Emergency Department: Acute Musculoskeletal Pain and Acute Spinal Pain
Musculoskeletal injury may be present in any patient who has sustained other trauma, and it is managed according to the extent of injury and other injuries. In this section, focus will be on the musculoskeletal aspect alone. Patients presenting with spinal pain (neck, thoracic, lumbar or sacral) must be evaluated by taking a thorough systemic history followed by a clinical examination. Take note
Musculoskeletal injury may be present in any patient who has sustained other trauma, and it is managed according to the extent of injury and other injuries. In this section, focus will be on the musculoskeletal aspect alone.
Patients presenting with spinal pain (neck, thoracic, lumbar or sacral) must be evaluated by taking a thorough systemic history followed by a clinical examination. Take note of the following: the type of pain (duration, location, constant, intermittent, referred, spreading), chills and fever, local tenderness, physical activity, overuse injury, other skeletal pains, age (aortic aneurism), neurological complaints (spreading or referred pain, numbness, spasticity, weakness), GI complaints (peptic ulcer, jaundice, weight loss, faecal incontinence), genitourinary system (haematuria, incontinence, difficulty to pass urine) and haematological problems (anaemia, bruising). Also examine the breasts and thyroid.
Acute musculoskeletal pain usually follows injury (muscle injury, ligament injury, fracture, haemarthrosis or septic arthritis), overuse, gout and exacerbations of inflammatory arthropathies, such as rheumatoid arthritis and osteoarthritis. However, less common but very important causes must be kept in mind, including malignancy and haematological disorders.
The same approach is followed as with spinal pain. Usually, the diagnosis is obvious from the age of the patient and their history. Important information suggested in the history should not be overlooked. For example, an elderly person presenting with acute hip pain after a fall may have a fractured hip, but why did they fall? Dizziness and falls could be caused by, among others, autonomic neuropathy, diabetes mellitus, cardiac disease, carotid disease, epilepsy and drugs such as antihypertensive agents and analgesics (tramadol and meprobamate-containing preparations). Remember, shoulder pain may be referred cardiac pain.
South African Society of Anaesthesiologists (SASA) Guidelines for the Management of Acute Pain in Specific Scenarios 2022