Overview of musculoskeletal pain

Related Diseases & Conditions

• Adhesive capsulitis

  Summary

  Chronic fibrosing condition characterized by insidious and progressive severe restriction of both active and passive shoulder range of motion, in the absence of a known intrinsic disorder of the shoulder. Many patients experience shoulder pain, but shoulder pain is not an essential component of adhesive capsulitis.
• Ankle fractures

  Summary

  Although other fractures around and including the ankle can occur (such as distal tibial plafond fractures), the term "ankle fracture" most commonly refers to fracture types in which one or more of either the medial, lateral, or posterior malleolus is broken. Pain is bony and present over the medial or lateral malleolus.
• Ankylosing spondylitis

  Summary

  Axial spondyloarthritis is a chronic progressive inflammatory arthropathy, which ultimately may lead to radiographic changes in the spine and sacroiliac joints. This radiographic stage is known as ankylosing spondylitis. Inflammatory back pain is the hallmark clinical feature. This is defined as back pain that is of insidious onset, worse in the morning, and improves with exercise.
• Anterior cruciate ligament injury

  Summary

  Injury typified by sudden, painful, audible "pop" noise. Patient typically presents with inability to return to activity, joint instability, and rapid development of effusion (hemarthrosis). Often tender at lateral femoral condyle, lateral tibial plateau, and tibiofemoral joint lines.
• Back pain, evaluation of

  Summary

  Back pain is extremely common, and low back pain (LBP) in particular causes more disability globally than any other condition.[7] [8]​ Various spinal structures including ligaments, facet joints, paravertebral musculature and fascia, intervertebral disks, and spinal nerve roots have been implicated as pain generators.[9]​ The etiologies can be subdivided into 3 groups: mechanical, systemic, and referred. By far the most common cause is mechanical (97%).[9]​​ However, most LBP is nonspecific and the cause cannot be identified.​[8]​
• Brachial plexus injury

  Summary

  Most commonly results from motor vehicle accidents, gunshot or stab wounds, contact sport accidents, or workplace accidents during heavy physical labor.[10]​ The effects of the injury include paralysis, loss of sensation, and pain. The specific clinical presentation will depend on the nerve roots involved and the degree of injury to each root.
• Bursitis

  Summary

  A bursa is a sac containing a small amount of synovial fluid that lies between a tendon and either skin or bone to act as a friction buffer. In bursitis there is thickening and proliferation of the synovial lining, bursal adhesions, villus formation, tags, and deposition of chalky deposits. This may result from repetitive stress, infection, autoimmune disease, or trauma. Key diagnostic findings are localized pain and tenderness over a bursa and swelling if superficially sited.
• Calcium pyrophosphate deposition (pseudogout)

  Summary

  Calcium pyrophosphate arthritis is caused by deposition of calcium pyrophosphate (CPP) crystals. It can be difficult to diagnose. CPP crystals in synovial fluids can be small, sparse, and difficult to find. It typically occurs in older patients. In patients ages <60 years, underlying metabolic conditions associated with calcium pyrophosphate deposition, such as hyperparathyroidism or hemochromatosis, should be investigated.
• Carpal tunnel syndrome

  Summary

  A collection of symptoms and signs caused by compression of the median nerve in the carpal tunnel. It is the most common entrapment neuropathy.[11]​ Symptoms include numbness and/or tingling of the thumb and radial fingers, aching wrist, and clumsiness.
• Cervical spine trauma, acute

  Summary

  Encompasses a wide range of potential injuries to ligaments, muscles, bones, and spinal cord that follow acute incidents ranging from a seemingly innocuous fall to a high-energy motor vehicle accident. In all cases, careful investigation is required to ensure that the stability of the cervical spine has not been compromised. In extreme cases, cervical spine instability can lead to progressive neurologic deficit, quadriplegia, and even death.
• Cervical spine disease, degenerative

  Summary

  Osteoarthritis of the spine, including the spontaneous degeneration of either disk or facet joints. Presenting symptoms include axial neck pain and neurologic complications.
• Myalgic encephalomyelitis (chronic fatigue syndrome)

  Summary

  Characterized by a sudden or gradual onset of persistent disabling fatigue, postexertional malaise, unrefreshing sleep, cognitive and autonomic dysfunction, and pain, with symptoms lasting at least 6 months.[12]​ These symptoms are otherwise unexplainable and persist for at least 6 months, are not alleviated by rest, and significantly impair quality of life.

  Although diagnostic criteria stipulate that diagnosis in adults should not be made until after 6 months of symptoms (3 months for children) and negative medical evaluation, the 2021 UK National Institute for Health and Care Excellence (NICE) guidance discusses the negative impact of a 6-month delay in starting management. NICE therefore recommends that observation in adults be reduced to 3 months before initiating therapy.
• Chronic pain syndromes

  Summary

  Chronic pain is one of the most common reasons for seeing a primary care physician. There are many causes of chronic pain, and these may be attributed to musculoskeletal (mechanical) causes, neurologic causes, causes of headaches, psychologic causes or localized disease, or as part of a generalized disease process. The prevalence of chronic pain increases with age, affecting nearly 30% of older people.[13] Typical etiologies in this population are arthritis, osteoporosis with fractures, and lumbar stenosis. These conditions are treatable and should not be considered part of the normal aging process. Untreated chronic pain in older adults can result in depression, poor quality of life, and loss of independence.
• Coccygodynia

  Summary

  Disabling pain in the coccyx, usually provoked by sitting or rising from sitting. May be post-traumatic (e.g., a fall or childbirth), nontraumatic, or idiopathic in origin.
• Compartment syndrome of extremities

  Summary

  Characterized by elevated interstitial pressure in a closed osteofascial compartment that results in microvascular compromise (restriction of capillary blood flow).[14]​ Can be caused by fracture, compartment hemorrhage, direct soft-tissue injury, or direct muscular injury.
• Complex regional pain syndrome

  Summary

  Prolonged pain, disproportionate to the initiating event, most frequently a minor trauma and most commonly affecting the distal aspect of an extremity. Pain is often described as spontaneous, burning, lancinating, sharp, shooting, or electric. Characteristically develops dull, boring, and aching qualities with chronicity.
• Costochondritis

  Summary

  Presents with insidious onset of anterior chest wall pain exacerbated by certain movements of the chest and deep inspiration. Key sign is pain on palpation of costochondral joints (particularly the second to the fifth).
• Discogenic low back pain

  Summary

  A complex, multi-factorial, clinical condition characterized by LBP with or without the concurrence of radicular lower limb symptoms in the presence of radiologically-confirmed degenerative disc disease. The pain is exacerbated by activity, but may be present in certain positions, such as sitting.
• Epicondylitis

  Summary

  Typically occurs during the fourth and fifth decades of life. Patients describe a history of activities contributing to overuse of the forearm muscles that originate at the elbow. Both lateral epicondylitis (commonly known as tennis elbow) and medial epicondylitis (commonly known as golfer's elbow) are characterized by pain during or following elbow flexion and extension.
• Fibromyalgia

  Summary

  A syndrome characterized by widespread pain in the body present for at least 3 months.[15] [16] It is thought to be related to amplified pain signals in the spinal cord and brain. Patients with fibromyalgia typically present with chronic, waxing and waning, widespread body pain. Comorbid symptoms such as fatigue, memory difficulties, and sleep and mood difficulties are common.
• Ganglion cyst

  Summary

  Smooth, soft, benign masses that are usually located on the wrist. Patients may experience occasional aching discomfort secondary to compression of surrounding structures. In some patients, this aching is only present after activity. Occult ganglia are usually undetectable by physical exam but may be a cause of vague wrist pain.
• Gout

  Summary

  Acute onset of severe joint pain, with swelling, effusion, warmth, erythema, and/or tenderness of the involved joint(s). The disease most commonly affects the first toe (podagra), foot, ankle, knee, fingers, wrist, and elbow; however, it can affect any joint.
• Groin pain

  Summary

  Most common presentation for intra-articular pathology of the hip joint; however, referred pain from other sources is not uncommon. Signs and symptoms typically include activity-related pain, pain with movement of the hip, and antalgic gait.
• Hip fractures

  Summary

  Generally considered to be any fracture of the femur distal to the femoral head and proximal to a level a few centimeters below the lesser trochanter. Associated most commonly with low-energy injury (e.g., fall from standing height) and osteoporosis or osteopenia. The risk increases significantly with age.
• Iliotibial band syndrome

  Summary

  Iliotibial band syndrome is the most common cause of lateral knee pain in runners, related to repetitive friction of the iliotibial band sliding over the lateral femoral epicondyle. Runners predisposed to this injury are typically in a phase of overtraining and often have underlying weakness of the hip abductor muscle.
• Joint dislocation

  Summary

  Complete separation of 2 articulating bony surfaces, often caused by a sudden impact to the joint. Typically, patients have significant pain when attempting motion and are significantly apprehensive about moving the affected joint. Diagnosis is usually confirmed with plain x-rays.
• Joint, inflamed, evaluation of

  Summary

  Inflammatory arthritis is a common term for several conditions that manifest as joint pain, swelling, and stiffness with varying degrees of functional impairment. In patients with pain and swelling in a single joint, acute infection is a relatively common cause - one that can result in rapid and irreversible damage. In contrast, the majority of patients with involvement of multiple joints tend to have disorders of chronic duration.
• Juvenile idiopathic arthritis

  Summary

  Most common chronic rheumatic disorder of children and includes several subtypes. Affected joints can be painful, especially during motion and on palpation. Objective arthritis in joints for at least 6 weeks is necessary for diagnosis.[17]
• Knee injury, evaluation of

  Summary

  By most definitions, acute knee injuries are defined as being diagnosed within the first 30 to 42 days of the injury or onset of symptoms. Chronic knee injuries are due to residual old trauma or surgery, existing degenerative diseases, or previous conditions not resolved within the first 30 to 42 days after the onset.
• Medial collateral ligament injury

  Summary

  Occurs when excessive valgus stresses or external rotation forces are placed on the knee joint. Most common symptom is medial-sided knee pain above or below the joint line. Patients are usually able to walk. Diagnosis and grading is primarily made with history taking and physical exam.
• Meniscal tear

  Summary

  Menisci can tear due to traumatic injury or degenerative wear (e.g., in knee joint arthritis), and can compromise force distribution across the knee joint. Tears can cause knee pain, swelling, limited range of motion, and catching, locking, and buckling of the knee joint.
• Muscle cramps

  Summary

  Although mostly benign and self-limited, muscle cramps may also be indicative of a wide variety of potentially serious systemic disorders. Idiopathic (ordinary) muscle cramps are common, short-lived, and usually involve the calf muscle and/or foot. The diagnostic approach for idiopathic muscle cramps is one of exclusion.
• Musculoskeletal lower back pain

  Summary

  Pain, stiffness, and/or soreness of the lumbosacral region. Diagnosis is made by eliminating specific causes of LBP arising from neurologic compromise, neoplasia, inflammatory arthritis, fracture, or referred pain from other locations or organ systems.
• Musculoskeletal sprains and strains

  Summary

  Strain is an injury to the muscle or musculotendinous junction, whereas a sprain is an injury to the ligament. History and physical exam are key in diagnosis and grading of the injury as grade 1 (mild), 2 (moderate), or 3 (severe with complete rupture).
• Neck pain, evaluation of

  Summary

  Patients may present acutely, particularly in the setting of trauma, or with more chronic pain. The estimated lifetime prevalence of a significant episode of neck pain is 40% to 70%, and the global point prevalence of neck pain is 4.9%.[18] It is important to detect neck pain caused by significant causes (e.g., primary or metastatic cancer) and neck pain associated with neurologic compromise.
• Osgood-Schlatter disease

  Summary

  Overuse syndrome of the pediatric population that results in traction apophysitis of the tibial tubercle. Typically occurs during an adolescent growth spurt in young athletes who participate in sports that involve repeated knee flexion and forced extension. Males are affected more often than females. Diagnosis is clinical; patients typically present with pain, swelling, warmth, and localized tenderness to palpation over the tibial tubercle.
• Osteoarthritis

  Summary

  A common and frequently debilitating joint disorder; prevalence increases with age.[19]​ The most commonly affected joints are the knee, hip, hands, and lumbar and cervical spine. Patients present with joint pain and stiffness that is typically worse with activity.
• Osteochondritis dissecans

  Summary

  An acquired, potentially reversible idiopathic lesion of subchondral bone resulting in delamination and sequestration with or without articular cartilage involvement and instability.[20] [21] [22]​ Majority of patients are adolescent or young adult athletes. Main joints involved include the knee, ankle, and radiocapitellar joint of the elbow. Variable presentation: traumatic or atraumatic, insidious onset, nonspecific joint pain, exacerbation of symptoms with exercise (especially stair or hill climbing), recurrent effusion, catching, or locking.
• Osteomalacia

  Summary

  A metabolic bone disease characterized by incomplete mineralization of the underlying mature organic bone matrix (osteoid) following growth plate closure in adults. Vitamin D deficiency is the most common cause. Patients frequently complain of diffuse bony pain with a history of limited sunlight exposure. Proximal muscle weakness, spinal tenderness to percussion, pseudofractures, and skeletal deformities are found commonly.
• Osteomyelitis

  Summary

  An inflammatory condition of bone caused by an infecting organism, most commonly Staphylococcus aureus. Severity can be staged depending on the etiology of the infection, its pathogenesis, extent of bone involvement, duration, and host factors particular to the individual patient. Broadly, bone infection is either hematogenous or contiguous-focus.
• Osteoporosis

  Summary

  Asymptomatic until fracture occurs. Diagnosis based on history of prior fragility fracture or low bone mineral density, which is defined as a T-score ≤-2.5. Screening is based on individual risk factors, including female sex, maternal history of fragility fracture/osteoporosis, older age, low body mass index (<20 kg/m²), androgen deprivation treatment (in males), aromatase inhibitor treatment (in females), corticosteroid use, tobacco use, and excessive alcohol intake.
• Osteoporotic spinal compression fractures

  Summary

  Most osteoporotic spinal compression fractures represent an isolated failure of the anterior spinal column due to a combination of flexion and axial compression loading. Patients may report sudden back pain from atraumatic activities such as standing from a seated position, bending forward, or coughing and sneezing.[23]​ Pain is characteristically exacerbated by movement. May also be an incidental finding in asymptomatic patients.
• Osteosarcoma

  Summary

  The most common nonhematological primary malignant neoplasm of bone in children and adolescents. Worsening pain over weeks to months is the first and most common symptom. Pain is usually mild initially, becoming more severe. It is often reported as more severe at rest and at night. The pain is often described as deep, dull, boring, and relentless.[24]
• Paget disease of bone

  Summary

  Chronic localized bone remodeling disorder characterized by increased bone resorption, bone formation, and remodeling, which may lead to major long bone and skull deformities. Majority of patients are asymptomatic, but may present with severe pain in long bones and, rarely, in some facial areas.
• Patellofemoral pain syndrome

  Summary

  Patellofemoral pain syndrome is one of the most common disorders of the knee seen in a sports medicine clinic.[25]​ The causes of patellofemoral problems are multifactorial, including abnormal patellofemoral joint mechanics, lower kinetic chain alterations, and overuse.
• Plantar fasciitis

  Summary

  An acute or chronic pain in the inferior heel at the attachment of the medial band of the plantar fascia to the medial calcaneal tubercle. Most commonly affects people between 40 and 60 years of age who are overweight or obese. Also occurs in 10% of runners.[26] Pain may radiate to the lateral heel. To make a diagnosis of plantar fasciitis, the pain must be relieved with rest.
• Polymyalgia rheumatica

  Summary

  Manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than age 50 years. Patients complain of difficulty rising from seated or prone positions, significant shoulder and hip girdle stiffness, varying degrees of muscle tenderness, shoulder/hip bursitis, and/or oligoarthritis. More common in women.[27]​ 15% to 20% of patients with polymyalgia rheumatica (PMR) have giant cell arteritis (GCA); 40% to 60% of GCA patients have PMR.[28]
• Popliteal cyst

  Summary

  Usually the result of pathology of the knee joint, such as arthritis or a cartilage tear. May present with swelling or pain behind the knee, but most cases are asymptomatic. A popliteal cyst may rupture, leading to severe pain and calf swelling.
• Psoriatic arthritis

  Summary

  Chronic inflammatory musculoskeletal disease associated with psoriasis. Psoriatic arthritis frequently presents with a pattern of monoarticular or oligoarticular joint involvement. In patients with multiple joints involved, the pattern lacks the symmetry of rheumatoid arthritis.
• Reactive arthritis

  Summary

  An inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections, particularly Chlamydia species, Campylobacter jejuni, Salmonella enteritidis, Shigella, and Yersinia. Patients may give a history of an antecedent genitourinary or dysenteric infection 1 to 4 weeks before onset. Presenting features include systemic symptoms such as fever, peripheral and axial arthritis, enthesitis (inflammation where tendons insert into bone), dactylitis (swelling of an entire finger or toe), conjunctivitis and iritis, and skin lesions including circinate balanitis and keratoderma blennorrhagicum.
• Rheumatoid arthritis

  Summary

  The most common inflammatory arthritis, characterized by symmetric arthritis of the small joints of the hands and feet.[29]​ A chronic, erosive arthritis that requires early and aggressive treatment.
• Rib fractures

  Summary

  May be due to blunt force injury, falls, nonaccidental injury, aggressive CPR, or more rarely, severe coughing, athletic activities, or metastatic lesions and primary bone tumors. Rib fractures can be relatively benign, but often may be a marker of concomitant injuries such as pneumothorax, hemopneumothorax, and/or pulmonary contusions, flail chest, and possible nonthoracic injuries.
• Rickets

  Summary

  Deficient mineralization at the growth plate of long bones, resulting in growth retardation. If the underlying condition is not treated, bone deformity occurs, typically causing bowed legs and thickening of the ends of long bones. Only occurs in growing children before fusion of the epiphyses, and typically affects wrists, knees, and costochondral junctions. Occurs primarily because of a nutritional deficiency of vitamin D, but can be associated with deficiencies of calcium or phosphorus.
• Rotator cuff injury

  Summary

  Common cause of shoulder pain, especially in older and active people.[30] [31]​ Tears can be symptomatic or asymptomatic. Cause of tear can be traumatic or attritional.
• Scoliosis

  Summary

  Adolescent idiopathic scoliosis is a structural spinal deformity characterized by decompensation of the normal vertebral alignment during rapid skeletal growth in otherwise healthy children. Back pain is usually minimal or absent at presentation. Significant pain at presentation warrants a careful evaluation for other causes of the spinal deformity. Patients with a severe curvature are at risk of further curve progression and may develop long-term problems related to the degree of the deformity caused by this curvature and/or back pain.[32] [33]
• Slipped capital femoral epiphysis

  Summary

  Typically seen in the adolescent age group. It occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis. May present with an acute/insidious onset of pain and limp. Obligatory external rotation on hip flexion is a key exam finding.
• Cauda equina syndrome

  Summary

  Caused by compression of the lumbosacral nerve roots that extend below the spinal cord. Typical symptoms and signs of cauda equina syndrome (CES) include bladder dysfunction, LBP, bilateral or unilateral sciatica, lower limb weakness or numbness, bowel dysfunction, and sexual dysfunction.[34] [35]​​​ CES is a neurosurgical emergency, and delays in diagnosis and treatment may lead to permanent disability.
• Spinal stenosis

  Summary

  Condition typically resulting from degenerative changes in the lumbar spine. Patients typically present with long-term symptoms of neurogenic claudication characterized by back and leg pain and lower-extremity paresthesia, brought on by ambulation and relieved by sitting.
• Synovitis of the hip, transient

  Summary

  A self-limiting inflammatory disorder of the hip that commonly affects young children between 2 and 12 years of age. Presents acutely with mild to moderate hip pain and limp.[36]
• Temporomandibular disorders

  Summary

  Temporomandibular disorders (previously temporomandibular joint syndrome) are a group of disorders associated with pain in the mouth and face that can progress to chronic pain.[37] [38]​ Typically presents with 4 characteristic features: temporomandibular joint pain, noise in the joint, masticatory muscle tenderness, and limited mandibular movement.
• Tendinopathy

  Summary

  General term that describes tendon degeneration characterized by a combination of pain, swelling, and impaired performance. Common sites include the rotator cuff (supraspinatus tendon), wrist extensors (lateral epicondyle) and pronators (medial epicondyle), patellar and quadriceps tendons, and Achilles tendon.
• Tenosynovitis of the hand and wrist

  Summary

  Tenosynovitis of the hand and wrist is a group of entities with a common pathology involving the extrinsic tendons of the hand and wrist and their corresponding retinacular sheaths. They usually start as tendon irritation manifesting as pain, and can progress into catching and locking when tendon gliding fails.
• Thoracolumbar spine trauma

  Summary

  Thoracolumbar fractures are the usual outcome of thoracolumbar trauma. They usually occur as a result of high-energy trauma (e.g., road traffic accidents, falls from heights).[39]​ May occur spontaneously in patients with osteoporotic, neoplastic, or metabolic disorders of the spine.
• Torsion of the lower limb in children

  Summary

  Lower-extremity torsional abnormalities are common in children. Commonly attributed to femoral or tibial torsion, soft-tissue contractures, abnormal muscle tone, hindfoot varus/valgus, forefoot adduction/abduction, or a combination of these.
• Wrist fractures

  Summary

  Fractures of the distal radius are the most common fracture in adults. Typically caused by a fall on the outstretched hand. May be accompanied by fractures of the ulnar styloid, distal ulna and scaphoid. Isolated scaphoid fractures can also occur.