Musculoskeletal Health
Core concepts
Low back pain dominates. Most is mechanical and self-limited; red flags (cauda equina, cancer history, fever, IV drug use, trauma, progressive neuro deficit, age >50 with new pain) mandate imaging or urgent referral. Otherwise, avoid early imaging and opioids; favor activity, NSAIDs, and physical therapy. Radiculopathy with a consistent dermatomal pattern can be managed conservatively; surgery is for progressive deficits or refractory symptoms.
Osteoarthritis management is exercise and weight loss first, then topical NSAIDs, then oral NSAIDs, with intra-articular steroids for flares and arthroplasty for end-stage disease. Know that glucosamine/chondroitin have weak evidence and are not recommended. Osteoporosis: DXA screening in women 65+ and men 70+, with FRAX guiding treatment; bisphosphonates are first-line, with drug holidays after 3–5 years.
Other high-yield areas: fracture description (open vs. closed, neurovascular status), septic arthritis (hot swollen joint, fever, need for aspiration - do not delay), gout (podagra, negatively birefringent crystals; treat acute flares with NSAIDs, colchicine, or steroids), and carpal tunnel (nocturnal symptoms, Phalen/Tinel). Remember rotator cuff, plantar fasciitis, and de Quervain for pattern recognition.
Traps
- Imaging before 6 weeks in uncomplicated back pain.
- Opioids first-line for musculoskeletal pain - wrong.
- Missing red flags (bowel/bladder dysfunction, saddle anesthesia).
- Confusing septic arthritis with gout - aspiration is the answer.
Rule of thumb
For any acute joint or back complaint, first ask: Are there red flags? If no, favor conservative care and avoid imaging; if yes, escalate immediately.