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Musculoskeletal Hits Top 10 in Primary Care Visits
Published on Physicians Practice (http://www.physicianspractice.com)
Musculoskeletal Hits Top 10 in Primary Care Visits
June 23, 2015
By Leo Robert [1]
For key facts and figures about musculoskeletal disorders, perhaps a surprise as the fourth leading
diagnostic category in primary care, see the pages that follow.
Musculoskeletal Makes Its Bones in Primary Care
Musculoskeletal disorders encompass rheumatologic diseases (rheumatoid arthritis [RA],
osteoarthritis) and orthopedic conditions (back pain, sports injuries), so patients with these problems
might be expected to pay more visits to rheumatologists and orthopedic surgeons than to other
health care professionals.
In fact, patients with musculoskeletal problems most often visit primary care offices.
Of the total ambulatory care visits to physician offices and hospital outpatient and emergency
departments for diseases of the musculoskeletal system and connective tissue in 2009-2010, 37%
were to primary care offices, compared with 31% to surgical specialists and 16.5% to medical
specialists.
Why? Perhaps because patients who have muscle, bone, and joint concerns often go to their primary
care physician first. In many cases, the primary care physician can make the proper diagnosis and
treat the problem. In others, the primary care physician makes an appropriate diagnosis and then
refers the patient to a rheumatologist or orthopedic surgeon for treatment.
This article, the fifth in a series on “Top 10 Reasons Why Patients Come to Primary Care,” reports on
visits for diseases of the musculoskeletal system and connective tissue.
See the pages that follow for key facts and figures about musculoskeletal disorders, perhaps a
surprise as the fourth leading diagnostic category in primary care.
More Than 100 Million Visits for Musculoskeletal
• Almost 105 million of the more than 1.25 billion ambulatory care visits to physician offices and
hospital outpatient and emergency departments in the United States in 2009-2010 were for diseases
of the musculoskeletal system and connective tissue.
• Of these visits, 39 million were to primary care offices, 32.4 million to surgical specialists, and 17
million to medical specialists.
• For osteoarthritis and allied disorders, 3.5 million visits were to primary care offices (31% of visits,
compared with 54.5% and 8% of visits to surgical specialty and medical specialty offices,
respectively).
• Six million of the more than 17 million visits for “derangements and other unspecified disorders of
joints” went to primary care (35% of visits vs 37% and 10% to surgical specialty and medical
specialty offices, respectively).
• More than three-fourths of visits for RA were to medical specialty offices.
Front Line Musculoskeletal Disorders: Back Pain
• In a 3-month period, about one-fourth of US adults experience at least 1 day of back pain.
• Many medical problems can cause or contribute to back pain, including various forms of arthritis.
• Many types of doctors treat back pain, from family physicians to specialists in the musculoskeletal
or nervous system.
Osteoarthritis: Leading Cause of Disability
• Osteoarthritis is the most common form of joint disease and a leading cause of disability in older
persons. About 27 million Americans have this condition.
• Osteoarthritis tends to occur in the hand joints, spine, hips, knees, and great toes.
• The lifetime risk of knee and hip osteoarthritis is about 46% and 25%, respectively.
Fibromyalgia: “It’s All in Your Head!”
• Fibromyalgia, an arthritis-related rheumatologic condition, affects an estimated 5 million
Americans age 18 years or older.
• Between 80% and 90% of those who receive the diagnosis are women, but men and children can
be affected.
• Patients typically see many doctors before they receive the diagnosis, possibly because pain and
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Musculoskeletal Hits Top 10 in Primary Care Visits
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fatigue, the main symptoms, overlap with those of many other conditions.
• Because there is no generally accepted, objective test for fibromyalgia, some doctors conclude
that a patient’s pain is not real—“It’s all in your head!”
Slowing RA With Treatment Advances
• At least 1.3 million US adults have RA, the most common type of autoimmune arthritis.
• RA is one of the most disabling types of arthritis.
• Treatment advances have made it possible to stop or at least slow the progression of joint
damage.
Osteoporosis and Fracture Risk Increase With Age
• Persons older than 50 years are at greatest risk for osteoporosis and related fractures. In the
United States, about 4.5 million women and 0.8 million men older than 50 years have this condition.
Osteoporosis seems to be decreasing in the population.
• Osteoporosis is more common in older women, mainly non-Hispanic white and Asian women, but
can occur in men and children and in all ethnic groups.
• Major risk factors that cannot be changed include older age, non-Hispanic white or Asian ethnic
background, and small bone structure.
• Risk factors that might be changed include low levels of sex hormone, anorexia nervosa and
bulimia, and cigarette smoking.
• Another 22.7 million women and 11.8 million men older than 50 years have osteopenia.
Gout Still Affects Mostly Men
• Gout affects more than 3 million Americans, mostly men, women after menopause, and persons
who have kidney disease.
• Gout is strongly linked to obesity, hypertension, hyperlipidemia, and diabetes.
• The treatment goal with medications is a uric acid level lower than 6 mg/dL.
Psoriatic Arthritis Can Begin Early
• Psoriatic arthritis usually appears in persons aged 30 to 50 years but can begin as early as
childhood. Men and women are equally at risk. Children with psoriatic arthritis are at risk for uveitis.
• Psoriatic arthritis occurs in about 15% of patients who have psoriasis. The arthritis can appear
before the skin disorder.
• Persistent inflammation with psoriatic arthritis can lead to joint damage. Psoriatic arthritis can
affect any joint in the body. Early diagnosis is important.
Sports Injuries: When to Refer?
• Severe sports injuries need to be seen immediately in an emergency department.
• Most injuries can be evaluated by a primary care physician, who also may provide treatment.
• Appropriate referrals may include an orthopedic surgeon for diagnosis and treatment and a
physical therapist/physiotherapist for rehabilitation.
Musculoskeletal Physician Visits by Body Part: Knees First
• Knee: 18.6 million
• Back: 13 million
• Shoulder: 11 million
• Lower back: 8 million
• Leg: 7.8 million
• Neck: 7.6 million
• Hand and finger: 7 million
• Foot and toe: 6.3 million
• Hip: 4 million
• Ankle: 3.9 million
• Wrist: 3.4 million
• Arm: 3.2 million
• Elbow: 2 million
Source: Department of Research & Scientific Affairs, American Academy of Orthopaedic Surgeons.
Physician Visits for Musculoskeletal Symptoms and Complaints.
http://www.aaos.org/research/stats/patientstats.asp. Updated November 2013. Accessed June 23,
2015.
More to Come
• In the first article in this series, “Top 10 Reasons Why Patients Come to Primary Care,” we analyzed
the leading diagnostic categories in primary care and how they may affect your practice.
• The second article highlighted the number 1 diagnostic category in primary care, respiratory
disorders.
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Musculoskeletal Hits Top 10 in Primary Care Visits
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• In the third article, we featured the number 2 diagnostic category, circulatory disorders, including
hypertension, the most common diagnosis in primary care.
• The fourth article covered the third leading diagnostic category in primary care, endocrine
disorders, including diabetes, another leading primary care diagnosis.
• This fifth article reports on diseases of the musculoskeletal system and connective tissue, the
fourth leading diagnostic category in primary care.
• Next up: Nervous System and Sense Organs
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[1] http://www.physicianspractice.com/authors/leo-robert
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