MSK Conditions
Terry Stewart
Prevalence of MSK Conditions
Globally, musculoskeletal conditions affect approximately 1.71 billion people, and these conditions are the leading cause of disability with low back pain alone being the top cause of disability in approximately 160 countries. They substantially impair mobility and functional skills, and dexterity often resulting in early retirement, diminished well-being, and reduced social participation
So, why is this important for us as allied health and primary care practitioners?
Primary health professionals are essential in the early detection, effective management, and preventive care of musculoskeletal health, ultimately improving individual outcomes and reducing the societal and economic burden of musculoskeletal disabilities.
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The Diagnostic Challenge of MSK Conditions?
The diagnosis of musculoskeletal conditions presents several challenges due to their complex, varied, and often overlapping nature. Key diagnostic challenges include:
- Diverse and overlapping conditions: With over 150 different musculoskeletal diseases and syndromes affecting muscles, bones, joints, and connective tissues, distinguishing between specific conditions can be difficult, especially when symptoms overlap.
- Variable and non-specific symptoms: Many musculoskeletal conditions present with common symptoms such as pain, stiffness, or swelling, which are non-specific and can be caused by multiple disorders, making accurate diagnosis challenging.
- Chronic and fluctuating symptoms: Conditions like osteoarthritis, rheumatoid conditions, or fibromyalgia may have intermittent or progressive symptoms, complicating the clinical assessment and timing of diagnosis.
- Limitations of clinical examination: Physical findings can be subtle or non-specific, and signs may not be evident in early stages or in patients with comorbidities. Accuracy of diagnosis is also contingent upon the experience and skill of the practitioner assessing the patient.
- Imaging and tests: Accurate diagnosis of musculoskeletal conditions may require imaging and laboratory tests. It is important to interpret these results carefully, considering normal age-related and individual life history impacting tissue changes as such findings do not always directly correlate with levels of pain or symptoms.
- Differentiating between similar conditions: Conditions such as low back pain, neck pain, and widespread pain syndromes can have similar presentations but require different management strategies.
- Patient factors: Variability in patient age, comorbidities, pain perception, and reporting can complicate the clinical picture.
- Delayed or missed diagnoses: Due to the complexity and subtlety of early signs, some conditions are diagnosed late, impacting treatment outcomes.
These challenges underscore the importance of an interdisciplinary approach combining detailed clinical history, assessment, imaging, lab tests, and appropriate referrals to accurately diagnose musculoskeletal conditions. Frontline practitioners must recognise the complexity of these issues and prioritise early detection to enable timely and rational treatment to prevent the development of chronic pain conditions.
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- Williams A, Kamper SJ, Wiggers JH, O’Brien KM, Lee H, Wolfenden L, Yoong SL, Robson E, McAuley JH, Hartvigsen J, Williams CM. Musculoskeletal conditions may increase the risk of chronic disease: a systematic review and meta-analysis of cohort studies. BMC Medicine 2018; 16:167
- Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet 2018; 391: 2356–67.
