Nonarticular musculoskeletal pain

Rationale

Nonarticular musculoskeletal pain is a common condition, though seldom damaging or life-threatening. Often referred to as “soft tissue” pain, it is a frequent cause for concern, prompting those affected to seek medical advice.

Causal Conditions

(list not exhaustive)

1. Generalized pain
   1. Acute pain (e.g., viral infections)
   2. Chronic pain (e.g., fibromyalgia)
2. Localized pain
   1. Acute pain
      1. Trauma
      2. Infection (e.g., osteomyelitis, necrotizing fasciitis)
      3. Vascular (e.g., compartment syndrome, sickle cell disease)
      4. Referred pain from viscera (e.g., right shoulder tip pain from acute cholecystitis or splenic infarct; shoulder tip pain from ipsilateral subphrenic abscess; dissecting aneurysm; pleuritis; pericarditis)
   2. Chronic pain
      1. Mechanical (e.g., tendinopathy, bursitis, enthesitis)
      2. Vascular (e.g., intermittent claudication)
      3. Neoplastic
      4. Neuropathic
      5. Complex regional pain syndrome

Key Objectives

Given a patient with musculoskeletal pain, the candidate will differentiate symptoms arising from bone, joint, muscle, nerve, or vascular causes. The candidate will further classify the likely underlying pathology and determine if urgent action is required.

Enabling Objectives

Given a patient with musculoskeletal pain, the candidate will

1. list and interpret critical clinical findings, including those derived from
   1. determining likely anatomic and pathogenic pain mechanisms,
   2. determining whether the pain represents a condition requiring urgent investigation,
   3. identifying potential triggers,
   4. assessing the impact on function, and
   5. obtaining an occupational and recreational history;
2. list critical investigations and interpret the results of the investigations, including
   1. appropriate initial investigations (e.g., laboratory tests, radiography), and
   2. further specialized investigations if indicated (e.g., Doppler ultrasonography, magnetic resonance imaging, nerve conduction studies);
3. construct an effective management plan, including
   1. beginning urgent or acute management of any serious condition,
   2. providing education and counselling regarding self-limited or benign conditions,
   3. providing counselling regarding appropriate return to activities, and
   4. referring for specialized care if necessary.