Turkish Journal of Physical Medicine and Rehabilitation
2023 , Vol 69 , Num 1
Musculoskeletal involvement: COVID-19 and post COVID 19
Deniz Evcik 1
1 Department of Physical Medicine and Rehabilitation, Ankara Private Güven Hospital, Ankara, Türkiye
DOI :
10.5606/tftrd.2023.12521
The worldwide pandemic of coronavirus disease 2019 (COVID-19) was known to predominantly affect the lungs, but it was realized that
COVID-19 had a large variety of clinical involvement. Cardiovascular, gastrointestinal, neurological, and musculoskeletal systems are
involved by direct or indirect mechanisms with various manifestations. The musculoskeletal involvement can manifest during COVID-19
infection, due to medications used for the treatment of COVID-19, and in the post/long COVID-19 syndrome. The major symptoms are
fatigue, myalgia/arthralgia, back pain, low back pain, and chest pain. During the last two years, musculoskeletal involvement increased,
but no clear consensus was obtained about the pathogenesis. However, there is valuable data that supports the hypothesis of angiotensinconverting
enzyme 2, inflammation, hypoxia, and muscle catabolism. Additionally, medications that were used for treatment also have
musculoskeletal adverse effects, such as corticosteroid-induced myopathy and osteoporosis. Therefore, while deciding the drugs, priorities
and benefits should be taken into consideration. Symptoms that begin three months from the onset of the COVID-19 infection, continue
for at least two months, and cannot be explained by another diagnosis is accepted as post/long COVID-19 syndrome. Prior symptoms
may persist and fluctuate, or new symptoms may manifest. In addition, there must be at least one symptom of infection. Most common
musculoskeletal symptoms are myalgia, arthralgia, fatigue, back pain, muscle weakness, sarcopenia, impaired exercise capacity, and
physical performance. In addition, the female sex, obesity, elderly patients, hospitalization, prolonged immobility, having mechanical
ventilation, not having vaccination, and comorbid disorders can be accepted as clinical predictors for post/long COVID-19 syndrome.
Musculoskeletal pain is also a major problem and tends to be in chronic form. There is no consensus on the mechanism, but inflammation
and angiotensin-converting enzyme 2 seem to play an important role. Localized and generalized pain may occur after COVID-19, and
general pain is at least as common as localized pain. An accurate diagnosis allows physicians to initiate pain management and proper
rehabilitation programs.
Keywords :
Bone, COVID-19, muscle, post/long COVID-19