Mitzi Perdue

Musculoskeletal Problems In Women

CONSIDER MUSCULOSKELETAL PROBLEMS WHEN MAKING DIAGNOSES

When a woman comes in with pain, consider the possibility that her pain has a musculoskeletal cause. I’ve seen many cases of women who’ve seen a dozen specialists over the years but none diagnosed the musculoskeletal problems that were causing the pain. These patients may feel depressed because of the pain but also worried about their sanity, given that the specialists haven’t been able to find what’s wrong. When these women get a correct diagnosis, it’s a life-changing experience for them.

WHEN MAKING A DIAGNOSIS FOR THE CAUSE OF PAIN, TAKE THE PATIENTS’ HISTORY

As a typical example of why I take a patient’s history when she complains of pain; take the case of a woman who came into my office complaining of pain above her pubic bone. There are a number of tests that might seem appropriate in the absence of further information; such as a colonoscopy or checking for an ovarian cyst.

However, consider this example. You take a patients history and learn that just recently she slipped on ice and fell. You then start touching the rectus abdominus, and you find that this is exactly where it hurts. When you ask her to hold a sit-up position, she tells you that this increases the pain. These are strong indications that the problem is muscular. Having taken her history, and taking anatomy into account, you may be able to get to a correct diagnosis rapidly without subjecting her to unnecessary, expensive, and time-consuming tests.

CHECK PELVIC FLOOR MUSCLES AFTER CHILDBIRTH

After delivery, it’s important to get a sense of how the pelvic floor muscles are recovering. Unfortunately, pelvic floor problems tend to be invisible and undertreated, and left untreated, they may set the woman up for urinary incontinence later in life. Urinary incontinence is the number one reason for women entering nursing homes, so doing something to prevent it early on is important. To check the pelvic floor muscles, palpate to see if the woman is having pain, and do this both through the vagina and the rectum. If there’s a problem, refer her to a pelvic floor physical therapist.

PRACTICE TRIAGE FOR MUSCULOSKELETAL PROBLEMS

Learning to figure out which problems need referral for surgical care and which can be treated in house is an important skill for the primary care provider. An anterior cruciate ligament (ACL) tear can be a devastating injury and is likely to require surgical care. On the other hand, many if not most knee problems can be treated in house. The reason to be careful about not sending knee patients for surgical care if they’re not true candidates for surgery is that the patient is likely to end up at the back of the line for treatment. In a hospital setting, I’ve come across patients who had waited for months before being seen.

ENCOURAGE EXERCISE AND GOOD POSTURE

Exercise and good posture are important at any age.  Post-menopause, the costs of poor posture and lack of exercise show up in a significant increase in complaints of pain. Poor posture can result in compression fractures in the spine. The habit of leaning forward can mean the arms aren’t hanging from the shoulders in the right position, and this in turn can mean rotator cuff pain. Further, the frailty associated with sarcopenia (muscle loss) and osteoporosis can be devastating. Exercise can slow both muscle loss and bone loss, and strengthening the back can mean better posture.