Musculoskeletal Medicine Research Articles

Musculoskeletal Learning and Knowledge Retention Among Postgraduate Physicians: Evaluating the Long-Term Impact of a New Preclerkship Curriculum at a Nationally Accredited Medical Program.

Musculoskeletal (MSK) injuries and disorders are exceptionally prevalent in the clinical setting. Despite this, physician training in MSK medicine has been historically inadequate contributing to a lack of MSK knowledge, confidence, and clinical skills among postgraduate physicians. The goal of this investigation was to examine the long-term impact of a new preclerkship MSK curriculum implemented by a nationally accredited medical program on postgraduate physician's learning and knowledge retention in the area of MSK medicine. Five hundred sixty-eight postgraduate physicians (years 1-6) who had previously completed the new curriculum over a 6-year period were recruited to complete a standardized and validated MSK examination that consisted of 30 multiple-choice questions on core or must-know topics in MSK medicine that could be directly mapped to learning objectives within the new preclerkship MSK curriculum. Ninety postgraduate physicians completed the examination, obtaining an average score of 75.0% (±10.2; range 57.0-100.0). Physicians who completed MSK-related electives during clerkship training or specialized in fields related to MSK medicine (i.e., orthopaedics, PM&R, sports medicine, and rheumatology) performed significantly better on the MSK examination (p ≤ 0.01). Data indicated that the program's new preclerkship curriculum supports high levels of MSK learning and knowledge retention among postgraduate physicians. These findings are expected to assist with the establishment of minimum curriculum standards and can be used to guide MSK curricular reform at other medical programs.

Angiotensin II receptor blockers and their applications in orthopaedic surgery and musculoskeletal medicine

Angiotensin II receptor blockers and their applications in orthopaedic surgery and musculoskeletal medicine

Advances in Ultrasound-Guided Surgery and Artificial Intelligence Applications in Musculoskeletal Diseases.

Ultrasound imaging is a vital imaging tool in musculoskeletal medicine, with the number of publications on ultrasound-guided surgery increasing in recent years, especially in minimally invasive procedures of sports, foot and ankle, and hand surgery. However, ultrasound imaging has drawbacks, such as operator dependency and image obscurity. Artificial intelligence (AI) and deep learning (DL), a subset of AI, can address these issues. AI/DL can enhance screening practices for hip dysplasia and osteochondritis dissecans (OCD) of the humeral capitellum, improve diagnostic accuracy for carpal tunnel syndrome (CTS), and provide physicians with better prognostic prediction tools for patients with knee osteoarthritis. Building on these advancements, DL methods, including segmentation, detection, and localization of target tissues and medical instruments, also have the potential to allow physicians and surgeons to perform ultrasound-guided procedures more accurately and efficiently. This review summarizes recent advances in ultrasound-guided procedures for musculoskeletal diseases and provides a comprehensive overview of the utilization of AI/DL in ultrasound for musculoskeletal medicine, particularly focusing on ultrasound-guided surgery.

Evaluation of range of motion using vision artificial intelligence (AI) in musculoskeletal medicine

Evaluation of range of motion using vision artificial intelligence (AI) in musculoskeletal medicine

Patient Experience and Satisfaction with Orthopedic Services at a Community (Rural) Setting Hospital-How Is It Different from Urban Setting.

Patient experience and satisfaction are the keystones in evaluating the effectiveness of clinical care in musculoskeletal medicine. Although all orthopedic settings work on the same principles of providing safe and quality health care, community hospitals represent a unique environment. There may be key differences with regard to patient experience between these settings. Accessibility to care, choices of provider, personalized care, availability of and access to resources, cultural and social variances, and waiting times are a few of the many elements that may impact patient experience and satisfaction. This narrative review aims to explore the core differences in these settings and how they can reflect on patient experience and satisfaction.

Ozone therapy in musculoskeletal medicine: a comprehensive review

Musculoskeletal disorders encompass a wide range of conditions that impact the bones, joints, muscles, and connective tissues within the body. Despite the ongoing debate on toxicity and administration, ozone demonstrated promise in managing several musculoskeletal disorders, modulating pain and inflammation. A literature search was conducted. The research design, methods, findings, and conclusions of the studies were then examined to evaluate the physiological effects, clinical application, controversies, and safety of the application of ozone in musculoskeletal medicine. Ozone application demonstrates considerable therapeutic applications in the management of musculoskeletal disorders, including fractures, osteoarthritis, and chronic pain syndromes. Despite these advantages, studies have raised concerns regarding its potential toxicity and emphasized the importance of adhering to stringent administration protocols to ensure safety. Additionally, heterogeneities in patient reactions and hazards from oxidizing agents were observed. Given its anti-inflammatory and analgesic qualities, ozone therapy holds potential in the management of several musculoskeletal disorders. Additional high-quality research with long follow-up is required to refine indications, efficacy and safety profile. Finally, for wider clinical acceptability and utilization, the development of international recommendations is essential.

Posttraumatic osteoarthritis after athletic knee injury: A narrative review of diagnostic imaging strategies.

Intraarticular knee injuries and subsequent posttraumatic arthritis (PTOA) are common in athletes. Unfortunately, PTOA may significantly affect performance and overall function, but this condition remains difficult to characterize. In this review, we provide an overview of imaging modalities used to evaluate PTOA among athletes and physically active individuals following knee injury, with the goal to discuss the strengths and limitations of their application in this population. A literature search was performed to identify clinical studies focusing of knee injuries in athletes and athletic persons, specifically using imaging for diagnosis or monitoring disease progression. A total of 81 articles were identified, and 23 were included for review. Studies on plain radiographs (n = 8) and magnetic resonance imaging (MRI) assessed arthritic burden (n = 13), with MRI able to depict the earliest cartilage changes. Few studies (n = 2) leveraged ultrasound. Challenges persist, particularly regarding standardization and reliability across different radiographic grading systems. Additionally, further research is needed to establish the clinical significance of techniques to assess cartilage composition on MRI, including ultrashort echo-time enhanced T2*, T1rho and T2 imaging. Addressing these challenges through standardized protocols and intensified research efforts will enhance the diagnostic utility of imaging modalities in musculoskeletal medicine and enable high-quality prospective studies.

Gender Disparities in Endowed Professorships Within Orthopaedic Surgery.

Background Orthopaedic surgery has the lowest number of full-time faculty positions held by women, at 19%, with endowed chairs among the most coveted and advantageous. We examined the characteristics of endowed professors from the US top 100 orthopaedic academic centers and highest-funded musculoskeletal (MSK)researchers to determine if gender is associated with endowed professorship. Additionally, we sought to determine ifgender is associated with increased NIH funding for top-performing musculoskeletal researchers. Methods Our primary study group included the top 100 orthopaedic academic centers defined by US News World Report and Doximity's rankings. Our secondary study group examined the top MSK researchers, defined as principal investigators, who received >$400,000 in annual NIH funding from 2018 to 2021. Orthopaedic departments included MSK researchers and subspecialties within orthopaedics and medicine. Publicly available sources were used to compile institutional, gender, H-index, citation number, and subspecialty data on endowed professors; statistical comparisons were calculated. Results Within the top 100 orthopaedic academic departments, 4674 faculty were identified. Seven hundred and thirty-three (15.68%) were identified as women, 3941 as men (84.32%). One hundred and ninety-four held endowed professorships; 13 were awarded to women (6.7%), and 185 (95.3%) were awarded to men, with a significant odds ratio (OR) of 2.95, favoring men. For MSK researchers, the OR increases to 11.4. Arthroplasty and sports had the highest numbers of endowments. Significant differences in H-index, publications, and graduation year were identified between men and women for top MSK researchers and orthopaedic-trained surgeons; however, these differences disappeared when considering heterogenous orthopaedic departments that included medicine subspecialties, plastic surgery, hand surgery, and neurosurgery. Additional gender differences were observed in endowment names, with awards commemorating 51.5% men, 7.2% women, and 34% families or groups. Conclusion Gender inequities at the endowment level are substantial, and there are very few women in musculoskeletal medicine to achieve endowments. Differences in H-index, publications, and graduation year between men and women MSK researchers and orthopaedic-trained surgeons, but not combined orthopaedic, PM&R, and medical subspecialty departments, suggest unique challenges in orthopaedic surgery environments and histories that may contribute to endowment disparity. Gender was not found to be associated with funding bias for top-performing musculoskeletal researchers.

Inadequacies in Undergraduate Musculoskeletal Education-A Survey of Nationally Accredited Allopathic Medical Programs in Canada.

The aim of the study is to document the current state of musculoskeletal (MSK) medicine education across nationally accredited undergraduate medical programs. A cross-sectional survey design was used to gather curricular data on the following three musculoskeletal themes: (1) anatomy education, (2) preclinical education, and (3) clerkship education. The survey had a 100% response rate with all 14 English-language medical schools in Canada responding. The mean time spent teaching musculoskeletal anatomy was 29.8 hrs (SD ± 13.7, range = 12-60), with all but one program using some form of cadaveric-based instruction. Musculoskeletal preclinical curricula averaged 58.0 hrs (SD ± 53.4, range = 6-204), with didactic lectures, case-based learning, and small group tutorials being the most common modes of instruction. Curricular content varied greatly, with only 25% of "core or must-know" musculoskeletal topics being covered in detail by all programs. Musculoskeletal training in clerkship was required by only 50% of programs, most commonly being 2 wks in duration. Results document the large variability and curricular inadequacies that exist in musculoskeletal education across nationally accredited allopathic programs and highlight the need for the identification and implementation of more consistent musculoskeletal curricular content and educational standards by all nationally accredited medical programs.

Neuromuscular implants: Interfacing with skeletal muscle for improved clinical translation of prosthetic limbs.

After an amputation, advanced prosthetic limbs can be used to interface with the nervous system and restore motor function. Despite numerous breakthroughs in the field, many of the recent research advancements have not been widely integrated into clinical practice. This review highlights recent innovations in neuromuscular implants-specifically those that interface with skeletal muscle-which could improve the clinical translation of prosthetic technologies. Skeletal muscle provides a physiologic gateway to harness and amplify signals from the nervous system. Recent surgical advancements in muscle reinnervation surgeries leverage the "bio-amplification" capabilities of muscle, enabling more intuitive control over a greater number of degrees of freedom in prosthetic limbs than previously achieved. We anticipate that state-of-the-art implantable neuromuscular interfaces that integrate well with skeletal muscle and novel surgical interventions will provide a long-term solution for controlling advanced prostheses. Flexible electrodes are expected to play a crucial role in reducing foreign body responses and improving the longevity of the interface. Additionally, innovations in device miniaturization and ongoing exploration of shape memory polymers could simplify surgical procedures for implanting such interfaces. Once implanted, wireless strategies for powering and transferring data from the interface can eliminate bulky external wires, reduce infection risk, and enhance day-to-day usability. By outlining the current limitations of neuromuscular interfaces along with potential future directions, this review aims to guide continued research efforts and future collaborations between engineers and specialists in the field of neuromuscular and musculoskeletal medicine.

Fostering Excellence in Knee Arthroplasty: Developing Optimal Patient Care Pathways and Inspiring Knowledge Transfer of Advanced Surgical Techniques.

Osteoarthritis of the knee is common. Early sports trauma or cartilage defects are risk factors for osteoarthritis. If conservative treatment fails, partial or total joint replacement is often performed. A joint replacement aims to restore physiological biomechanics and the quality of life of affected patients. Total knee arthroplasty is one of the most performed surgeries in musculoskeletal medicine. Several developments have taken place over the last decades that have truly altered the way we look at knee arthroplasty today. Some of the fascinating aspects will be presented and discussed in the present narrative review.

An update on technical and safety practice patterns in transforaminal epidural steroid injections

IntroductionPrevious studies have suggested variability in practice patterns for transforaminal epidural steroid injections (TFESIs) despite published safety guidance. The purpose of this study was to understand recent trends in periprocedural safety practices in TFESIs and how some aspects of interventional pain practice may have been influenced by the coronavirus disease 2019 (COVID-19) pandemic and related supply chain shortages. MethodsA 91-item survey was distributed to 111 program directors of Accreditation Council for Graduate Medical Education accredited Pain Management fellowships, 42 North American Spine Society and Interventional Spine and Musculoskeletal Medicine recognized fellowship directors, and 100 private practice interventional pain physicians to capture current practices in epidural steroid injections from March 2021 to March 2022. Additional responses were obtained through advertising on social media platforms consisting of interventional pain physicians. Cross sectional data from survey responses specific to TFESI-related practices were gathered and analyzed. ResultsOf 103 complete survey responses, 102 physicians perform TFESIs (cervical, 33.3%; thoracic, 40.2%; lumbar, 100%; sacral, 89.2%). There was variability in preprocedural imaging review, sedation practices, contrast and fluoroscopy techniques, and type and dose of steroid preferred. Many physicians saw a decrease in number of procedures performed weekly as a result of the COVID-19 pandemic. ConclusionsThere remains practice variability in various periprocedural aspects of TFESIs despite existing safety recommendations. Further research is needed to identify ongoing barriers to adherence to established guidelines. Recent practice trends may have been affected by unique challenges posed by the COVID-19 pandemic, and these trends should be considered in the event of future supply chain limitations and/or need for disaster response.

A roadmap for delivering a human musculoskeletal cell atlas.

Advances in single-cell technologies have transformed the ability to identify the individual cell types present within tissues and organs. The musculoskeletal bionetwork, part of the wider Human Cell Atlas project, aims tocreate a detailed map of the healthy musculoskeletal system at a single-cell resolution throughout tissue development and across the human lifespan, with complementary generation of data from diseased tissues. Given the prevalence of musculoskeletal disorders, this detailed reference dataset will be critical to understanding normal musculoskeletal function in growth, homeostasis and ageing. The endeavour will also help to identify the cellular basis for disease and lay the foundations for novel therapeutic approaches to treating diseases of the joints, soft tissues and bone. Here, we present a Roadmap delineating the critical steps required to construct the first draft of a human musculoskeletal cell atlas. We describe the key challenges involved in mapping the extracellular matrix-rich, but cell-poor, tissues of the musculoskeletal system, outline early milestones that have been achieved and describe the vision and directions for a comprehensive musculoskeletal cell atlas. By embracing cutting-edge technologies, integrating diverse datasets and fostering international collaborations, this endeavour has the potential to drive transformative changes in musculoskeletal medicine.

Forty-Six Years of Technological Innovation in Musculoskeletal Medicine: An Analysis of a Patent Database (1973 to 2018).

Technological innovation in orthopaedics is key to advancing patient care. As emerging technologies near maturity, clinicians must be able to objectively assess where and when these technologies can be implemented. Patent databases are an underappreciated resource for quantifying innovation, especially within orthopaedic surgery. This study used a patent database to assess patent activity and relative growth of technologies in musculoskeletal medicine and orthopaedics over a period of 46 years. A total of 121,471 patent records were indexed from Lens.org , a patent database. These patents were grouped into subspecialty clusters and technology clusters using patent codes. Five-year (2014 to 2018), 10-year (2009 to 2018), and 30-year (1989 to 2018) compound annual growth rates were calculated and compared for each cluster. Annual patent activity increased from one patent in 1973 to 4,866 patents in 2018. Of the eight subspecialty clusters, the largest number of patents were related to 'Inflammation' (n = 63,128; 40.57%). The 'Elbow', 'Shoulder', and 'Knee' clusters experienced increased annual patent activity since 2000. Of the 12 technological clusters, the largest number of patents were related to 'Drugs' (n = 55,324; 39.75%). The 'Custom/patient-specific instrumentation, 'Computer Modeling', 'Robotics', and 'Navigation' clusters saw growth in the average annual patent activity since 2000. Innovation, as measured by patent activity in musculoskeletal medicine and orthopaedics, has seen notable growth since 1973. The 'Robotics' cluster seems poised to experience exponential growth in industry investment and technological developments over the next 5 to 10 years. The 'Diagnostics', 'Computer Modeling', 'Navigation', and 'Design and Manufacturing' clusters demonstrate potential for exponential growth in industry investment and technological developments within the next 10 to 20 years.

Disparities in arthroplasty utilization for rotator cuff tear arthropathy.

Rotator cuff tear arthropathy (CTA) carries a significant symptomatic burden for patients. Reverse shoulder arthroplasty (RSA) is an effective treatment intervention for CTA. Disparities in musculoskeletal medicine are well documented; however, there is a paucity of literature on how social determinants of health affect utilization rates. The purpose of this study is to determine how social determinants of health affect the utilization rates of RSA. A single-center retrospective review was conducted for adult patients diagnosed with CTA between 2015 and 2020. Patients were divided by those who underwent RSA and those who were offered RSA but did not undergo surgery. Each patient's zip code was used to determine the most specific median household income in the US Census Bureau database and compared to the multistate metropolitan statistical area median income. Income levels were defined by the US Department of Housing and Urban Development's (HUD's) 2022 Income Limits Documentation System and the Federal Reserve's (FED's) Community Reinvestment Act. Because of numeric restrictions, patients were grouped into racial cohorts of Black, White, and all other races. Patients of other races had significantly lower odds of continuing to surgery compared with White patients in models controlled for median household income (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.18-0.81, P=.01), HUD's 3 income levels (OR 0.36, 95% CI 0.18-0.74, P=.01), and FED's income levels (OR 0.37, 95% CI 0.17-0.79, P=.01). There was no significantly different odds of going on to surgery between FED income levels and median household income levels, but when compared with those with low HUD income, those below median had significantly lower odds of going on to surgery (OR 0.43, 95% CI 0.23-0.80, P=.01). Although contradictory to reported health care utilization for Black patients, our study supports reported disparities in utilization for other ethnic minorities. These findings may suggest that improvements in utilization efforts targeted Black-identifying patients but not necessarily other ethnic minorities. The findings of this study can help providers understand how social determinants of health play a role in the utilization of care for CTA and direct mitigation efforts to reduce disparities in access to adequate orthopedic care.

Applications of Platelet-rich Plasma in the Treatment of Musculoskeletal Injuries

The use of platelet-rich plasma (PRP), which has the ability to hasten the repair of soft tissue, cartilage, and bone, has revolutionized musculoskeletal medicine. Applications include treatment of osteoarthritis, tendinopathy, chondropathy, acute and chronic soft tissue injuries, muscle or ligament tears, as well as enhancement of healing of cartilage joints. With the ability to promote safe and natural healing, PRP is considered a promising alternative to surgery. Recently, there is an emerging literature on the beneficial effects of PRP for chronic non-healing tendon injuries and cartilage degeneration. This review article provides an overview of recent basic science and clinical studies on the applications of PRP to the treatment of musculoskeletal injuries.

The impact of social deprivation on patient satisfaction in physical medicine and rehabilitation outpatient interventional spine and musculoskeletal medicine using the press Ganey® outpatient medical practice survey

IntroductionMultiple factors (patient age, wait time, depression, etc.) have been associated with lower patient satisfaction as assessed by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS). Social deprivation has been shown to impact multiple aspects of patient care but its impact on patient satisfaction in Physical Medicine and Rehabilitation (PM&R) is limited. ObjectiveWe hypothesized that increased social deprivation would independently predict lower patient satisfaction, as measured by the PGOMPS. DesignRetrospective large cohort study. SettingSingle tertiary academic institution. PatientsAdult patients seen by PM&R physicians practicing outpatient interventional spine and musculoskeletal medicine who completed PGOMPS between January 1, 2014 and December 31, 2019. InterventionsIndependent variables include: Social deprivation as measured by 2015 Area Deprivation Index (ADI), wait time, patient age, and sex. Main outcome measurePatient satisfaction was defined as receiving a perfect PGOMPS Total Score. ResultsA totla of 64,875 patients (mean age 52.7 ± 21.8 years, 41.4% male, mean ADI 29.9 ± 18.8) were included. Univariate analysis showed a decreased odds of achieving satisfaction for each decile increase in ADI (odds ratio 0.965; 95% confidence interval 0.957–0.973; p < 0.001). The most socially deprived quartile was significantly less likely to report satisfaction on PGOMPS compared to the least deprived quartile (91.1 vs 93.2; p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction was 0.99 (95% confidence interval 0.980 to 0.997; p = 0.009) for the Total Score, independent of age, wait time, and patient sex for each decile increase in ADI. ConclusionsIn this cohort, increased social deprivation independently predicted patient dissatisfaction in PM&R.

Platelet-Rich Plasma Power-Mix Gel (ppm)-An Orthobiologic Optimization Protocol Rich in Growth Factors and Fibrin.

Platelet- and fibrin-rich orthobiologic products, such as autologous platelet concentrates, have been extensively studied and appreciated for their beneficial effects on multiple conditions. Platelet-rich plasma (PRP) and its derivatives, including platelet-rich fibrin (PRF), have demonstrated encouraging outcomes in clinical and laboratory settings, particularly in the treatment of musculoskeletal disorders such as osteoarthritis (OA). Although PRP and PRF have distinct characteristics, they share similar properties. The relative abundance of platelets, peripheral blood cells, and molecular components in these orthobiologic products stimulates numerous biological pathways. These include inflammatory modulation, augmented neovascularization, and the delivery of pro-anabolic stimuli that regulate cell recruitment, proliferation, and differentiation. Furthermore, the fibrinolytic system, which is sometimes overlooked, plays a crucial role in musculoskeletal regenerative medicine by regulating proteolytic activity and promoting the recruitment of inflammatory cells and mesenchymal stem cells (MSCs) in areas of tissue regeneration, such as bone, cartilage, and muscle. PRP acts as a potent signaling agent; however, it diffuses easily, while the fibrin from PRF offers a durable scaffolding effect that promotes cell activity. The combination of fibrin with hyaluronic acid (HA), another well-studied orthobiologic product, has been shown to improve its scaffolding properties, leading to more robust fibrin polymerization. This supports cell survival, attachment, migration, and proliferation. Therefore, the administration of the "power mix" containing HA and autologous PRP + PRF may prove to be a safe and cost-effective approach in regenerative medicine.

Bio-Enhanced Neoligaments Graft Bearing FE002 Primary Progenitor Tenocytes: Allogeneic Tissue Engineering & Surgical Proofs-of-Concept for Hand Ligament Regenerative Medicine.

Hand tendon/ligament structural ruptures (tears, lacerations) often require surgical reconstruction and grafting, for the restauration of finger mechanical functions. Clinical-grade human primary progenitor tenocytes (FE002 cryopreserved progenitor cell source) have been previously proposed for diversified therapeutic uses within allogeneic tissue engineering and regenerative medicine applications. The aim of this study was to establish bioengineering and surgical proofs-of-concept for an artificial graft (Neoligaments Infinity-Lock 3 device) bearing cultured and viable FE002 primary progenitor tenocytes. Technical optimization and in vitro validation work showed that the combined preparations could be rapidly obtained (dynamic cell seeding of 105 cells/cm of scaffold, 7 days of co-culture). The studied standardized transplants presented homogeneous cellular colonization in vitro (cellular alignment/coating along the scaffold fibers) and other critical functional attributes (tendon extracellular matrix component such as collagen I and aggrecan synthesis/deposition along the scaffold fibers). Notably, major safety- and functionality-related parameters/attributes of the FE002 cells/finished combination products were compiled and set forth (telomerase activity, adhesion and biological coating potentials). A two-part human cadaveric study enabled to establish clinical protocols for hand ligament cell-assisted surgery (ligamento-suspension plasty after trapeziectomy, thumb metacarpo-phalangeal ulnar collateral ligamentoplasty). Importantly, the aggregated experimental results clearly confirmed that functional and clinically usable allogeneic cell-scaffold combination products could be rapidly and robustly prepared for bio-enhanced hand ligament reconstruction. Major advantages of the considered bioengineered graft were discussed in light of existing clinical protocols based on autologous tenocyte transplantation. Overall, this study established proofs-of-concept for the translational development of a functional tissue engineering protocol in allogeneic musculoskeletal regenerative medicine, in view of a pilot clinical trial.

Preference of musculoskeletal pain treatment in middle-aged and elderly chinese people: a machine learning analysis of the China health and retirement longitudinal study

BackgroundMusculoskeletal pain is a major cause of physical disability, associated with huge socioeconomic burden. Patient preference for treatment is an important factor contributing to the choice of treatment strategies. However, effective measurements for evaluating the ongoing management of musculoskeletal pain are lacking. To help improve clinical decision making, it’s important to estimate the current state of musculoskeletal pain management and analyze the contribution of patient treatment preference.MethodsA nationally representative sample for the Chinese population was derived from the China Health and Retirement Longitudinal Study (CHARLS). Information on the patients’ demographic characteristics, socioeconomic status, other health-related behavior, as well as history on musculoskeletal pain and treatment data were obtained. The data was used to estimate the status of musculoskeletal pain treatment in China in the year 2018. Univariate analysis and multivariate analysis were used to find the effect factors of treatment preference. XGBoost model and Shapley Additive exPlanations (SHAP) method were performed to analyze the contribution of each variable to different treatment preferences.ResultsAmong 18,814 respondents, 10,346 respondents suffered from musculoskeletal pain. Approximately 50% of musculoskeletal pain patients preferred modern medicine, while about 20% chose traditional Chinese medicine and another 15% chose acupuncture or massage therapy. Differing preferences for musculoskeletal pain treatment was related to the respondents’ gender, age, place of residence, education level, insurance status, and health-related behavior such as smoking and drinking. Compared with upper or lower limb pain, neck pain and lower back pain were more likely to make respondents choose massage therapy (P < 0.05). A greater number of pain sites was associated with an increasing preference for respondents to seek medical care for musculoskeletal pain (P < 0.05), while different pain sites did not affect treatment preference.ConclusionFactors including gender, age, socioeconomic status, and health-related behavior may have potential effects on people’ s choice of treatment for musculoskeletal pain. The information derived from this study may be useful for helping to inform clinical decisions for orthopedic surgeons when devising treatment strategies for musculoskeletal pain.