Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 6 Issue 3

COVID-19 and its Multiple Long Term Neuromuscular Features and Implications

Ray Marks

Department of Health and Behavior Studies, Teachers College, Columbia University, New York, USA

*Corresponding Author: Ray Marks, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, USA.

Received: February 01, 2023; Published: February 16, 2023


Since the emergence of the novel virus later termed COVID-19, its rate of infection and its widespread impact remains an immense public health concern and challenge. But how specifically can orthopaedic problems such as hip fractures and falls injuries, plus painful arthritis become specifically impacted? This mini review updates what is known about the recently observed long COVID syndrome neuromuscular challenges not apparently associated with their health history profile in all cases. A second was to establish if any health associated preventive and intervention can be recommended especially for the older adult with long COVID-19 manifestations, who may still be very vulnerable to falling, and fracturing a bone, plus varying degrees of joint pain. Although long COVID symptoms have been attributed to psychosocial factors, it appears that more attention to how COVID-19 can induce neuromuscular disability through biological mechanisms is indicated.

Keywords: COVID -19; Long-COVID-19; Myalgia; Older Adults; Prevention


  1. Koc Ho Cheng., et al. “Long COVID and its management”. International Journal of Biological Sciences12 (2022): 4768-4780.
  2. Cavallieri Francesco., et al. “Neurologic complications of coronavirus and other respiratory viral infections”. Handbook of Clinical Neurology 189 (2022): 331-358.
  3. Zeng Na., et al. “A systematic review and meta-analysis of long term physical and mental sequelae of COVID-19 pandemic: call for research priority and action”. Molecular Psychiatry1 (2023): 423-433.
  4. Kalra Rajkumar Singh., et al. “COVID-19, neuropathology, and aging: SARS-CoV-2 neurological infection, mechanism, and associated complications”. Frontiers in Aging Neuroscience 13 (2021): 662786.
  5. Terai Hidetomi., et al. “Impact of the COVID-19 pandemic on the development of locomotive syndrome”. Journal of Orthopaedic Surgery (Hong Kong)3 (2021).
  6. Graham Edith L., et al. “Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 "long haulers"“. Annals of Clinical and Translational Neurology5 (2021): 1073-1085.
  7. Piotrowicz Karolina., et al. “Post-COVID-19 acute sarcopenia: physiopathology and management”. Aging Clinical and Experimental Research10 (2021): 2887-2898.
  8. Anaya Juan-Manuel., et al. “Post-COVID syndrome. A case series and comprehensive review”. Autoimmunity Reviews11 (2021): 102947.
  9. Huerne Katherine., et al. “Epidemiological and clinical perspectives of long COVID syndrome”. American Journal of Medicine Open (2023): 100033.
  10. López-Sampalo A., et al. “Persistent COVID-19 syndrome. A narrative review”. Revista Clinica Espanola 4 (2022): 241-250.
  11. Maamar Meryam., et al. “Post-COVID-19 syndrome, low-grade inflammation and inflammatory markers: a cross-sectional study”. Current Medical Research and Opinion6 (2022): 901-909.
  12. Lisco Giuseppe., et al. “COVID-19 and the endocrine system: a comprehensive review on the theme”. Journal of Clinical Medicine13 (2021): 2920.
  13. Palmer Katie., et al. “The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing”. Aging Clinical and Experimental Research7 (2020): 1189-1194.
  14. Nalbandian Ani., et al. “Post-acute COVID-19 syndrome”. Nature Medicine. 27.4 (2021): 601-615.
  15. Yong Shin Jie. “Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments”. Infectious Diseases10 (2021): 737-754.
  16. Montani David., et al. “Post-acute COVID-19 syndrome”. European Respiratory Review163 (2022): 210185.
  17. Goodman Michael L., et al. “Long COVID and mental health correlates: a new chronic condition fits existing patterns”. Health Psychology and Behavioral Medicine.1 (2023): 2164498.
  18. Ceban Felicia., et al. “Fatigue and cognitive impairment in post-COVID-19 syndrome: a systematic review and meta-analysis”. Brain, Behavior, and Immunity101 (2022): 93-135.
  19. Astin Rónan., et al. “Long COVID: mechanisms, risk factors and recovery”. Experimental Physiology1 (2023): 12-27.
  20. Alkodaymi Mohamad Salim., et al. “Prevalence of post-acute COVID-19 syndrome symptoms at different follow-up periods: a systematic review and meta-analysis”. Clinical Microbiology and Infection 5 (2022): 657-666.
  21. Lutchmansingh Denyse D., et al. "Long Haulers". Seminars in Respiratory and Critical Care Medicine1 (2023): 130-142.
  22. di Filippo Luigi., et al. “The osteo-metabolic phenotype of COVID-19: an update”. Endocrine 2 (2022): 247-254.
  23. Awosanya Olatundun D., et al. “Osteoclast-mediated bone loss observed in a COVID-19 mouse model”. Bone 154 (2022): 116227.
  24. de Blasio Francesco., et al. “Poor nutritional status and dynapenia are highly prevalent in post-acute COVID-19”. Frontiers in Nutrition 9 (2022): 888485.
  25. Montes-Ibarra Montserrat., et al. “The impact of long COVID-19 on muscle health”. Clinics in Geriatric Medicine3 (2022): 545-557.
  26. Larsen Nicholas W., et al. “Preparing for the long-haul: Autonomic complications of COVID-19”. Autonomic Neuroscience: Basic and Clinical 235 (2021): 102841.
  27. Tabacof Laura., et al. “Post-acute COVID-19 syndrome negatively impacts physical function, cognitive function, health-related quality of life, and participation”. American Journal of Physical Medicine and Rehabilitation1 (2022): 48-52.
  28. Zacharias Hannah., et al. “Rheumatological complications of Covid 19”. Autoimmunity Reviews9 (2021): 102883.
  29. Van Kessel Sophie AM., et al. “Post-acute and long-COVID-19 symptoms in patients with mild diseases: a systematic review”. Family Practice1 (2022): 159-167.
  30. Sapra Leena., et al. “Long-term implications of COVID-19 on bone health: pathophysiology and therapeutics”. Inflammation Research9 (2022): 1025-1040.
  31. Vanichkachorn Greg., et al. “Post-COVID-19 syndrome (long haul syndrome): description of a multidisciplinary clinic at Mayo Clinic and characteristics of the initial patient cohort”. Mayo Clinic Proceedings7 (2021): 1782-1791.
  32. Subramanian Anuradhaa., et al. “Symptoms and risk factors for long COVID in non-hospitalized adults”. Nature Medicine8 (2022): 1706-1714.
  33. Sudre Carole H., et al. “Attributes and predictors of long COVID”. Nature Medicine4 (2021): 626-631.
  34. Davis Hannah E., et al. “Long COVID: major findings, mechanisms and recommendations”. Nature Reviews. Microbiology 1-14 (2023): 13.
  35. Sigfrid Louise., et al. “Long COVID in adults discharged from UK hospitals after Covid-19: a prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol”. The Lancet Regional Health. Europe 8 (2021): 100186.
  36. Taquet Maxime., et al. “Incidence, co-occurrence, and evolution of long-COVID features: a 6-month retrospective cohort study of 273,618 survivors of COVID-19”. PLoS Medicine9 (2021): e1003773.
  37. Etter Manina M., et al. “Severe Neuro-COVID is associated with peripheral immune signatures, autoimmunity and neurodegeneration: a prospective cross-sectional study”. Nature Communications1 (2022): 6777.
  38. Sykes Dominic L., et al. “Post-COVID-19 symptom burden: what is long-COVID and how should we manage it?” Lung. 199.2 (2021): 113-119.
  39. Cabrera Martimbianco Ana Luiza., et al. “Frequency, signs and symptoms, and criteria adopted for long COVID-19: a systematic review”. International Journal of Clinical Practice10 (2021): e14357.
  40. Ramakrishnan Rakhee K., et al. “Unraveling the mystery surrounding post-acute sequelae of COVID-19”. Frontiers in Immunology 12 (2021): 686029.
  41. Premraj Lavienraj., et al. “Mid and long-term neurological and neuropsychiatric manifestations of post-COVID-19 syndrome: a meta-analysis”. Journal of the Neurological Sciences 434 (2022): 120162.
  42. Jennings Glenn., et al. “Comprehensive clinical characterisation of brain fog in adults reporting long COVID symptoms”. Journal of Clinical Medicine12 (2022): 3440.
  43. Orfei Maria Donata., et al. “A new look on Long-COVID effects: the functional Brain Fog Syndrome”. Journal of Clinical Medicine19 (2022): 5529.
  44. Parker Ann M., et al. “Addressing the post-acute sequelae of SARS-CoV-2 infection: a multidisciplinary model of care”. The Lancet. Respiratory Medicine11 (2021): 1328-1341.
  45. Stefanou Maria-Ioanna., et al. “Neurological manifestations of long-COVID syndrome: a narrative review”. Therapeutic Advances in Chronic Disease 13 (2022): 20406223221076890.
  46. Munblit Daniel., et al. “Incidence and risk factors for persistent symptoms in adults previously hospitalized for COVID-19”. Clinical and Experimental Allergy9 (2021): 1107-1120.
  47. Pilotto Andrea., et al. “Long-term neurological manifestations of COVID-19: prevalence and predictive factors”. Neurological Sciences12 (2021): 4903-4907.
  48. Cacciatore Martina., et al. “Neurological and mental health symptoms associated with post-COVID-19 disability in a sample of patients discharged from a COVID-19 ward: a secondary analysis”. International Journal of Environmental Research and Public Health7 (2022): 4242.
  49. Saeed Sy Atezaz., et al. “COVID-19 and its impact on the brain and Mind- A conceptual model and supporting evidence”. The Psychiatric Quarterly1 (2022): 271-284.
  50. Taribagil Priyal., et al. “'Long COVID' syndrome”. BMJ Case Reports4 (2021): e241485.
  51. Lombardo Michele Davide Maria., et al. “Long-term Coronavirus Disease 2019 complications in inpatients and outpatients: a one-year follow-up cohort study”. Open Forum Infectious Diseases 8 (2021): ofab384.
  52. Liu Jonathan., et al. “Long-term orthopedic manifestations of COVID-19: heterotopic ossification and digital necrosis”. Rhode Island Medical Journal 7 (2022): 31-35.
  53. Pavli Androula., et al. “Post-COVID syndrome: incidence, clinical spectrum, and challenges for primary healthcare professionals”. Archives of Medical Research6 (2021): 575-581.
  54. Daitch Vered., et al. “Characteristics of long-COVID among older adults: a cross-sectional study”. International Journal of Infectious Diseases 125 (2022): 287-293.
  55. Zaninotto Paola., et al. “Immediate and longer-term changes in the mental health and well-being of older adults in England during the COVID-19 pandemic”. JAMA Psychiatry2 (2022): 151-159.
  56. Poenaru Sonia., et al. “COVID-19 and post-infectious myalgic encephalomyelitis/chronic fatigue syndrome: a narrative review”. Therapeutic Advances in Infectious Disease8 (2021): 20499361211009385.
  57. Janbazi Lobaneh., et al. “The incidence and characteristics of chronic pain and fatigue after 12 months later admitting with COVID-19; The Post- COVID 19 syndrome”. American Journal of Physical Medicine and Rehabilitation (2022).
  58. Karaarslan Fatih., et al. “Long COVID: rheumatologic/musculoskeletal symptoms in hospitalized COVID-19 survivors at 3 and 6 months”. Clinical Rheumatology 1 (2022): 289-296.
  59. Healey Quin., et al. “Symptoms and signs of long COVID: a rapid review and meta-analysis”. Journal of Global Health 12 (2022): 05014.
  60. Lauwers Marianne., et al. “COVID-19 in joint ageing and osteoarthritis: current status and perspectives”. International Journal of Molecular Sciences2 (2020): 720.
  61. Nguyen Nhu Ngoc., et al. “Clinical patterns of somatic symptoms in patients suffering from post-acute long COVID: a systematic review”. European Journal of Clinical Microbiology and Infectious Diseases.4 (2022): 515-545.
  62. Al-Ramadan Ali., et al. “Acute and post-acute neurological complications of COVID-19”. Neurology International1 (2021): 102-119.
  63. Sapkota Hem Raj, and Arvind Nune. “Long COVID from rheumatology perspective - a narrative review”. Clinical Rheumatology.2 (2022): 337-348.
  64. Aly Menna AEG and Heba G Saber. “Long COVID and chronic fatigue syndrome: a survey of elderly female survivors in Egypt”. International Journal of Clinical Practice12 (2021): e14886.
  65. Rees Justin T., et al. “Generalizable Long COVID Subtypes: Findings from the NIH N3C and RECOVER Programs”. medRxiv 24 (2022): 22275398.
  66. Karaarslan Fatih., et al. “Long COVID: rheumatologic/musculoskeletal symptoms in hospitalized COVID-19 survivors at 3 and 6 months”. Clinical Rheumatology1 (2022): 289-296.
  67. Saunders Chloe., et al. “A new paradigm is needed to explain long COVID”. The Lancet. Respiratory Medicine (2023).
  68. Ahmad Samuel J., et al. “Neurological sequelae of COVID-19”. Journal of Integrative Neuroscience3 (2022): 77.
  69. Ramírez-Vélez Robinson., et al. “Reduced muscle strength in patients with long-COVID-19 syndrome is mediated by limb muscle mass”. Journal of Applied Physiology (Bethesda, Md: 1985)1 (2023): 50-58.
  70. Yong Shin Jie. “Persistent brainstem dysfunction in long-COVID: a hypothesis”. ACS Chemical Neuroscience4 (2021): 573-580.
  71. Rothstein Ted L. “Cortical grey matter volume depletion links to neurological sequelae in post COVID-19 "long haulers"”. BMC Neurology1 (2023): 22.
  72. Prabhakaran Divya., et al. “Neurophenotypes of COVID-19: risk factors and recovery trajectories”. Research Square 3 (2021): 2363210.
  73. Silva Camilla Costa., et al. "Muscle dysfunction in the long coronavirus disease 2019 syndrome: Pathogenesis and clinical approach”. Reviews in Medical Virology 6 (2022): e2355.
  74. Di Girolamo Filippo G., et al. "Skeletal muscle in hypoxia and inflammation: insights on the covid-19 pandemic”. Frontiers in Nutrition 9 (2022).
  75. Soares Madu N., et al. "Skeletal muscle alterations in patients with acute Covid‐19 and post‐acute sequelae of Covid‐19”. Journal of Cachexia, Sarcopenia and Muscle1 (2022): 11-22.


Citation: Ray Marks. “COVID-19 and its Multiple Long Term Neuromuscular Features and Implications”. Acta Scientific Orthopaedics 6.3 (2023): 126-133.


Copyright: © 2023 Ray Marks. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate33%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US