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Upon completion of the chapter, the reader will be able to:

  1. Describe the pathophysiologic principles of tissue injury and inflammation.

  2. Identify the desired therapeutic outcomes for a patient with musculoskeletal injury or pain.

  3. Identify the factors that guide selection of an analgesic or counterirritant for a particular patient.

  4. Recommend appropriate nonpharmacologic and pharmacologic therapy for a patient with musculoskeletal injury or low back pain.

  5. Design a patient education plan, including nonpharmacologic therapy and preventative strategies.

  6. Develop a monitoring plan to assess treatment of a patient with a musculoskeletal injury.


The musculoskeletal system consists of muscles, bones, joints, and associated structures (eg, ligaments, tendons, cartilage, bursas). Injuries related to the musculoskeletal system are classified by etiology. Acute soft-tissue injuries include strains and sprains of muscles and ligaments.1 Repeated movements in sports, exercise, work, or activities of daily living can lead to repetitive strain injury, where cumulative damage occurs to the muscles, ligaments, or tendons.2,3 Although tendonitis and bursitis can arise from acute injury, more commonly these conditions occur because of chronic microtrauma and stress.4,5 This chapter addresses injuries to the skeletal muscle and joint components with a focus on self-care treatment and limited discussion of non–self-care options. Other forms of chronic musculoskeletal pain, such as pain from rheumatoid arthritis (see Chapter 58) or osteoarthritis (see Chapter 59), are discussed elsewhere in this textbook.


Musculoskeletal injuries are commonly self-treated, so true estimates of the incidence of both acute and chronic injury are difficult to obtain. In the United States, a 3-year average from 2012 to 2014 demonstrated 145 million physician office visits per year and 423 million prescriptions attributed to musculoskeletal injury.6 These injuries may arise from activities in the workplace or from sports, and the most common etiology may differ throughout the lifespan.

Workplace musculoskeletal injuries may be caused by trauma, acute overexertion, or repetition and overuse.6 Overuse injury describes musculoskeletal injuries arising from repetitive motion.2,3 Other common terms include repetitive strain injury or cumulative trauma disorders. The most common sites of workplace injury include the upper extremities (eg, hand, shoulder, and wrist), back, and lower extremities (eg, ankle, knee). Workplace injuries are a leading cause of lost workdays, resulting in a substantial economic burden from lost productivity and lost wages.

Sprains and strains comprise the majority of sports-related injuries.6 In adults, the ankle is the most common site of injury, whereas in children the forearm, wrist, and hand are the most common injury sites.7 Tendon injuries are common in the foot and ankle, whereas bursitis tends to occur in the hip, shoulder, elbow and knee.4,5

In older adults, musculoskeletal injuries may not be related to work but to daily life. ...

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