An Overview of the Management of Persistent Musculoskeletal Pain

One of the most common reasons patients seeks medical treatment from healthcare providers is for musculoskeletal pain. A detailed history is the first step towards an accurate diagnosis. By simply asking a patient point to the source of pain or filling out a pain diagram are effective tools in the diagnosis of chronic pain. Because musculoskeletal symptoms can be the result of a wide range of disorders (orthopedic, neurologic or rheumatologic), a comprehensive neuromuscular exam is needed. It should include both motor and sensory evaluation of extremities as well as reflexes. Diagnostic Imaging is also recommended to help rule out concerning pathology that may be the cause of the pain, however it can be non-diagnostic at times. Treatment options can be grouped into four categories: therapies, medications, injections and surgery. By education the patient about these options can give the patient further awareness in directing their course of treatment and encouraging participation in their own care plan. It is also important to understand that some patients with chronic pain may also have associated psychological factors that may impede recovery. The main importance is to educate the patient that the primary goal is to rule out concerning pathology and that appropriate care is best achieved with the combination of an accurate diagnosis and an informed, motivated patient. By encouraging the patient to take an active role in the decision-making process regarding their treatment decisions is vital to their long term success.


Hans Carlson, M., & Nels Carlson, M. (2011, April 1). Therapeutic Advances in Musculoskeletal Disease. Retrieved April 7, 2011, from Medscape News Nurses: (Audria Herrera)

Imaging in Musculoskeletal Complications of Hemophilia

People with one of these bleeding disorders are prone to have recurrent episodes of hemorrhage into the joints. Acute bleeding increases the pressure in the synovial cavity and bone marrow, which possibly leads osteonecrosis or a pseudotumoral mass. Intra-articular bleeding produces a direct chemical effect on the synovium, cartilage, and bone. Over time, the blood becomes deposited in the form of hemosiderin in these tissues. Recurrent hyperemia of the joint in the growing child causes juxta-articular osteoporosis and overgrowth of the epiphysis. However, the imaging changes that appear first are effusion and synovial proliferation. Damage to the bone and articular cartilage appears later. The disease tends to be asymmetric in its involvement. Approximately 50% of patients with hemophilia develop permanent changes in the joint.

Imaging tests such as plain radiography or magnetic resonance imaging (MRI) are helpful in defining the degree of joint destruction. Treatment of patients with hemophilia at an early age may prevent progression to the later, destructive changes seen on radiographs.

Radioactive injections into joints (radiosynoviorthesis) can control hemorrhage. This treatment was initially used in cases of juvenile rheumatoid arthritis. Subsequently, radiosynoviorthesis was shown to be effective in reducing bleeding and effusion in selected cases of hemophilic arthropathy.


Ray F Kilcoyne, M. (2008, March 21). Imaging in Musculoskeletal Complications of Hemophilia . Retrieved April 8, 2011, from Medscape:

Baxter, A. (2009, December 18). Joint bleeding in Haemophilia. Retrieved April 8, 2011, from Youtube:
Video and Article by Greg Volz