MUSCULOSKELETAL INJURIES: SYMPTOMS, CAUSES, PREVENTION - MEDICINE - 2025

The musculoskeletal injuries are by far the most frequent reason for consultation in the emergency department worldwide. This concept does not refer to a specific disease but to a set of lesions that share certain common characteristics.

Considering its name, it is easy to intuit that these are injuries that affect the bones (osteo) and the muscles (muscular). However, its scope goes further since the concept also includes the elements of fixation of the joints (ligaments) and the points of attachment of the muscles in the bones (tendons).

Thus, musculoskeletal injuries include different types, so they can be classified according to the affected structure into bone, muscle, joint and tendon injuries.

On many occasions, two types of injury can occur simultaneously, which somewhat complicates their classification. On the other hand, according to their time of evolution, musculoskeletal injuries can be classified as acute or chronic.

Likewise, according to the production mechanism, there are at least three types of musculoskeletal injuries: mechanical (due to overuse), traumatic (due to blows, sprains or any external force that acts on the musculoskeletal system) and degenerative (due to the natural wear and tear of the muscles). structures affected; very common in joints).

In order to make a rational approach to treatment, and more importantly, to prevent these injuries, it is very important to know the basic elements of the pathophysiology in each case.

Types

As already mentioned, musculoskeletal injuries can be classified according to their location, time of evolution and mechanism of production. From this general classification, numerous combinations of injuries can be generated, such as:

- Muscle injury, acute, traumatic.

- Joint injury, denerative, chronic.

- Tendon injury, mechanical, acute.

- Tendon injury, traumatic, acute.

Thus one could continue until all possible combinations were completed; however, it would not make any sense if the basic characteristics of each type of injury are not known.

At this point, it is the responsibility of the physician to determine the combination that corresponds to each particular patient, based on in-depth knowledge of the pathophysiology of each of these lesions. The diagnosis of musculoskeletal injuries must be individualized for each patient.

Even so, a fairly detailed description of each type of injury can be made, in order to facilitate its understanding and subsequent clinical application.

Osteomuscular injuries according to the affected structure

This is the basic classification, since it allows anatomically locating the lesion and, therefore, predicting its evolution, prognosis and potential complications. These are four main types:

Muscle injuries

We speak of muscle injury when the injury affects the striated muscle tissue, either by rupture of its fibers or alterations of the intercellular space. In this sense, the most frequent muscle injuries are tears.

A muscle tear is nothing more than the breakdown of the fibers that make up a muscle. According to the amount of muscle involved, tears are classified using a scale from I to IV, with I being a partial, marginal tear that occupies less than 10% of the thickness of the muscle; and grade IV the complete rupture of it.

Muscle tears are very common in the muscles of the extremities and are almost always associated with sports activities or very heavy physical work.

After muscle tears, the most common types of muscle injury are pathological muscle contractures and contusions.

Pathological muscle contracture occurs when a striated muscle contracts continuously and involuntarily, causing discomfort to the person. The typical case is mechanical low back pain, in which the muscles of the back remain contracted constantly, causing pain and disability.

Generally these injuries are derived from the overuse or overload of a muscle group for a prolonged period.

For their part, muscle contusions are usually the result of trauma. In these injuries, there is inflammation (edema) in the interstitial muscle tissue and, in the most severe cases, bruising.

Finally there is a group of degenerative inflammatory diseases that include the group of myositis. These are diseases where muscle fibers become inflamed and their cells are destroyed, causing long-term disability.

Bone injuries

The bone lesion par excellence is the fracture; that is, the breaking of the bone at one or more points due to the effects of external forces acting on it.

Fractures are always acute, although there may be cases of poorly treated fractures that progress to a chronic condition known as pseudoarthrosis; however, it is not the most common.

Although the most common cause of fractures is trauma, they are not the only cause. Pathological fractures may occur, in these cases a bone that is fragile due to some medical condition (osteoporosis, calcium-binding diseases, etc.) breaks due to the force that the muscles themselves exert on it.

Joint injuries

They are all those injuries that affect a bone at the point where it connects with another; that is, in the joint.

Joint injuries can affect different structures: from the bone itself (as in the case of intra-articular fractures), through the cartilage (the classic example is the menisci of the knees) and reaching the ligaments and the synovial capsule.

The most common joint injury is a sprain or strain. In these cases there is an elongation of the ligament apparatus of the joint due to a joint movement that goes beyond the physiological range. In the most severe cases of sprains, the ligaments may rupture.

After sprains, another very common injury at the joint level is dislocation. In this type of injury, one of the bone structures that make up a joint literally "slips out" of its place, causing limited or no movement of the affected joint.

Another structure that is very frequently injured in the joints is the cartilage. When the injury is traumatic, we speak of cartilage fractures, being the fracture of the menisci of the knee one of the most common clinical entities in this group. On the other hand, when the lesion is degenerative, it is called osteoarthritis.

In osteoarthritis, the articular cartilage thins due to overuse, wear and tear and degeneration, gradually causing the bone surfaces to come into contact with each other, which generates inflammation and, eventually, destruction of the joint.

In regard to the joints, chronic inflammation can also occur, as in the case of different types of arthritis. Likewise, in cases of trauma there may be accumulation of fluid in the joint space (hemarthrosis).

Tendon injuries

Tendon injuries are very common, especially in the lower limbs, near the ankle joint, where there is a very high concentration of tendons under stress.

Tendons can become inflamed (tendinitis) usually due to overuse; the classic example is Achilles tendonitis (inflammation of the Achilles tendon). They can also become inflamed from overuse, as in the case of rotator cuff tendonitis of the shoulder.

In addition, the tendons can rupture (tendon rupture), either due to overload (as in the Achilles tendon rupture) or trauma (rupture of the tendons of the fibular muscles in the grade IV ankle sprain that affects the external aspect of the joint).

In the case of tendons there is a clinical condition known as avulsion fracture, which affects the attachment of the tendon to the bone.

In these cases, the muscle contracts with such force that the tendon dislodges from its insertion point, usually "tearing" part of the cortex. It is a very painful injury and difficult to diagnose, so the experience of the doctor is crucial to be able to identify it.

Musculoskeletal injuries according to time of evolution

They are classified into two large groups: acute and chronic. At this point it is very important to establish a clear difference, since the treatment and prognosis vary according to the evolution.

Some injuries can present in both forms, both acute and chronic, while others have only one (acute or chronic). Also, there are some acute injuries that have the potential to become chronic, so that the diagnosis changes over time.

Acute injuries

An acute musculoskeletal injury is considered to be any one that appears in a previously healthy patient and evolves in a matter of minutes, hours or a few days.

In general, there is a clear cause-effect relationship between a certain event and the appearance of symptoms, which usually appear abruptly, intensely and untimely.

Acute injuries are usually traumatic, although some mechanical injuries can also begin with an acute episode.

Chronic injuries

A musculoskeletal injury is classified as chronic when it evolves over weeks, months, or years.

Usually the onset of symptoms is insidious, the person does not clearly identify when the first complaints began, and there is no clear causal association between a given event and the appearance of symptoms.

It is common for the discomfort to progress, increasing in intensity as well as the disability that they generate as time passes.

Most of the time, chronic injuries are degenerative (such as arthritis), although in certain cases of poorly treated trauma (non-immobilized sprains, for example) a chronic condition derived from the acute event may appear.

The same is true for mechanical injuries; However, in these cases the acute event usually goes unnoticed or is interpreted as a mild discomfort; however, as the injury reappears over and over again, it ends up becoming a chronic injury. The classic example of this condition is mechanical low back pain.

Osteomuscular injuries according to the mechanism of production

According to the mechanism of production, musculoskeletal injuries are divided into three main types: mechanical, traumatic, and degenerative.

It is very important to identify the exact cause, since not only the treatment depends on it, but also the prognosis of the patient.

In general, traumatic injuries have the best prognosis, while degenerative ones have a more ominous future; For their part, mechanical injuries are located midway between the previous ones in terms of prognosis.

Mechanical injuries

Mechanical injury is defined as all that derived from overuse, overload or abuse of the musculoskeletal system without external factors.

This means that there is no type of trauma or element involved in the genesis of the injury, deriving this from the execution of their normal activities but in an exaggerated way.

Examples of this type of injury are many; the most common are tennis elbow, golfer's shoulder, and mechanical low back pain. Here is a description of these conditions:

Tennis elbow

Known technically as "epicondylitis", it is the inflammation of the elbow ligaments due to the continuous repetition of the flexion-extension movement of the elbow.

Although it was first described in tennis players, anyone who repeatedly flexes and extends the elbow for very long periods can develop tennis elbow, no matter that they have never played tennis.

Golfer's shoulder

It is similar to tennis elbow, but in this case it is the inflammation of the shoulder ligaments, as well as the muscles that move it (rotator cuff) due, once again, to the overuse of the joint.

As with tennis elbow, golfer's shoulder can appear in anyone whose work or sports activity requires frequent and repetitive movement of any of the shoulder movements.

Lumbago Mechanical

It is one of the most common muscle problems, popularly known as lumbago. It is the pathological and inflammatory contracture of the muscles of the lower back due to the overuse or misuse of the muscle groups of the lumbar region.

Traumatic injuries

In these cases, the mechanism of action is the transfer of energy from the outside to the musculoskeletal system through a direct impact (blow, fall, etc.).

Trauma often results in fractures, ligament ruptures, and contusions. They can be open and closed, the common denominator of all being the transfer of a large amount of energy to the anatomical elements.

Degenerative lesions

Degenerative lesions are due to the natural wear and tear of the anatomical elements, either by use over the years or by tissue degeneration due to age. The typical case is osteoarthritis.

In addition to degeneration and aging, there are also autoimmune and inflammatory diseases that can degenerate bone or joint structures, as is the case with rheumatoid arthritis.

Symptoms

The symptoms of musculoskeletal injuries are very varied and depend largely on the affected structure, the time of evolution and the cause. Even so, it can be said that all these lesions present common symptoms, which will manifest with greater or lesser intensity in each case.

These symptoms are pain in the affected area, inflammation, and a local increase in temperature; Furthermore, depending on the degree of severity, some degree of functional limitation may occur in the affected structures.

The degree of functional limitation can be so mild that it cannot be perceived unless special clinical tests are performed, or so severe that the affected person needs assistance to perform daily tasks, such as walking or even combing their hair.

Causes

The causes of musculoskeletal injuries were described in their classification according to the mechanism of action.

In this sense, it can be summarized that the mechanical causes include the overuse of the musculoskeletal structures.

For its part, trauma includes all injuries derived from impacts, blows, falls, projectiles and even explosions that transfer energy to the tissues, these being absorbed by the tissues of the musculoskeletal system.

Finally, degenerative lesions are due to chronic inflammation of the tissue (as in arthritis) or to the natural wear and tear of the tissues due to aging and movement (such as occurs in osteoarthritis).

Prevention

The prevention of musculoskeletal injuries largely depends on the clinical condition of each patient. However, certain general measures can be listed that should greatly prevent the appearance of these lesions:

- Adequate warm-up before sports activities.

- Stretching after exercising.

- Use of adequate protection measures when there are risks of trauma (helmets, shoulder pads, etc.), either at work or when playing sports.

- Diet rich in calcium, iron and magnesium.

- Exercise regularly.

- Avoid lifting weights that exceed 10% of body weight.

- Limit repetitive movements of the joints.

- Use of suitable footwear.

- Maintain an appropriate weight for sex, height and age.

- Consume proteins of high biological value at least 3 times a week.

- Maintain a correct posture at all times.

- Adhere to ergonomic standards in the workplace and in activities of daily life.

- Raise loads using the proper technique and avoiding exceeding the recommended limits for sex, weight and age.

- Consult a doctor in case of any symptoms suggestive of musculoskeletal problems.

Treatment

Depending on the cause, the patient's clinical conditions and the severity of the injury, there are different therapeutic strategies, which may include one or more of the following treatments:

- Physical means (local heat or cold).

- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).

- Steroids (oral or parenteral).

- Physiotherapy.

- Orthopedic measures (immobilizations, orthotics).

- Surgery.

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