For many of us who have been in the medical industry for some time, we might remember the term locomotor system – which has been replaced by the more modern term ‘muscular-skeletal’. The industry-standard definition of the muscular-skeletal system is “the skeleton and connective tissues (muscles, ligaments, joints and tendons) which are directly involved in support, protection of vital organs and movement of the body.” It’s important to emphasize that muscular-skeletal conditions do not merely refer to a break or fracture in a bone, but also to the surrounding impact on the connective tissues – such as muscle tears, internal inflammation (osteoarthritis) and muscle sprains. Turnberry defines muscular-skeletal as any diagnosis or condition relating to bones, muscles, cartilage, tendons, ligaments, joints and/or connective tissue.
From this definition, we can classify muscular-skeletal issues as being either traumatic or chronic conditions.
A traumatic condition would be caused by some form of trauma to the body for example a broken bone or a torn ligament. Most traumatic muscular-skeletal conditions would be a Prescribed Minimum Benefit (PMB). PMBs are a list of 271 medical conditions and 25 chronic conditions legislated by the Medical Schemes Act 131 of 1998, that medical schemes need to fund in full from the risk benefit, provided that a member makes use of the medical scheme’s Designated Service Providers (DSP). Should a member voluntarily choose not to make use of a DSP then they could be liable for a medical expense shortfall.
Chronic’ muscular-skeletal conditions often develop based on predispositions or due to ageing for example arthritis or the need for a joint replacement due to wear and tear.