Musculoskeletal Treatments

One of the best parts of my job as a family medicine interest group and family medicine career advisor is reading student drafts of their personal statements for residency applications. It is deeply rewarding to read the students’ values highlighted in their stories and experiences. One of the values that students often highlight as they describe their reasons for joining this field is whole-person care.

I thought about whole-person care frequently as I worked on this edition of FP Essentials. Musculoskeletal conditions are often acute and episodic; a single injury occurs and heals, and the patient is back to baseline quickly. Just as often, though, musculoskeletal conditions are chronic, ongoing concerns, and these require a whole-person approach to care. Chronic conditions are associated with significant mobility restrictions that can affect other health problems, such as respiratory or cardiovascular disease.¹ Ongoing pain from musculoskeletal or other sources is associated with anxiety and depression as well.² Taking care of the musculoskeletal concern truly means taking care of the whole person.

This edition of FP Essentials addresses acute and chronic aspects of musculoskeletal care. The first section reviews fracture management, with focuses on recognizing injuries that can be safely managed in family medicine and those requiring referral. The second section discusses injection therapies, emphasizing indications, techniques, and safety considerations when using corticosteroids, prolotherapy, viscosupplementation, and other injections. The third section explores physical modalities, including exercise, physical therapy, osteopathic manipulation therapy, and other nonpharmacologic approaches to treating musculoskeletal pain. In the fourth section, you’ll find information on screening for and diagnosis of co-existing mental health conditions, as well as information on integrative therapies. This section also recommends ways to assess the quality and reliability of integrative therapies, which is useful for both clinicians and patients.

I hope you share my optimism about the students who are writing these thoughtful personal statements, and I hope you find this edition useful in your clinical practice.

Kate Rowland, MD, MS, FAAFP, Associate Medical Editor
Vice Chair of Education and Associate Professor,
Department of Family Medicine
Rush University, Chicago, Illinois

Kana Maeji Carter, DO, CAQSM, is an assistant professor and faculty physician at the University of Hawai’i Family Medicine Residency Program. She is also a family medicine and sports medicine physician for University Family Medicine at Pali Momi Medical Center. Dr. Carter completed a fellowship in primary care sports medicine. Her clinical interests include musculoskeletal and procedural ultrasonography, as well as lifestyle medicine.

Bradlee Sako, MD, CAQSM, is a family medicine physician affiliated with the Queens Health Care Center–Mililani. He completed a fellowship in primary care sports medicine. His clinical interests include point-of-care ultrasonography, diagnostic and procedural sports medicine, and teaching.

Cynthia L. Kim, LCSW, is the director of behavioral health at the University of Hawai’i Family Medicine Residency Program and a licensed mental health clinician for University Family Medicine at Pali Momi Medical Center. Her clinical interests include neurobiopsychology of trauma, healing, and well-being and lesbian, gay, bisexual, transgender, and queer plus affirmative care in integrated behavioral health and medicine.

Liana Kobayashi, DO, MPH, is a family medicine physician who is board certified in osteopathic neuromusculoskeletal medicine and practices at the Waipahu Academic Health Center. She is also a faculty physician at the University of Hawaiʻi Family Medicine Residency Program. Dr. Kobayashi completed a fellowship in osteopathic neuromusculoskeletal medicine. Her clinical interests include osteopathic manipulative medicine, public health, and lifestyle medicine.

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

• Identify common fractures in primary care.
• Describe management of common fractures in family medicine.
• Summarize indications for injection therapies for musculoskeletal conditions.
• Assess the risks and benefits of injection therapies for musculoskeletal conditions.
• Explain the physical modalities used to treat musculoskeletal conditions.
• Describe the evidence to guide the choice of physical modalities for musculoskeletal conditions.
• Diagnose comorbid mental health conditions in patients with chronic pain.
• Describe methods of identifying accurate information about integrative therapies.