Musculoskeletal Pain

Musculoskeletal pain can be caused by disorders of bones, joints, muscles, tendons, ligaments, bursae, or a combination (see Introduction to the Biology of the Musculoskeletal System Introduction to the Biology of the Musculoskeletal System The musculoskeletal system provides form, stability, and movement to the human body. It consists of the body's bones (which make up the skeleton), muscles, tendons, ligaments, joints, cartilage... read more ). Injuries are the most common cause of pain.

Bone pain is usually deep, penetrating, or dull. It commonly results from injury. Other less common causes of bone pain include bone infection (osteomyelitis Osteomyelitis Osteomyelitis is a bone infection usually caused by bacteria, mycobacteria, or fungi. Bacteria, mycobacteria, or fungi can infect bones by spreading through the bloodstream or, more often, by... read more ), hormone disorders, and tumors Overview of Bone Tumors Bone tumors are growths of abnormal cells in bones. Bone tumors may be cancerous (malignant) or noncancerous (benign). Cancerous tumors may start in the bone (primary cancer) or start in other... read more .

Muscle pain (known as myalgia) is often less intense than 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, loss of blood flow to the muscle, infection, or a tumor. Polymyalgia rheumatica Polymyalgia Rheumatica Polymyalgia rheumatica involves inflammation of the lining of joints, causing severe pain and stiffness in the muscles of the neck, back, shoulders, and hips. The cause is unknown. The neck... read more is a disorder that causes severe pain and stiffness in the neck, shoulders, upper and lower back, and hips.

Tendon and ligament pain is often less intense than bone pain. It is often described as "sharp" and is worse when the affected tendon or ligament is stretched or moved and is usually relieved by rest. Common causes of tendon pain include tendinitis Tendinitis and Tenosynovitis Tendinitis is inflammation of a tendon. Tenosynovitis is tendinitis accompanied by inflammation of the protective covering around the tendon (tendon sheath). The cause is not always known. Tendons... read more , tenosynovitis Tendinitis and Tenosynovitis Tendinitis is inflammation of a tendon. Tenosynovitis is tendinitis accompanied by inflammation of the protective covering around the tendon (tendon sheath). The cause is not always known. Tendons... read more , lateral epicondylitis Lateral Epicondylitis Lateral epicondylitis is inflammation of the tendons of muscles that extend the hand backward and away from the palm. (See also Overview of Sports Injuries.) Pain develops in the outer aspect... read more or medial epicondylitis Medial Epicondylitis Medial epicondylitis is inflammation of the tendons of the muscles that flex or bend the palm toward the wrist, causing pain on the inner aspect of the elbow and forearm. (See also Overview... read more , and tendon injuries. The most common cause of ligament pain is injury (sprains Overview of Sprains and Other Soft-Tissue Injuries Sprains are tears in ligaments (tissues that connect one bone to another). Other soft-tissue injuries include tears in muscles (strains) and tears (ruptures) in tendons (tissues that connect... read more ).

Bursae pain can be caused by trauma, overuse, gout, or infection. Bursae are small fluid-filled sacs that provide a protective cushion around joints. Usually, pain is worse with movement involving the bursa and is relieved by rest. The affected bursa may swell.

Joint pain (called arthralgia) may or may not be related to joint inflammation (called arthritis). Arthritis may cause swelling as well as pain. A wide variety of disorders can cause arthritis, including

Arthritic pain can be new (acute, for example, when caused by infections, injuries, or gout), or longstanding (chronic, for example, when caused by rheumatoid arthritis or osteoarthritis). Pain resulting from arthritis is typically worse when the joint is moved but usually is present even when the joint is not being moved. Sometimes pain originating in structures near the joint, such as ligaments, tendons, and bursae, seems to be coming from the joint.

Fibromyalgia Fibromyalgia Fibromyalgia is characterized by poor sleep, fatigue, mental cloudiness, and widespread aching and stiffness in soft tissues, including muscles, tendons, and ligaments. Poor sleep, stress, strains... read more may cause pain in the muscles, tendons, or ligaments. The pain is usually felt or causes tenderness in multiple locations and may be difficult to describe precisely but is usually not coming from the joints. Affected people usually have other symptoms, such as fatigue and poor sleep.

Some musculoskeletal disorders cause pain by compressing nerves. These conditions include the tunnel syndromes (for example, carpal tunnel syndrome Carpal Tunnel Syndrome Carpal tunnel syndrome is a painful compression (pinching) of the median nerve as it passes through the carpal tunnel in the wrist. The cause of most cases of carpal tunnel syndrome is unknown... read more , cubital tunnel syndrome Cubital Tunnel Syndrome Cubital tunnel syndrome is a disorder caused by compression (pinching) of the ulnar nerve at the elbow. Repetitive use of the elbow can cause cubital tunnel syndrome. Symptoms include numbness... read more , and tarsal tunnel syndrome Tarsal Tunnel Syndrome Tarsal tunnel syndrome is pain in the ankle, foot, and sometimes toes caused by compression of or damage to the nerve supplying the heel and sole (posterior tibial nerve). Symptoms include burning... read more ). The pain tends to radiate along the path supplied by the nerve and may be burning. It is usually accompanied by tingling, numbness, or both.

Sometimes, pain that seems to be musculoskeletal is actually caused by a disorder in another organ system. For instance, shoulder pain may be caused by a disorder affecting the lungs, spleen, or gallbladder. Back pain may be caused by a kidney stone Stones in the Urinary Tract Stones (calculi) are hard masses that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine. Tiny stones may cause no symptoms, but larger stones... read more , abdominal aortic aneurysm Abdominal Aortic Aneurysms Abdominal aortic aneurysms are bulges (dilations) in the wall of the aorta in the part that passes through the abdomen (abdominal aorta). Abdominal aortic aneurysms typically slowly expand and... read more , inflammation of the pancreas, or, in women, pelvic disorders. Arm pain may be caused by a heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or a heart attack (myocardial infarction), depending on the location and amount... read more (myocardial infarction).

In trying to establish the cause of joint pain, doctors first determine

Determining these factors gives important clues to what disorder is likely causing the pain. Doctors do a physical examination to help determine these factors and detect other important findings that could help determine the cause of the pain.

Sometimes, the type of pain suggests where the pain has originated. For example, pain that worsens with movement suggests a musculoskeletal disorder. Pain with muscle spasm suggests that pain is caused by a muscle disorder (sometimes a chronic spinal cord injury). The site of swelling or the location of tenderness when the doctor feels (palpates) the area (for example, a joint, ligament, or bursa) or passively moves a joint often indicates the source of pain.

However, often these characteristics of pain do not indicate its origin or cause. Thus, doctors usually base a specific diagnosis on the presence of other symptoms, physical examination findings, and often the results of laboratory tests and x-rays. For example, Lyme disease often causes joint pain with swelling and a bull's eye-like rash, and blood tests show antibodies to the bacteria that cause Lyme disease. Gout is characterized by a sudden attack of pain, swelling, and redness in the joint at the base of the big toe or other joints. Tests of the joint fluid generally show the presence of uric acid crystals.

Pain is usually best relieved by treating its cause. The doctor may recommend pain relievers (see also Treatment of Pain Treatment of Pain Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more ) such as acetaminophen Acetaminophen Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more , nonsteroidal anti-inflammatory drugs Nonsteroidal Anti-Inflammatory Drugs Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more (NSAIDs), or, if pain is severe, opioids Opioid Pain Relievers Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more . Depending on the cause, applying cold Cold therapy (cryotherapy) Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more or heat Heat therapy Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more or immobilizing the joint may help relieve musculoskeletal pain.