wraps, RICE method, stretching

Strain

  • Definition: Hyperextension of muscle or tendon

  • Symptoms:

    • Swelling, bruising

    • Muscle weakness, continual pain during movement and at rest

  • Treatment: Similar to sprains: RICE, stretching, protective wraps

Osteoarthritis

  • Affected Joints: Weight-bearing joints (knees, hips, etc.)

  • Condition Description: Degenerative joint disease with cartilage destruction

  • Symptoms: Dull pain relieved by rest, joint stiffness lasting less than 20-30 minutes, localized pain

Lower Back Pain

  • Prevalence: 5th most common reason for medical visits; 80% lifetime prevalence

  • Contributing Factors: Sedentary lifestyle, poor posture, heavy lifting, improper footwear

Treatment Goals

  • Objectives:

    • Decrease severity and duration of pain

    • Restore function

    • Prevent re-injury and transition to chronic pain

  • Case Study: Julius Jones

    • Concerns about pain following intense workouts

    • Seeking recommendations while avoiding NSAIDs due to GI history

Nonpharmacologic Therapy

  • Methods:

    • RICE

    • Stretching

    • Heat application

Recommendations for Treatment Techniques

  • RICE Components: Rest, Ice, Compression, Elevation

  • RACE Components: Recover Actively, Compression, Elevation

  • MEAT Components: Movement, Exercise, Analgesics, Treatment

  • PEACE & LOVE Components: Protection, Elevation, Avoid anti-inflammatories, Compression, Load, Optimism, Vascularization, Exercise

Pharmacologic Therapy

  • Analgesics: Systemic medications such as NSAIDs and acetaminophen

  • Administration: Schedule doses for 1-3 days and taper as symptoms improve

  • Osteoarthritis Treatment: Oral NSAIDs recommended for hands, hips, knees; consider topical for short-term relief

  • Topical Products: Used for local analgesic effect; includes various active ingredients

Specific Topical Agents

Methyl Salicylate

  • Source: Naturally from wintergreen oil, produces localized inflammatory reaction

  • Cautions: Potential local and systemic reactions, contraindicated with warfarin

Camphor

  • Derived from camphor tree, acts as a topical analgesic

  • Considerations: Apply cautiously due to potential CNS toxicity

Menthol

  • Provides a cooling sensation that distracts from pain

  • Usage: Apply regularly for short-term pain management

Capsicum Preparations

  • Contain capsaicin, reduces pain through depleting substance P from sensory neurons

  • Cautions: Can cause burning sensation; wash hands after application

Topical NSAIDs

  • Diclofenac Sodium 1% (Voltaren): Now available OTC for arthritis pain relief in specified joints, may take up to a week to show effects

  • Case Study Example: Seek safe topical recommendations for young athletes

Key Takeaways (MSK Pearls)

  • Initiate treatment early for acute pain

  • Monitor and document changes in pain

  • Utilize RICE, RACE, MEAT, PEACE & LOVE strategies

  • Differentiate between acetaminophen and NSAIDs

  • Limit topical applications to intact skin and avoid heat with dressings

  • Seek medical assistance if issues persist after 10 days.