5. Soft tissue diseases Flashcards
What are the red flags for severe disease?
Fever Unexplained weight loss History of carcinoma Immunosuppression Ill health or presence of other medical illness Severe night pain/progressive pain Persistant mono-arthritits
What are yellow flags?
These are factors that increase pain and the risk of developing or perpetuating long term disability and work loss associated with persistent pain
What is meant by the ‘enthesis’?
This is the area of the ligamentous attachment to bone - where the tendon sheath inserts into the bone
What is ‘tendonitis’ characterised by?
Characterised by pain on resisted movement
What is De Quervain’s tenosynovitis?
Inflammation of the tendons on the side of the wrist at the base of the thumb
Type of tendonitis
Where is pain felt in De Quervain’s tenosynovitis?
Around the thumb, at the base of the thumb and at the wrist
Which tendons are affected in De Quervain’s tenosynovitis? x3
Extensor pollicis brevus
Abductor pollicis longus
Extensor pollicis longus
Other than pain, how does De Quervain’s tenosynovitis present?
Crepitus on movement
How is De Quervain’s tenosynovitis treated?
Topical anti-inflammatory medication e.g. ibuprofen
How is De Quervain’s tenosynovitis tested? x3
Pain on resisted movement (!)
Crepitus
Finkelstein’s test
What is trigger finger?
Nodule on the relevant flexor/tendon forms - gets stuck passing through the tendon sheath of the palm
How is trigger finger treated?
Topical anti-inflammatories
What is carpal tunnel syndrome?
Compression of the median nerve in the carpal tunnel
How does carpal tunnel syndrome present?
Presents as pain and parasthesia due to sensory loss first thing in the morning
What is the effect of advanced carpal tunnel syndrome?
Atrophy of the thenar eminence
What other conditions are closely associated with carpal tunnel syndrome?
Hypothyroidism RA Diabetes Pregnancy Acromegaly
Name the two tests used to diagnose carpal tunnel syndrome
Tinel’s test
Phalen’s test
What is Tinel’s test?
Tap/percuss on the medial nerve
Should illicit sensation of tingling over the distribution of the nerve
What is Phalen’s test?
Push the wrists into complete and forced flexion
How can you treat carpal tunnel syndrome?
Immobilise the joint
Inject steroids to release inflammation
All treatment is aimed at decompression of the median nerve
What is dupuytren’s contracture?
Fibrosis of the palmar aponeurosis causing the fingers to bend inwards
In whom is dupuytren’s contracture most common?
Men
Heavy drinkers
Smokers
Diabetics
What is tennis elbow?
Inflammation of the enthesis where of the extensor muscles of the forearm at the lateral epicondyle of the humerus
What is tennis elbow also known as?
Lateral epicondylitis
How is tennis elbow diagnosed?
Local tenderness
Pain at resisted wrist extension
What is the treatment for tennis elbow?
Rest/topical NSAID
Massage
Injection
In severe cases - surgery
What is the dermatomal distribution of true shoulder pain?
What is not affected by this pain?
C5
The elbow
What is the other name for frozen shoulder?
Adhesive capsulitis
What is frozen shoulder?
Capsulitis - the capsule of the shoulder joint becomes thickened and very adherent - glues up - becomes sticky and gooey
What happens to the size of the joint capsule of the shoulder in frozen shoulder?
The whole capsule shrinks and there is a reduced area of space for movement
What is the cause of frozen shoulder?
Idiopathic
What is the treatment for frozen shoulder?
Re-assurance/education
Analgesia
Injection
Physiotherapy
What is rotator cuff tendinitis?
Impingement of the rotator cuff muscles between the greater tuberosity and the acromium- common in young athletes where there is overuse
How does rotator cuff tendinitis present?
Painful arc on active abduction
Pain on resisted abduction
What is the treatment for rotator cuff tendinitis?
Physiotherapy
Steroid injection
Surgery may be considered if this does not settle
What is meralgia paraesthetica?
This is the hip equivalent of carpal tunnel syndrome
What is ‘march fracture’?
This is a fatigue/stress fracture of the distal third of the metatarsal due to recurrent stress (marching)
What is mortons neuroma?
Benign neuroma at the planter nerve of the foot
Meralgia paraesthetica - compression of which nerves?
Lateral cutaneous nerves
