Chronic damage of the locomotor system is a common clinical condition. Repeated mechanical movements can lead to injuries of the structures involved in movement, such as bones, joints, muscles, tendons, ligaments, fasciae, bursae, and adjacent blood vessels and nerves, resulting in corresponding clinical symptoms and signs. Chronic damage of the locomotor system typically does not significantly affect life-threatening functions and rarely requires surgical intervention, but the chronic pain it causes can impact daily life, work, and mental health. Early diagnosis and treatment are important. Most chronic injuries are preventable, and symptoms can often be alleviated or eliminated with proper management. However, if the underlying cause is not addressed, recurrence is likely.
Etiology
Common causes of chronic damage to the locomotor system include the following:
- Pathological tension or spasm of local tissues caused by systemic diseases.
- Vascular spasms induced by environmental temperature changes, leading to reduced circulation, accumulation of metabolic byproducts, and localized injury.
- Prolonged repetition of a single posture that exceeds the local compensatory capacity of the body, causing tissue damage without timely repair.
- Improper operation techniques, lack of focus, or incorrect posture during activity, resulting in abnormal stress on specific areas.
- Abnormal physiological structure or posture causing uneven stress distribution.
- Acute injuries that fail to undergo proper rehabilitation and transition into chronic injuries.
Classification
Based on the affected tissues, chronic damage of the locomotor system can be categorized into four types:
- Chronic injuries of soft tissues: Injuries to muscles, tendons, tendon sheaths, ligaments, and bursae.
- Chronic injuries of bones: Stress fractures occurring in regions of concentrated stress or thinner bone structures.
- Chronic injuries of cartilage: Injuries to articular cartilage and epiphyseal cartilage.
- Peripheral nerve compression injuries: Nerve injuries due to repetitive activities or proliferation and narrowing of surrounding structures, leading to localized nerve damage.
Clinical Features
Chronic damage often involves multiple tissues and organs of the locomotor system. Common clinical features include:
- Persistent local chronic pain without a clear history of trauma.
- Presence of a pressure-sensitive point or mass at specific locations, often accompanied by characteristic signs.
- Localized inflammation without signs of acute inflammation.
- A recent history of excessive activity associated with the painful site.
- Postures, work habits, or occupational factors contributing to chronic damage of the locomotor system in some individuals.
Treatment Principles
Chronic injuries can be prevented to a certain extent. Prevention and treatment should be combined, with an emphasis on eliminating the underlying cause. Recurrent cases are generally more difficult to cure.
Limiting injurious movements, correcting improper posture, enhancing muscle strength, maintaining non-weight-bearing joint activities, and periodically changing posture to distribute stress can help reduce harmful factors and increase protective mechanisms. These are key to treatment and preventing recurrence.
Physical therapy methods, such as physiotherapy and massage, can improve local circulation, reduce adhesions, and soften scar tissue, thereby alleviating symptoms. Topical application of non-steroidal anti-inflammatory drugs (NSAIDs), combined with massage, can enhance skin penetration and reduce local inflammation.
NSAIDs are a common treatment for chronic injuries of the locomotor system, effectively reducing or eliminating local inflammation. They can be used intermittently for short periods but may cause adverse effects with long-term use, particularly gastrointestinal mucosal damage, followed by liver and kidney toxicity.
Local injections of glucocorticoids can help suppress inflammation and reduce adhesions, and are commonly used in clinical practice. However, the application of this method requires specific indications, often for superficial sites, and repeated injections are avoided. Overuse of glucocorticoids in localized areas can lead to exacerbated degeneration of tissues such as tendons or ligaments. Patients with poorly controlled diabetes or weakened immunity are at increased risk of infections following local glucocorticoid injections.
Surgical treatment is considered for chronic injuries unresponsive to conservative treatment, such as stenosing tenosynovitis, nerve compression syndrome, and synovial cysts.