This page compiles our content related to musculoskeletal pain. For further information on diagnosis and treatment, follow the links below to our full BMJ Best Practice topics on the relevant conditions and symptoms.
Introduction
Relevant conditions
Adhesive capsulitis | go to our full topic on Adhesive capsulitis Chronic fibrosing condition characterised by insidious and progressive severe restriction of both active and passive shoulder range of motion, in the absence of a known intrinsic disorder of the shoulder. Many patients experience shoulder pain, but shoulder pain is not an essential component of adhesive capsulitis. |
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Ankle fractures | go to our full topic on Ankle fractures Although other fractures around and including the ankle can occur (such as distal tibial plafond fractures), the term 'ankle fracture' most commonly refers to fracture types in which one or more of either the medial, lateral, or posterior malleolus is broken. Pain is bony and present over the medial or lateral malleolus. |
Ankylosing spondylitis | go to our full topic on Ankylosing spondylitis Axial spondyloarthritis is a chronic progressive inflammatory arthropathy, which ultimately may lead to radiographical changes in the spine and sacroiliac joints. This radiographical stage is known as ankylosing spondylitis. Inflammatory back pain is the hallmark clinical feature. This is defined as back pain that is of insidious onset, worse in the morning and improves with exercise. |
Anterior cruciate ligament injury | go to our full topic on Anterior cruciate ligament injury Injury typified by sudden, painful, audible 'pop' noise. Patient typically presents with inability to return to activity, joint instability, and rapid development of effusion (haemarthrosis). Often tender at lateral femoral condyle, lateral tibial plateau, and tibiofemoral joint lines. |
Back pain, assessment of | go to our full topic on Back pain, assessment of Back pain is extremely common, and low back pain (LBP) in particular causes more disability globally than any other condition.[7][8] Various spinal structures including ligaments, facet joints, paravertebral musculature and fascia, intervertebral discs, and spinal nerve roots have been implicated as pain generators.[9] The aetiologies can be subdivided into 3 groups: mechanical, systemic, and referred. By far the most common cause is mechanical (97%).[9] However, most LBP is non-specific and the cause cannot be identified.[8] |
Brachial plexus injury | go to our full topic on Brachial plexus injury Most commonly results from motor vehicle accidents, gunshot or stab wounds, contact sport accidents, or workplace accidents during heavy physical labour.[10] The effects of the injury include paralysis, loss of sensation, and pain. The specific clinical presentation will depend on the nerve roots involved and the degree of injury to each root. |
Bursitis | go to our full topic on Bursitis A bursa is a sac containing a small amount of synovial fluid that lies between a tendon and either skin or bone to act as a friction buffer. In bursitis, there is thickening and proliferation of the synovial lining, bursal adhesions, villus formation, tags, and deposition of chalky deposits. This may result from repetitive stress, infection, autoimmune disease, or trauma. Key diagnostic findings are localised pain and tenderness over a bursa and swelling if superficially sited. |
Calcium pyrophosphate deposition (pseudogout) | go to our full topic on Calcium pyrophosphate deposition (pseudogout) Calcium pyrophosphate arthritis is caused by deposition of calcium pyrophosphate (CPP) crystals. It can be difficult to diagnose. CPP crystals in synovial fluids can be small, sparse, and difficult to find. It typically occurs in older patients. In patients aged <60 years, underlying metabolic conditions associated with calcium pyrophosphate deposition, such as hyperparathyroidism or haemochromatosis, should be investigated. |
Carpal tunnel syndrome | go to our full topic on Carpal tunnel syndrome A collection of symptoms and signs caused by compression of the median nerve in the carpal tunnel. It is the most common entrapment neuropathy.[11] Symptoms include numbness and/or tingling of the thumb and radial fingers, aching wrist, and clumsiness. |
Cervical spine trauma, acute | go to our full topic on Cervical spine trauma, acute Encompasses a wide range of potential injuries to ligaments, muscles, bones, and spinal cord that follow acute incidents ranging from a seemingly innocuous fall to a high-energy motor vehicle accident. In all cases, careful investigation is required to ensure that the stability of the cervical spine has not been compromised. In extreme cases, cervical spine instability can lead to progressive neurological deficit, quadriplegia, and even death. |
Cervical spine disease, degenerative | go to our full topic on Cervical spine disease, degenerative Osteoarthritis of the spine, including the spontaneous degeneration of either disc or facet joints. Presenting symptoms include axial neck pain and neurological complications. |
Myalgic encephalomyelitis (chronic fatigue syndrome) | go to our full topic on Myalgic encephalomyelitis (chronic fatigue syndrome) Characterised by a sudden or gradual onset of persistent disabling fatigue, post-exertional malaise, unrefreshing sleep, cognitive and autonomic dysfunction, and pain, with symptoms lasting at least 6 months.[12] These symptoms are otherwise unexplainable and persist for at least 6 months, are not alleviated by rest, and significantly impair quality of life. Although diagnostic criteria stipulate that diagnosis in adults should not be made until after 6 months of symptoms (3 months for children) and negative medical evaluation, the 2021 UK National Institute for Health and Care Excellence (NICE) guidance discusses the negative impact of a 6-month delay in starting management. NICE therefore recommends that observation in adults be reduced to 3 months before initiating therapy. |
Chronic pain syndromes | go to our full topic on Chronic pain syndromes Chronic pain is one of the most common reasons for seeing a primary care physician. There are many causes of chronic pain, and these may be attributed to musculoskeletal (mechanical) causes, neurological causes, causes of headaches, psychological causes or localised disease, or as part of a generalised disease process. The prevalence of chronic pain increases with age, affecting nearly 30% of older people.[13] Typical aetiologies in this population are arthritis, osteoporosis with fractures, and lumbar stenosis. These conditions are treatable and should not be considered part of the normal ageing process. Untreated chronic pain in older adults can result in depression, poor quality of life, and loss of independence. |
Coccygodynia | go to our full topic on Coccygodynia Disabling pain in the coccyx, usually provoked by sitting or rising from sitting. May be post-traumatic (e.g., a fall or childbirth), non-traumatic, or idiopathic in origin. |
Compartment syndrome of extremities | go to our full topic on Compartment syndrome of extremities Characterised by elevated interstitial pressure in a closed osteofascial compartment that results in microvascular compromise (restriction of capillary blood flow).[14] Can be caused by fracture, compartment haemorrhage, direct soft-tissue injury, or direct muscular injury. |
Complex regional pain syndrome | go to our full topic on Complex regional pain syndrome Prolonged pain, disproportionate to the initiating event, most frequently a minor trauma and most commonly affecting the distal aspect of an extremity. Pain is often described as spontaneous, burning, lancinating, sharp, shooting, or electric. Characteristically develops dull, boring, and aching qualities with chronicity. |
Costochondritis | go to our full topic on Costochondritis Presents with insidious onset of anterior chest wall pain exacerbated by certain movements of the chest and deep inspiration. Key sign is pain on palpation of costochondral joints (particularly the second to the fifth). |
Discogenic low back pain | go to our full topic on Discogenic low back pain A complex, multi-factorial, clinical condition characterised by LBP with or without the concurrence of radicular lower limb symptoms in the presence of radiologically-confirmed degenerative disc disease. The pain is exacerbated by activity, but may be present in certain positions, such as sitting. |
Epicondylitis | go to our full topic on Epicondylitis Typically occurs during the fourth and fifth decades of life. Patients describe a history of activities contributing to overuse of the forearm muscles that originate at the elbow. Both lateral epicondylitis (commonly known as tennis elbow) and medial epicondylitis (commonly known as golfer's elbow) are characterised by pain during or following elbow flexion and extension. |
Fibromyalgia | go to our full topic on Fibromyalgia A syndrome characterised by widespread pain in the body present for at least 3 months.[15][16] It is thought to be related to amplified pain signals in the spinal cord and brain. Patients with fibromyalgia typically present with chronic, waxing and waning, widespread body pain. Comorbid symptoms such as fatigue, memory difficulties, and sleep and mood difficulties are common. |
Ganglion cyst | go to our full topic on Ganglion cyst Smooth, soft, benign masses that are usually located on the wrist. Patients may experience occasional aching discomfort secondary to compression of surrounding structures. In some patients, this aching is only present after activity. Occult ganglia are usually undetectable by physical examination but may be a cause of vague wrist pain. |
Gout | Acute onset of severe joint pain, with swelling, effusion, warmth, erythema, and/or tenderness of the involved joint(s). The disease most commonly affects the first toe (podagra), foot, ankle, knee, fingers, wrist, and elbow; however, it can affect any joint. |
Groin pain | go to our full topic on Groin pain Most common presentation for intra-articular pathology of the hip joint; however, referred pain from other sources is not uncommon. Signs and symptoms typically include activity-related pain, pain with movement of the hip, and antalgic gait. |
Hip fractures | go to our full topic on Hip fractures Generally considered to be any fracture of the femur distal to the femoral head and proximal to a level a few centimetres below the lesser trochanter. Associated most commonly with low-energy injury (e.g., fall from standing height) and osteoporosis or osteopenia. The risk increases significantly with age. |
Iliotibial band syndrome | go to our full topic on Iliotibial band syndrome Iliotibial band syndrome is the most common cause of lateral knee pain in runners, related to repetitive friction of the iliotibial band sliding over the lateral femoral epicondyle. Runners predisposed to this injury are typically in a phase of overtraining and often have underlying weakness of the hip abductor muscle. |
Joint dislocation | go to our full topic on Joint dislocation Complete separation of 2 articulating bony surfaces, often caused by a sudden impact to the joint. Typically, patients have significant pain when attempting motion and are significantly apprehensive about moving the affected joint. Diagnosis is usually confirmed with plain x-rays. |
Joint, inflamed, assessment of | go to our full topic on Joint, inflamed, assessment of Inflammatory arthritis is a common term for several conditions that manifest as joint pain, swelling, and stiffness with varying degrees of functional impairment. In patients with pain and swelling in a single joint, acute infection is a relatively common cause - one that can result in rapid and irreversible damage. In contrast, the majority of patients with involvement of multiple joints tend to have disorders of chronic duration. |
Juvenile idiopathic arthritis | go to our full topic on Juvenile idiopathic arthritis Most common chronic rheumatic disorder of children and includes several subtypes. Affected joints can be painful, especially during motion and on palpation. Objective arthritis in joints for at least 6 weeks is necessary for diagnosis.[17] |
Knee injury, assessment of | go to our full topic on Knee injury, assessment of By most definitions, acute knee injuries are defined as being diagnosed within the first 30 to 42 days of the injury or onset of symptoms. Chronic knee injuries are due to residual old trauma or surgery, existing degenerative diseases, or previous conditions not resolved within the first 30 to 42 days after the onset. |
Medial collateral ligament injury | go to our full topic on Medial collateral ligament injury Occurs when excessive valgus stresses or external rotation forces are placed on the knee joint. Most common symptom is medial-sided knee pain above or below the joint line. Patients are usually able to walk. Diagnosis and grading is primarily made with history taking and physical examination. |
Meniscal tear | go to our full topic on Meniscal tear Menisci can tear due to traumatic injury or degenerative wear (e.g., in knee joint arthritis), and can compromise force distribution across the knee joint. Tears can cause knee pain, swelling, limited range of motion, and catching, locking, and buckling of the knee joint. |
Muscle cramps | go to our full topic on Muscle cramps Although mostly benign and self-limited, muscle cramps may also be indicative of a wide variety of potentially serious systemic disorders. Idiopathic (ordinary) muscle cramps are common, short-lived, and usually involve the calf muscle and/or foot. The diagnostic approach for idiopathic muscle cramps is one of exclusion. |
Musculoskeletal lower back pain | go to our full topic on Musculoskeletal lower back pain Pain, stiffness, and/or soreness of the lumbosacral region. Diagnosis is made by eliminating specific causes of LBP arising from neurological compromise, neoplasia, inflammatory arthritis, fracture, or referred pain from other locations or organ systems. |
Musculoskeletal sprains and strains | go to our full topic on Musculoskeletal sprains and strains Strain is an injury to the muscle or musculotendinous junction, whereas a sprain is an injury to the ligament. History and physical examination are key in diagnosis and grading of the injury as grade 1 (mild), 2 (moderate), or 3 (severe with complete rupture). |
Neck pain, assessment of | go to our full topic on Neck pain, assessment of Patients may present acutely, particularly in the setting of trauma, or with more chronic pain. The estimated lifetime prevalence of a significant episode of neck pain is 40% to 70%, and the global point prevalence of neck pain is 4.9%.[18][19] It is important to detect neck pain caused by significant causes (e.g., primary or metastatic cancer) and pain associated with neurological compromise. |
Osgood-Schlatter's disease | go to our full topic on Osgood-Schlatter's disease Overuse syndrome of the paediatric population that results in traction apophysitis of the tibial tubercle. Typically occurs during an adolescent growth spurt in young athletes who participate in sports that involve repeated knee flexion and forced extension. Males are affected more often than females. Diagnosis is clinical; patients typically present with pain, swelling, warmth, and localised tenderness to palpation over the tibial tubercle. |
Osteoarthritis | go to our full topic on Osteoarthritis A common and frequently debilitating joint disorder; prevalence increases with age.[20] The most commonly affected joints are the knee, hip, hands, and lumbar and cervical spine. Patients present with joint pain and stiffness that is typically worse with activity. |
Osteochondritis dissecans | go to our full topic on Osteochondritis dissecans An acquired, potentially reversible idiopathic lesion of subchondral bone resulting in delamination and sequestration with or without articular cartilage involvement and instability.[21][22][23] Majority of patients are adolescent or young adult athletes. Main joints involved include the knee, ankle, and radiocapitellar joint of the elbow. Variable presentation: traumatic or atraumatic, insidious onset, non-specific joint pain, exacerbation of symptoms with exercise (especially stair or hill climbing), recurrent effusion, catching, or locking. |
Osteomalacia | go to our full topic on Osteomalacia A metabolic bone disease characterised by incomplete mineralisation of the underlying mature organic bone matrix (osteoid) following growth plate closure in adults. Vitamin D deficiency is the most common cause. Patients frequently complain of diffuse bony pain with a history of limited sunlight exposure. Proximal muscle weakness, spinal tenderness to percussion, pseudofractures, and skeletal deformities are found commonly. |
Osteomyelitis | go to our full topic on Osteomyelitis An inflammatory condition of bone caused by an infecting organism, most commonly Staphylococcus aureus. Severity can be staged depending on the aetiology of the infection, its pathogenesis, extent of bone involvement, duration, and host factors particular to the individual patient. Broadly, bone infection is either haematogenous or contiguous-focus. |
Osteoporosis | go to our full topic on Osteoporosis Asymptomatic until fracture occurs. Diagnosis based on history of prior fragility fracture or low bone mineral density, which is defined as a T-score ≤-2.5. Screening is based on individual risk factors, including female sex, maternal history of fragility fracture/osteoporosis, older age, low body mass index (<20 kg/m²), androgen deprivation treatment (in males), aromatase inhibitor treatment (in females), corticosteroid use, tobacco use, and excessive alcohol intake. |
Osteoporotic spinal compression fractures | go to our full topic on Osteoporotic spinal compression fractures Most osteoporotic spinal compression fractures represent an isolated failure of the anterior spinal column due to a combination of flexion and axial compression loading. Patients may report sudden back pain from atraumatic activities such as standing from a seated position, bending forward, or coughing and sneezing.[24] Pain is characteristically exacerbated by movement. May also be an incidental finding in asymptomatic patients. |
Osteosarcoma | go to our full topic on Osteosarcoma The most common non-haematological primary malignant neoplasm of bone in children and adolescents. Worsening pain over weeks to months is the first and most common symptom. Pain is usually mild initially, becoming more severe. It is often reported as more severe at rest and at night. The pain is often described as deep, dull, boring, and relentless.[25] |
Paget's disease of bone | go to our full topic on Paget's disease of bone Chronic localised bone remodelling disorder characterised by increased bone resorption, bone formation, and remodelling, which may lead to major long bone and skull deformities. Majority of patients are asymptomatic, but may present with severe pain in long bones and, rarely, in some facial areas. |
Patellofemoral pain syndrome | go to our full topic on Patellofemoral pain syndrome Patellofemoral pain syndrome is one of the most common disorders of the knee seen in a sports medicine clinic.[26] The causes of patellofemoral problems are multifactorial, including abnormal patellofemoral joint mechanics, lower kinetic chain alterations, and overuse. |
Plantar fasciitis | go to our full topic on Plantar fasciitis An acute or chronic pain in the inferior heel at the attachment of the medial band of the plantar fascia to the medial calcaneal tubercle. Most commonly affects people between 40 and 60 years of age who are overweight or obese. Also occurs in 10% of runners.[27] Pain may radiate to the lateral heel. To make a diagnosis of plantar fasciitis, the pain must be relieved with rest. |
Polymyalgia rheumatica | go to our full topic on Polymyalgia rheumatica Manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than age 50 years. Patients complain of difficulty rising from seated or prone positions, significant shoulder and hip girdle stiffness, varying degrees of muscle tenderness, shoulder/hip bursitis, and/or oligoarthritis. More common in women.[28] 15% to 20% of patients with polymyalgia rheumatica (PMR) have giant cell arteritis (GCA); 40% to 60% of GCA patients have PMR.[29] |
Popliteal cyst | go to our full topic on Popliteal cyst Usually the result of pathology of the knee joint, such as arthritis or a cartilage tear. May present with swelling or pain behind the knee, but most cases are asymptomatic. A popliteal cyst may rupture, leading to severe pain and swelling in the calf. |
Psoriatic arthritis | go to our full topic on Psoriatic arthritis Chronic inflammatory musculoskeletal disease associated with psoriasis. Psoriatic arthritis frequently presents with a pattern of monoarticular or oligoarticular joint involvement. In patients with multiple joints involved, the pattern lacks the symmetry of rheumatoid arthritis. |
Reactive arthritis | go to our full topic on Reactive arthritis An inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections, particularly Chlamydia species, Campylobacter jejuni, Salmonella enteritidis, Shigella, and Yersinia. Patients may give a history of an antecedent genitourinary or dysenteric infection 1 to 4 weeks before onset. Presenting features include systemic symptoms such as fever, peripheral and axial arthritis, enthesitis (inflammation where tendons insert into bone), dactylitis (swelling of an entire finger or toe), conjunctivitis and iritis, and skin lesions including circinate balanitis and keratoderma blennorrhagicum. |
Rheumatoid arthritis | go to our full topic on Rheumatoid arthritis The most common inflammatory arthritis, characterised by symmetric arthritis of the small joints of the hands and feet.[30] A chronic, erosive arthritis that requires early and aggressive treatment. |
Rib fractures | go to our full topic on Rib fractures May be due to blunt force injury, falls, non-accidental injury, aggressive CPR, or more rarely, severe coughing, athletic activities, or metastatic lesions and primary bone tumours. Rib fractures can be relatively benign, but often may be a marker of concomitant injuries such as pneumothorax, haemopneumothorax, and/or pulmonary contusions, flail chest, and possible non-thoracic injuries. |
Rickets | go to our full topic on Rickets Deficient mineralisation at the growth plate of long bones, resulting in growth retardation. If the underlying condition is not treated, bone deformity occurs, typically causing bowed legs and thickening of the ends of long bones. Only occurs in growing children before fusion of the epiphyses, and typically affects wrists, knees, and costochondral junctions. Occurs primarily because of a nutritional deficiency of vitamin D, but can be associated with deficiencies of calcium or phosphorus. |
Rotator cuff injury | go to our full topic on Rotator cuff injury Common cause of shoulder pain, especially in older and active people.[31][32] Tears can be symptomatic or asymptomatic. Cause of tear can be traumatic or attritional. |
Scoliosis | go to our full topic on Scoliosis Adolescent idiopathic scoliosis is a structural spinal deformity characterised by decompensation of the normal vertebral alignment during rapid skeletal growth in otherwise healthy children. Back pain is usually minimal or absent at presentation. Significant pain at presentation warrants a careful evaluation for other causes of the spinal deformity. Patients with a severe curvature are at risk of further curve progression and may develop long-term problems related to the degree of the deformity caused by this curvature and/or back pain.[33][34] |
Slipped capital femoral epiphysis | go to our full topic on Slipped capital femoral epiphysis Typically seen in the adolescent age group. It occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis. May present with an acute/insidious onset of pain and limp. Obligatory external rotation on hip flexion is a key examination finding. |
Cauda equina syndrome | go to our full topic on Cauda equina syndrome Caused by compression of the lumbosacral nerve roots that extend below the spinal cord. Typical symptoms and signs of cauda equina syndrome (CES) include bladder dysfunction, LBP, bilateral or unilateral sciatica, lower limb weakness or numbness, bowel dysfunction, and sexual dysfunction.[35][36] CES is a neurosurgical emergency, and delays in diagnosis and treatment may lead to permanent disability. |
Spinal stenosis | go to our full topic on Spinal stenosis Condition typically resulting from degenerative changes in the lumbar spine. Patients typically present with long-term symptoms of neurogenic claudication characterised by back and leg pain and lower-extremity paraesthesia, brought on by ambulation and relieved by sitting. |
Synovitis of the hip, transient | go to our full topic on Synovitis of the hip, transient A self-limiting inflammatory disorder of the hip that commonly affects young children between 2 and 12 years of age. Presents acutely with mild to moderate hip pain and limp.[37] |
Temporomandibular disorders | go to our full topic on Temporomandibular disorders Temporomandibular disorders (previously temporomandibular joint syndrome) are a group of disorders associated with pain in the mouth and face that can progress to chronic pain.[38][39] Typically presents with 4 characteristic features: temporomandibular joint pain, noise in the joint, masticatory muscle tenderness, and limited mandibular movement. |
Tendinopathy | go to our full topic on Tendinopathy General term that describes tendon degeneration characterised by a combination of pain, swelling, and impaired performance. Common sites include the rotator cuff (supraspinatus tendon), wrist extensors (lateral epicondyle) and pronators (medial epicondyle), patellar and quadriceps tendons, and Achilles' tendon. |
Tenosynovitis of the hand and wrist | go to our full topic on Tenosynovitis of the hand and wrist Tenosynovitis of the hand and wrist is a group of entities with a common pathology involving the extrinsic tendons of the hand and wrist and their corresponding retinacular sheaths. They usually start as tendon irritation manifesting as pain, and can progress into catching and locking when tendon gliding fails. |
Thoracolumbar spine trauma | go to our full topic on Thoracolumbar spine trauma Thoracolumbar fractures are the usual outcome of thoracolumbar trauma. They usually occur as a result of high-energy trauma (e.g., road traffic accidents, falls from heights).[40] May occur spontaneously in patients with osteoporotic, neoplastic, or metabolic disorders of the spine. |
Torsion of the lower limb in children | go to our full topic on Torsion of the lower limb in children Lower-extremity torsional abnormalities are common in children. Commonly attributed to femoral or tibial torsion, soft-tissue contractures, abnormal muscle tone, hindfoot varus/valgus, forefoot adduction/abduction, or a combination of these. |
Wrist fractures | go to our full topic on Wrist fractures Fractures of the distal radius are the most common fracture in adults. Typically caused by a fall on the outstretched hand. May be accompanied by fractures of the ulnar styloid, distal ulna, and scaphoid. Isolated scaphoid fractures can also occur. |
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