University of Baghdad

College of Medicine
2023

Title: Regional musculoskeletal pain

Grade: 5rd
Module: Rheumatology
Speaker: Professor Dr. Faiq Isho Gorial
Date:23/11/2023
 University of Baghdad/ College of Medicine 2022-2023

Outlines
• LBP
• NP
• Shoulder pain
• Elbow pain
• Hand and Wrist pain
• Hip pain
• Knee pain
• Ankle and Foot pain
 University of Baghdad/ College of Medicine 2022-2023

Regional musculoskeletal pain

• Is a common presenting complaint

• Age-related degenerative disease of tendons and
ligaments, OA and trauma
 University of Baghdad/ College of Medicine 2022-2023

Back pain
• Affects 60%–80% of people in their lives.
• Disability from back pain has risen, despite stable prevalence.
• Back pain is the top reason for work absence in Western countries.
7% of UK adults see their GP yearly for back pain.
• Around 9% of people worldwide suffer from low back pain.
 University of Baghdad/ College of Medicine 2022-2023

Assessment of BP
University of Baghdad/ College of Medicine 2022-2023
University of Baghdad/ College of Medicine 2022-2023
University of Baghdad/ College of Medicine 2022-2023
IX of back pain University of Baghdad/ College of Medicine 2022-2023
Treatment University of Baghdad/ College of Medicine 2022-2023
 University of Baghdad/ College of Medicine 2022-2023

Neck pain
Shoulder pain University of Baghdad/ College of Medicine 2022-2023

• Common in individuals over 40 years of age.

University of Baghdad/ College of Medicine 2022-2023
University of Baghdad/ College of Medicine 2022-2023
Adhesive Capsulitis (Frozen Shoulder) University of Baghdad/ College of Medicine 2022-2023

 Pain with marked restriction of elevation and

external rotation.
 Commonly linked to diabetes mellitus and
neck/radicular lesions.
 Early stage treatment: Analgesia, intra- and
extracapsular glucocorticoid injections,
‘pendulum’ arm exercises.
 Recovery can take up to 2 years.
 Severe/persistent cases: Joint distension and
manipulation under anesthesia.
 University of Baghdad/ College of Medicine 2022-2023

Elbow pain
• Most common causes are repeated trauma
 University of Baghdad/ College of Medicine 2022-2023

Management
• is by rest
• analgesics and topical or systemic NSAIDs.
• Local glucocorticoid injections may be required in
resistant cases.
 University of Baghdad/ College of Medicine 2022-2023

Hand and wrist pain

 Articular
 Tenosynovitis
 Raynaud’s phenomenon:
 C6, C7 or C8 radiculopathy
 Carpal tunnel syndrome: hand position-dependent and/or
nocturnal pain, numbness and paraesthesia of thumb and
second to fourth digits
 University of Baghdad/ College of Medicine 2022-2023

Hip Pain
 University of Baghdad/ College of Medicine 2022-2023

Causes of hip pain

Knee Pain University of Baghdad/ College of Medicine 2022-2023
Knee pain important notes University of Baghdad/ College of Medicine 2022-2023

 Osteoarthritis (OA): Most prevalent cause of knee pain in

middle and older age.
 Meniscal Tear/Osteochondritis Dissecans: Associated with knee locking, a
sudden painful inability to fully extend the knee.
 Referred Pain from Hip: Presents at the knee but reproduced by hip
movement, not knee movement.
 Periarticular Lesions: Pain well localized to the involved structure.
 University of Baghdad/ College of Medicine 2022-2023

 Anterior Knee Pain:

 Due to patellar ligament or retinacular lesions such as enthesitis,
tendonitis, or fat-pad syndrome.
Often results from overuse or axial Spondyloarthritis (axSpA).
Common in adolescents, possibly due to patellar articular cartilage or
ligament insertion osteochondritis
Ankle and foot pain University of Baghdad/ College of Medicine 2022-2023
 University of Baghdad/ College of Medicine 2022-2023

Quiz
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#2923970

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Q1/ What is the most common cause of acute
back pain
in people aged 20-55?

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Q2/ Which condition is a common cause of
elbow pain due to repetitive trauma?

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 University of Baghdad/ College of Medicine 2022-2023

Q1/ What is the most common cause of acute back pain

in people aged 20-55?
A) Infection
B) Axial spondyloarthritis
C) Mechanical back pain
D) Malignancy
E) Spinal stenosis
 University of Baghdad/ College of Medicine 2022-2023

Q2/ Which condition is a common cause of elbow pain due to

repetitive trauma?
A) Osteoarthritis
B) Lateral epicondylitis
C) RA
D) Paget’s disease
E) Axial CPPD disease
University of Baghdad/ College of Medicine 2022-2023

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