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Musculoskeletal System Diseases and Disorders 97
Complementary and Alternative Therapy
Ayurveda Herbs yurveda is an alternative health care system from ancient India. It is considered to
be one of the oldest healing systems in science. It is based in a holistic culture and/
or natural view of health and well-being. Ayurveda focuses on plants, plant products,
sensible diet, exercise, and a well-rounded lifestyle. This is some research as to the effec
tiveness of using Ayurveda herbs in reducing pain in arthritis. The herbs have also been
used to treat ulcerative colitis and type 2 diabetes with some success. However, some
ayurvedic preparations may contain lead, mercury, or arsenic and could be harmful to
the user. Caution is recommended when using these products.
Source: NIH: National Center for Complementary and Integrative Health (2019).
group of conditions, but arthritis is a condition of
inflammation in a joint, whereas rheumatism is a con
dition of stiffness. Arthritis is any inflammation of a
joint. Everyone at some time or another has had arthri
tis; for example, a sprained ankle or jammed fingers are
arthritic conditions. Arthritis can be divided into two
main groups: osteoarthritis and rheumatoid arthritis.
Osteoarthritis is the most common form of arthritis,
but rheumatoid arthritis is the more serious and debil
itating type.
Osteoarthritis or Degenerative Joint Disease
■ Description. Osteoarthritis, a complex, degenerative
process, or wearing out of a joint, is the leading cause of
disability in the United States. It can begin as early as age
18 but is more common in the older population, with
80% of individuals older than age 65 affected.
■ Etiology. The exact cause of osteoarthritis is
unknown. The amount or degree of wear is associated
with several factors (Table 6-3). Sports injuries speed
the wear and tear on the joints, leading to osteoarthritis
at a younger age.
TABLE 6-3 Risk Factors for Osteoarthritis
The following are considered factors that increase
the risk of developing osteoarthritis:
■ Family history of osteoarthritis
■ Excessive wear and tear or injury to joints
■ Obesity
■ Increased risk with age
■ Female
■ Symptoms. Older adults are usually symptomatic
with this type of arthritis. It often affects frequently used
joints, such as those in the hands, and joints that are
weight-bearing such as those of the spine, hip, and knee.
Affected joints of the hands often swell and become
painful. The distal and proximal interphalangeal
(inter = between, phalangeal = finger bones) joints
are often affected and can acquire a crooked deformity
of the fingers. The metacarpophalangeal (meta =
beyond, carpo = wrist, phalangeal = finger bones)
joints are usually not affected (Figure 6-8).
Osteoarthritis that affects weight-bearing joints
often affects the spine, hips, and knees. As the joints of
the spinal column are affected with arthritis, individu
als can become symptomatic with back pain. Osteoar
thritis affects the hips and knees by wearing away the
articular (are-TICK-you-lar) cartilage at the end of the
long bones where bones articulate, or meet. Eventu
ally, the entire surface of the cartilage might be worn
away, exposing areas of raw bone. When this occurs,
new bone forms in and around the joint, causing the
bone ends to thicken. Fragments of this new bone are
called bone spurs and often lead to a decrease in joint
motion. X-ray examination might reveal the spurs and
only small patches of cartilage on the bone ends. This
is called a bone-on-bone condition, and at this point,
individuals are often candidates for total hip or knee
replacement surgery. Osteoarthritis peaks in the fifth to
sixth decades of life, with approximately 80% of indi
viduals showing symptoms by age 70.
■ Treatment. Treatment for osteoarthritis includes rest,
non-weight-bearing exercise such as swimming and
biking, the application of heat, and the use of analgesics
98 Chapter 6
Figure 6-8 Comparison of (left) osteoarthritis and (right) rheumatoid arthritis: hands and joints.
and anti-inflammatory medications. Severe osteoar
thritis can be treated by steroid injections into the joint
capsule to relieve pain. Total surgical joint replacement
might be recommended.
■ Diagnosis. The diagnosis is usually made based on
history and physical exam because X-rays do not always
correlate with symptoms.
■ Prevention. Maintaining a healthy body weight is
the single best prevention. Excess weight strains joints,
especially those of the knees and hips. It is estimated
that every 1 pound of body weight places approximately
3 pounds of stress on the joints of the knees and even
more on the hips.
Rheumatoid Arthritis
■ Description. Rheumatoid arthritis has been dis
cussed in Chapter 5, “Immune System Diseases and
Disorders,” as an autoimmune disorder that affects
not only the joints but also the connective tissues of
the entire body. Rheumatoid arthritis often affects the
lungs, heart, and blood vessels, causing the individual
to appear chronically ill. This type of arthritis often
affects people in the prime of life and affects women
more often than men. It is a debilitating, chronic dis
ease that destroys the joints.
■ Symptoms. A noticeable difference in the way osteo
arthritis and rheumatoid arthritis affect the joints can
be observed in joints of the hand. Osteoarthritis affects
the working joints of the hand (primarily the distal and
proximal interphalangeal joints), causing swelling and
pain. All joints of the hand can be affected in rheuma
toid individuals, often with noticeable deformity and
destruction in the metacarpophalangeal joints (see
Figure 6-8). Also, refer to Chapter 5 for more informa
tion on rheumatoid arthritis.
Gout
■ Description. Gout is often called gouty arthritis
because this condition leads to inflammation of the
affected joints.
■ Etiology. Gout is caused by a metabolic alteration
in the breakdown of certain protein foods. Individ
uals with gout deposit uric acid crystals in joints of
the body. Risk factors include being male, being over
weight, having hypertension, alcohol intake (especially
beer and spirits), using diuretics, and consuming a
protein-rich diet.
■ Symptoms. The primary joint affected is the
metatarsophalangeal (meta = between, tarso = foot,
phalangeal = toe bones) joint of the big toe. These
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Musculoskeletal System Diseases and Disorders 99
Stem Cell
Therapy for Knee
Osteoarthritis
Complementary and Alternative Therapy
S
tem cell therapy has been noted as the “miracle cure” for a variety of health condi
tions. It has also been considered a unique treatment for individuals suffering from
osteoarthritis of the knee. Animal research has shown success in treating diseases such
as parkinsonism, muscular dystrophy, low back pain, and even heart disease. Stem cell
therapy for knees has three goals:
■ Slow down the progression of the damage and/or repair the cartilage
■ Relieve the pain and inflammation
■ Prevent the need for knee replacement or delay the inevitable replacement
Stem cell therapy involves taking a small amount of blood from the patient, concentrat
ing the stem cells together and injecting this into the affected knee. As with any medical
procedure, there are risks and side effects so it might not be an option for everyone with
knee joint pain. The cost of the therapy is quite steep, and it is not offered but at limited
sites in the United States. It is still considered to be an investigational therapy by the
Federal Drug Administration.
Traditional treatments for osteoarthritis of the knee include conservative manage
ment, such as ice, compression, exercise, analgesics, and, finally, replacement surgery if
necessary. Perhaps, in the near future, stem cell therapy will be the treatment of choice
and affordable to all. Research into its use for osteoarthritic knees is ongoing.
Source: Leavitt (2020)
uric acid crystals have razor-sharp edges that irritate
the joint, causing an acute inflammatory response.
Symptoms are redness, heat, swelling, and pain in the
joint.
Gout is a disease that primarily affects men.
Chronic gout can be characterized by uric acid depos
ited in subcutaneous tissue as well as in the joint. These
deposits appear as small whitish nodules called tophi
and are commonly seen around a joint and in the soft
tissue of the ear (Figure 6-9). Kidney dysfunction and
an increase in the occurrence of kidney stones are also
common with chronic gout.
■ Diagnosis. Diagnosis is based on finding uric acid
crystals in joints, body fluids, tissues, or all of these. Uric
acid blood testing is also helpful in diagnosing gout.
(A) (B) (C)
Courtesy of Mark L. Kuss
Figure 6-9 Common sites of tophi.
100 Chapter 6
Healthy Highlight
Knuckle-Cracking
tt \k^UC ill knuckle-cracking cause arthritis in my joints?” This is a commonly asked
question by those who have developed the habit of knuckle-cracking, the
sound made by the rush of synovial fluid from one area of the joint to another as the
joint is forcefully pulled apart. Research supports the fact that this action does not cause
an increase in osteoarthritis, but it also supports the fact that individuals who crack
their knuckles eventually have decreased grip and hand function. Research does not
rule out the idea of knuckle-cracking causing joint damage. Knuckle-crackers might
not have to worry about an increase in osteoarthritic pain due to chronic knuckle
cracking, but they might still develop long-term pain from chronic ligament inflamma
tion. Some researchers feel that chronic joint pain, whether related to arthritis or not, is
still chronic joint pain and thus recommend that knuckle-crackers stop this behavior.
Interestingly, related research found that knuckle-crackers are also more likely to bite
their fingernails, smoke, and drink alcohol.
■ Treatment. Treatment can include antigout medi
cation (probenecid and allopurinol [Zyloprim
®
]) and
dietary adjustments to decrease the amount of protein
consumed. Weight loss in obese patients also can be
beneficial.
■ Prevention. Avoiding foods high in purine such as
meat, poultry, fish, and other seafood is helpful in pre
venting gouty attacks. Preventing dehydration by drink
ing plenty of fluids while avoiding diuretic drinks such
as tea and alcohol is also helpful.
Joint Deformities
Hallux Valgus
■ Description. Hallux (big toe) valgus (bent outward) is
a deformity affecting the metatarsophalangeal joint of
the big toe. It is more commonly called a bunion. This
condition occurs more frequently in women and tends
to run in families.
■ Etiology. The cause of bunions is controversial. Many
experts think the cause is an inherited faulty foot forma
tion that progresses over time and is irritated by poor or
improper footwear. Others think the footwear actually
causes the condition. Whatever the cause, all agree that
wearing pointed-toe shoes, especially with high heels,
aggravates the condition. This type of shoe forces the
great toe into a valgus position and increases the pres
sure on the metatarsophalangeal joint. Over time, this
chronic irritation leads to a buildup of soft tissue and
bone in the joint area (Figure 6-10).
■ Symptoms. Symptoms and signs include redness,
pain, and swelling in the area and, often, the inability to
wear pointed-toe or high-heeled shoes.
■ Diagnosis. Bunions are very visible and easily diag
nosed by X-rays.
Figure 6-10 Hallux valgus (bunion).
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Musculoskeletal System Diseases and Disorders 101
■ Treatment. Mild cases can be resolved by changing
to a properly fitting, low-heeled shoe. Analgesic and
anti-inflammatory medications can be beneficial in
relieving pain. More severe cases might need surgical
intervention with bunionectomy.
■ Prevention. Wearing proper footwear can prevent or
at least slow the progression of bunion.
Temporomandibular Joint Syndrome
■ Description. Temporomandibular joint syndrome
(TMJ) is an inflammation of the temporomandibular
joint, the joint that connects the lower jaw to the skull. This
disorder can result in significant pain and impairment.
■ Etiology. TMJ might be due to joint tissue lesions,
overbite, malocclusion, or improperly fitted dentures or
dental work.
■ Symptoms. Severe headaches and pain in the jaw
joint might be indicative of TMJ. This pain can be
made worse by chewing. Classic signs include a marked
decrease in the ability to open the mouth and a clicking
sound made during chewing motion.
■ Diagnosis. Examination of the mouth along with
dental X-rays, CT scan, or MRI scan aids in diagnosis
of TMJ.
■ Treatment. Treatment includes correction of the
causative factors, often leading to surgical intervention.
■ Prevention. Controlling or eliminating causative fac
tors aids in preventing TMJ.
Diseases of the Muscles
and Connective Tissue
Diseases of the muscles and connective tissue, unlike
many of the bone disorders, are quite common in very
young or young adult individuals. Some of these dis
orders, such as the muscular dystrophies, are chronic,
progressive, and devastating to families because they
usually result in early death. Other disorders of the
muscles and connective tissue are considered to be
rather minor and can be treated medically or surgically.
Consider This...
The tongue is the only muscle in the body
that is attached at only one end and is, for
its size, the strongest muscle in the body.
Muscular Dystrophy
■ Description. Muscular dystrophy (MD) is an inher
ited genetic disorder that affects skeletal muscle. There
are many types of dystrophies, but the most common
type is Duchenne’s MD, which primarily affects boys.
■ Symptoms. Duchenne’s MD is characterized by a
wasting away of shoulder and pelvic girdle muscles. Sur
vival beyond age 20 is rare. This disorder is discussed
in detail in Chapter 19, “Genetic and Developmental
Diseases and Disorders.”
Ganglion Cyst
■ Description. A ganglion cyst is a fluid-filled benign
tumor that usually develops on a tendon sheath near
the wrist area.
■ Etiology. The cause of these cysts is unknown,
although some feel that they might be associated with
a repetitive injury.
■ Symptoms. A cyst is commonly a single, smooth,
round lump just under the skin (Figure 6-11A, B). It
can be quite small or grow to the size of a dime or quar
ter. Usually, these are painless but unsightly. Cysts can
disappear gradually over a period of months.
■ Diagnosis. A physical exam is often all that is needed
to diagnose this condition.
■ Treatment. If they are painful or unsightly, the physi
cian might choose to rupture the cyst or drain it. Gangli
onectomy, or surgical removal, also can be performed.
■ Prevention. There are no preventive measures for
ganglion cysts.
Tetanus
■ Description. Tetanus, also called lockjaw, is an acute,
infectious, life-threatening disease characterized by
painful, uncontrolled contractions of skeletal muscle.
■ Etiology. A toxin produced by the bacillus bacterium,
Clostridium tetani, causes tetanus. This bacterium is
commonly found in animal feces and, when excreted,
lives as spores in the soil. The number of these spores is
especially high in barnyards, pastures, or garden areas
fertilized with animal manure. When this infectious
bacterium enters the body in an anaerobic (an = with
out, aerobic = air) wound such as a puncture, it grows
and produces a dangerous toxin. This toxin travels in
the blood and attaches to motor or muscle neurons.
The toxin irritates the nerve, producing the stimulus
(A)
rumruay/Shutterstock.com
Figure 6-11 (A) Ganglion cyst (B) Common sites of ganglion cysts
for skeletal muscle contraction. Because of the neuro
logic involvement, tetanus also may be categorized as a
nervous system disorder.
■ Symptoms. The bacterial toxin affects the nervous sys
tem rather slowly. The farther the distance between the
wound and the spinal cord, the slower the progression.
One to 3 weeks might pass before the onset of symptoms.
The jaw muscles are often the first muscles affected with
tetany (TET-ah-nee), or rigid muscle contraction, pre
venting the individual from opening the mouth, hence
the term lockjaw. Eventually, muscles of the esophagus,
neck, back, arms, and legs are affected. Other symptoms
are a high fever, tachycardia (rapid pulse rate), dysphagia
(difficulty swallowing), and intense pain.
■ Diagnosis. Diagnosis is confirmed by a spatula test,
which involves touching the posterior pharyngeal wall
(the very back of the throat) with a soft-tipped instrument.
A positive result is an involuntary contraction of the mus
cles causing the patient to bite down on the instrument.
■ Treatment. Treatment is a prompt and immediate
cleansing of wounds with special consideration given to
puncture-type wounds. Immunization might be needed,
depending on the individual’s immunization history. If
the individual has not received a tetanus toxoid injection
in the past 5 years, an antitoxin might be given to bind
and inactivate the tetanus toxin. Initially, tetanus tox
oid should be administered to children as part of basic
diphtheria, pertussis, and tetanus (DPT) immunization.
Tetanus antibodies must be boosted approximately
every 10 years throughout life. Individuals with low
tetanus antibody levels are susceptible to tetanus. An
antitoxin can be given to prevent tetanus following an
injury because the body does not have time to build up
its own antibodies. Following this episode, it is usually
recommended that the individual follow up with the
proper tetanus toxoid booster.
Care of an individual with tetanus includes symp
tomatic treatment, often including respiratory, nutri
tional, and hydration support. Antibiotics and muscle
relaxants also can be administered. Even with the best
of care, tetanus is usually fatal due to respiratory failure.
If the individual survives, the disease process usually
lasts 6 to 8 weeks. Surprisingly, the disease usually does
not leave any permanent disability, but it also does not
confer any lasting immunity to tetanus.
■ Prevention. Tetanus can be prevented by vaccination.
It is recommended that adults receive a booster vaccine
every 10 years. Standard care practice in many places is to
give the booster to any patient with a puncture wound who
is uncertain of when they were last vaccinated or if they
have had fewer than three lifetime doses of the vaccine.
Systemic Lupus Erythematosus
■ Description. Systemic lupus erythematosus is an
autoimmune disorder that affects the connective tissue
throughout the body. One of the main characteristics is
a butterfly-patterned rash across the nose and face. For
more details, see Chapter 5.
Neoplasms
Primary neoplasms of the musculoskeletal system are
uncommon. Typically, neoplasms of this system are
secondary, metastasizing from the lungs, breast, and
prostate. The most common primary tumor of bone
is osteosarcoma, which affects the tibia, humerus, or
femur. Ewing’s sarcoma is also primarily a bone tumor,
affecting long bones in children and teens. It is highly
malignant and quickly metastasizes to nearly every
organ of the body. Myeloma is the most common mar
row tumor, commonly affecting the pelvis, vertebrae,
and long bones of adults. Kaposi’s sarcoma affects the
soft tissue of primarily immunosuppressed individuals.
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Musculoskeletal System Diseases and Disorders 103
Rhabdomyosarcoma is a very rare but highly malignant
tumor of skeletal muscle.
Symptoms of musculoskeletal tumors can include
pathologic fracture and bone pain. Clinical examination
followed by radiologic studies, CT scan, blood studies,
and biopsy often confirm the diagnosis. The treatment
of malignant tumors of the musculoskeletal system can
include radiation, chemotherapy, and surgery. Surgi
cal procedures often involve excision and amputation.
Even with aggressive therapy, the prognosis for these
malignant neoplasms is often very poor.
Trauma
Trauma is the main cause of problems in the muscu
loskeletal system. Fractures are by far the most com
mon and frequent injury to bone. Tennis elbow is the
most frequent ailment of the upper body. Treatment
for sprains and strains is among the top 10 reasons that
patients seek medical attention for acute disease. Low
back pain is in the top 10 for chronic disease.
Fracture
A fracture (Figure 6-12) is any discontinuity of a bone. A
fracture and a break are synonymous, although a stress
(related to too much weight-bearing or pressure) frac
ture or incomplete fracture might not break the bone in
two. Fractures can be caused by trauma (injury) or can
be pathologic (caused by weakness from a disease).
Types of Fractures
Fractures may be classified in a number of ways. One
method of classification is based on the condition of
the overlying skin. If the bone has protruded through
the skin or an object has punctured the skin, mak
ing an opening through the skin to the fracture site,
it is an open fracture. Open fractures are also called
compound fractures because the fracture, plus the open
skin, is compounding the problem. An open fracture is
always an emergency due to the high risk of bone infec
tion. Patients with open fractures are taken to surgery
for cleaning and debridement. If there is no opening in
the skin, it is called a closed, or simple, fracture.
Another method of classification considers the
condition of the bone. If the fracture goes completely
through the bone, it is a complete fracture. If the bone
is fractured but not in two, it is an incomplete fracture.
A common incomplete fracture that occurs in children
is called a greenstick fracture because it appears to have
broken partially, like a sap-filled green stick.
Fractures also may be described by the number of
fragments or the position of the fragments. A displaced
fracture is one in which fragments are out of position,
whereas nondisplaced means the fragments are still in
correct position. If there are more than two ends or
fragments, the break is a comminuted fracture. Bone
appearing to be mashed down is a compression frac
ture. A common site of a compression fracture is in the
vertebrae. An impacted fracture is one characterized as
a bone end forced over the other end. Avulsion fracture
Figure 6-12 Fractured humerus (X-ray).
describes a separation of a small bone fragment from
the bone to which a tendon or ligament is attached.
The position of the fracture line as compared to bone
position might also describe the fracture. A longitudinal
fracture runs the length of the bone; a transverse fracture
runs across or at a 90-degree angle. Oblique fractures run
in a transverse pattern, and spiral fractures twist around
the bone. Stellate fractures form a starlike pattern.
Location may be used to describe the fracture. An
articular fracture involves a joint surface. Intracapsular
and extracapsular describe fractures inside or out
side the joint capsule, respectively. Intertrochanteric
describes fractures in the trochanter of the femur, and
femoral neck and subcapital fractures describe frac
tures located on the femur. Finally, fractures may be
named by the physician who first described them; for
example, Colles’ and Pott’s fractures are fractures of
the wrist and ankle, respectively (Figure 6-13).
To be very specific, a fracture may be more clearly
defined by using several descriptive names. For exam
ple, a diagnosis of a closed fracture is a broad diagnosis
Chapter 6
Colles’
fracture named for physician
Pathologic
caused by
weakness
from disease
Open
Closed
(compound) (simple) Lateral
(outside) view
Anterior
(front) view
Alila Medical Media/Shutterstock.com
Classification based
on skin condition
Femoral neck
fracture based on location
Pott’s fracture
Greenstick
Comminuted
Oblique
Compression
Impacted
Classification based on bone condition
Longitudinal Spiral Transverse
Classification based on position of fracture line
Figure 6-13 Types of fractures.
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Musculoskeletal System Diseases and Disorders 105
covering many kinds of fractures. A more descriptive
diagnosis would be a closed, comminuted fracture. An
even clearer diagnosis would be a closed, comminuted,
femoral neck fracture.
Sites and causes of fractures vary by age and gender.
Children commonly fracture their arms during falls.
Male adolescents commonly have long bone fractures
related to motor vehicle accidents (MVAs) or sports
injuries. Women suffer with hip fractures generally
related to falls and osteoporosis.
Treatment of Fractures
Treatment of fractures often involves first aid at the site of
the accident. First aid includes splinting the fracture site by
immobilizing the area to decrease movement and prevent
further injury. A splint should be applied in an as-is posi
tion. No attempt should be made to reduce the fracture
or place the bone back in a normal position at this time.
After medical assistance has been obtained, proper
treatment might require a reduction of the fracture. If
this can be accomplished without a surgical incision, it
is called a closed reduction, common in fractures of the
extremities. Radiography can confirm the proper posi
tion of the bones. If the fracture cannot be reduced with
out internal manipulation, the area is surgically opened,
or incised, and an open reduction is performed. Open
reductions commonly require some type of internal fixa
tion or holding device such as pins, plates, screws, or rods
in a procedure called an open reduction, internal fixa
tion (ORIF; Figure 6-14A, B, C). Open fractures require
surgical intervention to clean and debride the involved
tissue, usually by cleansing with copious (excessive)
amounts of fluid to prevent infection and osteomyelitis.
Closed and open reductions can require the appli
cation of a splint or cast to immobilize the area during
the healing process. Most fractures heal in 4 to 8 weeks,
depending on the site of fracture, the type of fracture, and
the age and nutritional status of the involved individual.
The application of traction might be beneficial to
relieve muscle spasms, hold a fracture in the correct
position, or stretch the muscles, allowing bone frag
ment ends to separate, thus reducing pain and further
tissue damage. Traction involves the application of
a device to maintain alignment and apply a pulling
force.
Traction may be classified by the type of application
device, two basic types of which are skeletal and skin.
Skeletal traction is used for long-term traction or when
large muscle groups are involved such as for a femur
fracture with resultant quadriceps spasm. Skeletal trac
tion involves placing a pin through the bone distal to
the fracture, and then ropes, pulley devices, and weights
apply traction or pull to the fracture site (Figure 6-15).
Skin traction is used for short-term traction or when
small muscle groups are involved. The traction device
is applied to the skin with the use of adhesive or elastic
wrapping. The same ropes, pulleys, and weights might
be used for skin traction, but the amount of weight
applied is usually less than with skeletal traction.
Complications of Fractures
Complications of fractures include malunion, non
union, avascular necrosis, and infection. Malunion is
the healing of a fracture in an abnormal or nonfunc
tional position; nonunion is the failure of the bone to
heal. The complication of avascular necrosis occurs
when the blood supply to the bone is not adequate to
maintain bone health and the bone tissue dies. Infection
of the bone has been discussed in detail under the sec
tion “Osteomyelitis.”
Healthy Highlight
Sports Injuries:
When to See
a Doctor
P
articipation in sports often results in numerous lumps, bumps, and bruises. Often,
these injuries heal without medical treatment, but some injuries, left unattended,
can lead to long-term difficulties. Often, individuals ask, “When should I see a doctor?
■
■
■
■
■
The following may be used as general guidelines for seeking medical attention:
Any injury in or near a joint
Pain that does not subside after 10 days
Any time there is obvious bone deformity
Injury that has not improved in 5 to 7 days
Any sign of infection: temperature of 101°F or greater, presence of pus, red streaks in
the tissue, or swollen lymph glands
106 Chapter 6
skyhawk x/Shutterstock.com
(A) (B)
(C)
Figure 6-14 Internal fixation devices. (A) Plate and screws of collar bone (B) Total hip fixation components (C) Plate and
screws of radius Left) AP view Right) Lateral view
Strains and Sprains
Strain
■ Description. A strain is a very common overstretch
ing injury of a muscle.
■ Etiology. Individuals commonly have lumbar strains
from lifting too much weight, lifting improperly, or
lifting repetitively. Strained backs are common after a
weekend of activity by an individual not in adequate
physical condition.
■ Symptoms. Symptoms include soreness, pain, and
tenderness.
■ Diagnosis. Strains, in most cases, are diagnosed
based on a history and physical exam. An exam
ination might reveal swelling and tenderness in the
affected area.
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