USBJD project draws attention to burden of musculoskeletal conditions

More than three of every five accidental injuries that occur annually in the United States are to the musculoskeletal system. In 2004, more than 57.2 million musculoskeletal injuries were treated in healthcare settings and accounted for 60 percent of injuries of all types treated that year.

Musculoskeletal injuries include sprains and strains, usually incurred during sudden movement or excessive use (16.3 million injuries in 2004); fractures (15.3 million); open wounds, cuts, and punctures (10.3 million); and contusions and bruises (8.4 million). Many more musculoskeletal injuries occur at home that are not reported.

One in two musculoskeletal injuries occurs in the home, more than in any other location. About one in 10 occurs while playing in sports activities and another one in 10 in automobile or pedestrian accidents.

Falls are the leading cause, 29 percent, of nonfatal musculo­skeletal injuries. Among persons aged 65 and older, falls were the cause of 63 percent of nonfatal injuries treated in 2003.

Workplace musculoskeletal injuries, known collectively as musculoskeletal disorders (MSDs), occur each year due to accidents and to cumulative and repetitive motion. MSDs are tracked by the U.S. Department of Labor, Bureau of Labor Statistics. MSD injuries are often more severe than the average nonfatal workplace injury or illness, with longer recovery time and an average of nine days away from work, two days longer than average for all workplace injuries. Even though long-term trends since 1996 show significant reductions in the total number of worker injuries each year, the proportion that are musculoskeletal related continues to account for more than one-half of all nonfatal injury cases involving days away from work.

The cost of musculoskeletal injuries
The estimated cost in 2004 of treating all musculoskeletal injuries was $127.4 billion. Since 1996, in 2004 dollars, the cost of treating musculoskeletal injuries has risen 37 percent. The share of cost attributed to prescription drugs rose from 11 percent in 1996 to 17 percent in 2004.

Only 3 percent of persons with a musculoskeletal injury were admitted to a hospital for treatment in 2004, yet this group represented 31 percent of all hospitalizations for an injury. The estimated total cost for treatment of hospitalized musculoskeletal injuries in 2004 was $26.6 billion. The majority of this cost, 88 percent, is related to hospitalization for fractures.

Musculoskeletal injuries also produce significant cost due to days spent in bed or lost work days. Slightly more than one in 10 persons in the workforce in 2005 reported a musculoskeletal injury caused them to miss work, with a cumulative total of 72.1 million work days lost due to these injuries.

Musculoskeletal injuries are often a cause of physical limitations in a person’s ability to perform activities of daily living. In 2004, four out of every 100 persons, and 11 of 100 persons aged 65 and older, reported they were currently experiencing limitations in their ability to perform their daily activities as a result of a fracture and/or bone or joint injury.

The future
Treatment of fractures, repetitive motion injuries, sprains and strains, and other musculoskeletal injuries will continue to be a major cost to the medical community and society. Education to increase awareness of the causes and how to avoid musculoskeletal injuries is needed. Improved treatment to reduce the long-term pain and disability, particularly from fractures in the elderly, is needed.

Editor’s Note: Each month AAOS Now will reprise a section of the Executive Summary prepared for The Burden of Musculoskeletal Diseases in the United States: Prevalence, Societal and Economic Cost. The text, which is available online at www.boneandjointburden.org, is a joint project of the AAOS, the American Academy of Physical Medicine and Rehabilitation, the American College of Rheumatology, the American Society for Bone and Mineral Research, the Arthritis Foundation, the National University of Health Sciences, the Orthopaedic Research Society, the Scoliosis Research Society, and the U.S. Bone and Joint Decade.