Musculoskeletal Medicine in Clinical Practice

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Filed under Basic Science. Musculoskeletal medicine MSM is that branch of medicine dealing with the conservative management of disorders of the musculoskeletal system, including the muscles, aponeuroses, joints and bones of the axial and appendicular skeletons, and those parts of the nervous system associated with them. These disorders represent the most common cause of disability in most countries across all age groups 1 and are the third most common reason for presentation to general practice.

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Yet, paradoxically, undergraduate and postgraduate education in MSM is at best elementary. The need for MSM training in medical schools and hospitals has been well established.

For instance, osteopathy and musculoskeletal medicine special-interest doctors are recognised in the United Kingdom, musculoskeletal physicians are recognised in Europe and the United States has osteopathic MDs. Historically in Australia it has been left to the allied healthcare professionals and alternative healthcare practitioners to absorb much of the demand for musculoskeletal MS management. The medical profession has been slow to embrace MSM, but has a vital role to play. The optimal management of MSM conditions epitomises the need for an integrated approach from practitioners knowledgeable in the biopsychosocial approach to management.

General practitioners with postgraduate MS training can work collaboratively with other healthcare providers to minimise pain and optimise function for patients. One of the most common MS disorders seen by healthcare practitioners in Australia is spinal pain. Persistent back pain is by far the most common reason for chronic MS patient encounter in Australian general practice, followed by knee, shoulder and neck.

This chapter focuses on the optimal management of spinal pain, although the general principles espoused may be used for all areas of the body.

Musculoskeletal Medicine in Clinical Practice - John K. Paterson - Google книги

The issue of low back pain LBP pervades Western society. Be it through lost work, missed recreation and sporting activities or money spent on prevention or cure, there are few people who have not had dealings with it.

Healthcare practitioners have been both blamed for exacerbating its prevalence and given credit for reducing it. It is abundantly covered in the media, and myths circulate swiftly through the populace. This section outlines the evidence on low back pain in a functional fashion.

TABLE Data on the natural history of LBP are variable but instructive when closely analysed. These studies paint a picture of recovery followed by relapse.

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History-taking primarily allows formulation of a diagnostic framework and assessment of prognosis. A reasonable framework is:. Although physical examination of LBP patients will rarely allow a patho-anatomic diagnosis to be made, it remains an extremely valuable tool.


Its strength lies in the opportunities it opens Box A confidently performed physical examination in association with meaningful dialogue is an important step in the overall management. BOX Initial inspection allows a record of asymmetry, pain behaviour, gait and skin lesions. A knowledge of surface landmarks Fig The physician should be alert for pain behaviour from the patient and its interpretation.

Overt or exaggerated pain behaviour is not a sign of malingering but, rather, a signal for the doctor to explore pain management issues in more depth.

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This would include psychosocial factors as well as biological. Spinous process of L4 lumbar vertebra lies at or just below the level of the iliac crest. T12 can be located by counting spinous processes back from the lumbosacral junction. T10 is at a line drawn along the 12th rib and continued to the midline to meet its contralateral fellow. Therefore, this book should be welcomed by all those for whom it is written, namely health care professionals and their patients.

Those who expect a textbook of practice will be disappointed. Whilst there is information aplenty, this is not a bench book; rather, it is a more leisurely guide to the clinical and admin- trative aspects of an important but neglected area of human s- fering. The reader must appreciate that this book needs more than a single read-through. It should be read thoroughly and inwardly digested before either rushing to take up the cudgels of manipulation or to condemn the author roundly for propagating witch-doctoring.

Chapter 5 The Economics of Musculoskeletal Medicine. Chapter 6 Teaching Musculoskeletal Medicine. Chapter 7 Headache and Migraine.

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Chapter 8 Neck Pain. Chapter 12 Pelvic Pain. Chapter 13 Leg Pain.

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Chapter 14 Will Musculoskeletal Medicine Work?