April 18, 2026
3 min learn
Key takeaways:
- Musculoskeletal points can usually be identified on scientific examination.
- Physical remedy is the mainstay therapy. Corticosteroids can be utilized to complement — not substitute — bodily remedy.
SAN FRANCISCO — Most musculoskeletal points might be managed in primary care as they usually don’t require advanced imaging or instant specialist referral, in response to a speaker right here.
Common musculoskeletal conditions embrace lateral hip ache, anterior knee ache, ankle inversion injuries, shoulder ache, stiff shoulders and lateral elbow ache, Joshua T. Goldman, MD, MBA, affiliate scientific professor in the division of sports drugs on the University of California, Los Angeles, instructed attendees at ACP’s Internal Medicine Meeting.
Understanding the way to diagnose and handle these circumstances can doubtlessly cut back ED overuse. For instance, “one ankle inversion injury is occurring per 10,000 people each day. Ankle sprains constitute 7% to 10% of all visits to the ED. So, if we’re trying to declutter our ERs, this is a good place to start,” Goldman stated.
He outlined some sensible suggestions for primary care physicians to maintain in thoughts when approaching musculoskeletal injuries:
- Most diagnoses might be made with a scientific examination. Goldman suggested primary care suppliers to “trust your targeted history and exam.” Although imaging is a useful adjunct, superior imaging might present abnormalities not associated to the affected person’s signs. For instance, he stated “there’s nothing more terrifying than MRI’ing the foot of a middle-aged runner. You’re going to see a lot of bad stuff in there. I warn patients … it’s going to look bad. Don’t freak out.”
- “-itis” is commonly a misnomer. Many circumstances aren’t primarily inflammatory however as a substitute are sometimes brought on by tissue degeneration, Goldman stated. For instance, “greater trochanteric pain syndrome is actually gluteal tendinosis, and lateral epicondylitis is actually common extensor tendinosis,” he stated. “When we start to reframe what that pathology is, the treatment starts to make more sense.”
- Biomechanics drive signs. Underlying mechanical points like muscle weak spot are sometimes the basis explanation for ache. Passive interventions alone can’t resolve the problem; the biomechanics should be corrected, Goldman stated.
- “Physical therapy is the cornerstone of treatment.” Most sufferers with musculoskeletal points profit from bodily remedy, in response to Goldman. But PCPs should “be specific, be prescriptive and be targeted” in what they want the physical therapist to work on, not just “‘PT, shoulder pain,’” he stated. Tendons in specific want “eccentric and progressive loading,” Goldman stated. “We’re taught if it hurts, don’t do it. We say that a lot to patients about their pathologies. Tendons are the exception. You need to grit it out, because if you don’t load the tendon, it’s not going to repair …. Soreness is actually part of that healing process.”
- Corticosteroids are “useful but limited.” Although they supply ache reduction, corticosteroid injections typically have inferior long-term outcomes, “especially for tendon pathology,” Goldman stated. “For a long, long time, we believed they were curative, [which is] not true,” he added. Goldman beneficial utilizing corticosteroid injections as an adjunct to bodily remedy, not as a substitute, “with the exception of frozen shoulder, specifically.”
- Early mobilization is healthier than immobilization. The conventional “rest, ice, compression and elevation” method can be utilized “for a little bit,” however Goldman stated “you have got to get moving.” For ankle sprains particularly, “we need to strengthen [and] fix the biomechanics,” he stated. “Give them a little supportive care with an ankle brace for that first week, but then you have got to get them out and get them into rehab.”
- “Know when to escalate care.” Goldman suggested referring sufferers to a specialist when they don’t seem to be enhancing with structured rehabilitation or if there’s concern about structural pathology like a tendon tear. “Get your advanced imaging. Feel free to refer them on for additional care,” he stated. “I always tell my fellows, if you look at an X-ray and you freak out, just send it to somebody else. That’s totally fine.”
Sources/Disclosures
Source:
Goldman J. Sports drugs for the primary care doctor. Presented at: ACP Internal Medicine Meeting; April 16-18, 2026; San Francisco.
Disclosures:
Goldman reviews receiving a grant/contract from WHOOP Inc.
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