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PR3154 > IC 15: Approach to the Management of Soft Tissue Injuries > Flashcards

IC 15: Approach to the Management of Soft Tissue Injuries Flashcards

1
Q

What are the two types of joint pain?

A

Articular and non-articular

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2
Q

What are the accompanying features for articular joint pain?

A
  • Swelling
  • Erythematous
  • Tender on palpation of joint line
  • Restricted motion
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3
Q

What are the features of periarticular joint pain?

A
  • On palpation: point of maximal tenderness not at joint line
  • Pain on active movement > passive movement
  • Pain maximal in certain lines of muscle pull
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4
Q

What are the traits of soft tissue injury?

A
  • Consequence of chronic repetitive low-grade trauma/overuse
  • Focal and non-systemic
  • Self-limiting
  • Responds to conservative measures (supportive measures)
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5
Q

Which soft tissue injury requires urgent referral?

A
  • Ligament rupture
  • Infection-related causes
  • Malignancy/metastasis (lower back pain)
  • Relating to underlying visceral conditions (lower back pain)
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6
Q

What is non-pharm treatment for soft tissue injuries?

A
  • To do: rest, ice, compression, elevation, referral (if required)
  • Not to: heat, alcohol, re-injury, massage
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7
Q

What is the first line pharmacological treatment for acute soft tissue injuries that result in non-lower back pain?

A
  • Topical NSAIDs
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8
Q

What are the common types of soft tissue injury and which part is damaged?

A
  • Sprains: stretching ligaments
  • Tendonitis: inflammation of tendon
  • Bursitis: inflammation of bursae
  • Plantar fasciitis: inflammation of plantar fascia
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9
Q

What are the functions the different connective tissues?

Ligament, tendon, bursae, plantar fascia

A

Ligament: connect bone to bone
Tendon: connect muscle to bone
Bursae: cushions tendons/muscles from adjacent bones
Plantar fascia: connect heel bone to base of toes

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10
Q

Who are more susceptible to sprains?

A
  • Children and adolescents > adults
  • Adult females > males
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11
Q

What are the different presentations for different severity of sprains and what is the treatment?

A

Mild stretching of ligaments: mild swelling and tenderness, able to bear weight and ambulate with minimal pain. Medical help not often sought
Incomplete tear of ligament: moderate pain, swelling, tenderness and bruising, painful weightbearing and ambulation. To protect, rest, ice, compress, elevate and pharm treatment if necessary
Complete tear of ligament: severe pain, swelling, tenderness and bruising, cannot bear weight or ambulate. Refer to ER

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12
Q

What is tendinosis?

A

Persistent tendinopathy (chronic)

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13
Q

What are the features of tendonitis?

A
  • Local pain and dysfunction
  • Inflammation
  • Degeneration
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14
Q

What is the etiology of tendonitis?

A
  • Overuse (repeated mechanical loading)
  • Sports injury
  • Inflammatory rheumatic disease
  • Calcium apatite deposition (from metabolic disturbances)
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15
Q

What drugs can induce tendonitis?

A
  • Fluoroquinolone antibiotics
  • Statins
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16
Q

What are the common sites for tendonitis?

A
  • Shoulder: rotator cuff tendinopathy
  • Elbow: tennis or golfer’s elbow
  • Wrist
  • Hip
  • Ankle: achilles tendinopathy (athletes involved in jumping sports/running over hilly terrain)
17
Q

What is the etiology of bursitis?

A
  • Trauma/injury (acute)
  • Crystal-induced process e.g. gouty bursitis (acute)
  • Infection (acute)
  • Overuse (chronic)
  • Prolonged pressure (chronic)
  • Inflammatory arthritis (chronic)
18
Q

What is the difference between acute bursitis and chronic bursitis?

A

Acute bursitis: pain when joints are fully flexed
Chronic bursitis: more swelling and thickening, minimal pain

19
Q

What are the commonly affected locations of bursitis?

A
  • Superficial: elbow, knee cap, posterior upper thigh region
  • Deep: hip, shoulder
20
Q

What can be given for bursitis that is located at a deep area?

A

Intrabursal glucocorticoid can be given

21
Q

What is the possible etiology of plantar fasciitis?

A
  • Prolonged standing/jumping/running on hard surfaces
  • Flat feet/high arched feet
  • Tight hamstring muscle
  • Reduced ankle dorsiflexion
  • Obesity
  • Lower SES
  • Associated with systemic rheumatic diseases
22
Q

What is the presentation of plantar fasciitis?

A
  • Pain worse when walking/running (esp in morning or after period of inactivity)
  • Pain lessens with increased activity but worse at end of day (prolonged weight bearing)
23
Q

What is frozen shoulder associated with?

A
  • Presence of DM
  • Hypothyroidism
  • Dyslipidemia
  • Prolonged immobilisation
24
Q

What is the presentation of frozen shoulder?

A
  • Unilateral
  • Limited reaching overhead, to side, across chest
  • Limited rotation
25
Q

What are the various stages of frozen shoulder?

A
  • Initial (2-9 months): diffuse, severe disabling shoulder pain, worse at night, increasing stiffness
  • Intermediate (4-12 months): stiffness and severe loss of shoulder motion, pain gradually lessen
  • Recovery (5-24 months): gradual return of range of motion
26
Q

When should frozen shoulder be referred?

A

Marked loss of motion is present

27
Q

What is the management of frozen shoulder?

A
  • Analgesics for pain
  • Range of motion exercises
  • Intraarticular glucocortocoid + physical therapy
28
Q

How is low back pain classified according to it’s duration?

A
  • Acute < 4 weeks
  • Subacute 4-12 weeks
  • Chronic > 12 weeks
29
Q

What are some differential diagnosis that should be excluded for low back pain?

A
  • Lumbar strain
  • Herniated disc (spinal cord or cauda equina compression)
  • Osteoporotic fractures
  • Sciatica
  • Neoplasia
  • Infection (spinal epidural abscess)
  • Malignancy/metastatic cancer
  • Osteomyelitis
30
Q

What symptoms require a referral to ER?

A
  • Neurologic symptoms like motor weakness, loss of bowel/bladder function
  • Chronic glucocorticoid use
  • Age
  • Trauma
  • PMH of osteoporotic/traumatic
  • Unintended weight loss
  • PMH of malignancy
  • Fever and malaise
  • Recent spinal injections/epidural catheter placement
  • Immunocompromised
  • Fever
  • Constant pain
31
Q

What is the treatment for low back pain?

A
  • Acute and subacute low back pain: non-pharm + NSAID/SMR
  • Chronic back pain: non-pharm inc exercise, then NSAIDs as first line; alternatively tramadol/duloxetine
32
Q

What are some counselling points for patients with low back pain?

A
  • Engage in low-impact core strengthening exercises to improve spine stability
  • Use correct lifting and moving techniques
  • Maintain correct posture when sitting/standing
  • Quit smoking
  • Avoid stressful situations
  • Maintain healthy weight
33
Q

What should we pay attention to for myalgia?

A
  • Onset
  • Location
  • Associated symptoms
34
Q

What is the management for myalgia?

A
  • RICE
  • Topical NSAIDs (?)
  • Proper warm up before exercise
35
Q

When is urgent referral to the emergency department required when there is myalgia?

A
  • Infection-related especially bacterial
  • Medication toxicity like statin-induced rhabdomyolysis
36
Q

What are the symptoms associated with statin-associated muscle symptoms?

A
  • Proximal symmetric muscle weakness and/or weakness
  • Nocturnal cramping
  • Stiffness
  • Tendon pain
  • Fatigue and tiredness

PR3154 (6 decks)

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