IC15 Management of soft tissue injuries Flashcards
What are the 2 types of joint pain?
- Articular
- Non-articular
Articular pain - pain from the joint
Articular pain is most painful at the joint line.
Non-articular pain - pain that is due to musculoskeletal
Pain is not at the joint. The pain on active movement and not passive movement.
A type of non-articular pain is periarticular pain.
Periarticular sources of pain originate in structures surrounding the joint.
What are these structures?
- Ligaments
- Tendons
- Muscles
What are the characteristics of soft tissue injuries?
- A consequence of chronic overuse / repetitive low-grade trauma
- Focal & non-systemic
- Self-limiting
- Responds to conservative measures / non-pharmacotherapy
What are some soft tissue injuries that require urgent referrals to the emergency department?
- Ligament rupture
- Infection-related causes
- Malignancy / metastasis
- Associated w lower back pain
What are the 3 main treatment goals for soft tissue disorders?
- Reduce pain
- Regain function
- Prevent future injury
Another type of treatment goal goes by the acronym RICERHARM.
What does RICERHARM represent?
R - rest
I - ice
C - compression
E - elevate
R - referral
H - no heat
A - no alcohol
R - no reinjury
M - no massage
If patient were to use ice for their injury, how should they go about doing it?
Patient should not put ice directly on the skin.
Wrap the ice around some cloth or plastic.
Ice the area for 10-15 mins. If it is still very painful, ice the area again.
What are the top 3 agents to use for pain relief in non-lower back pain?
For acute non-lower back pain:
1. PO paracetamol (not as effective)
2. Topical NSAIDs
3. Oral NSAIDs
What are the pros and cons of topical and oral NSAIDs?
Topical NSAIDs:
- (Pros) Fewer side effects as compared to oral NSAIDs
- (Cons) Unable to reach deeper regions
Oral NSAIDs:
- (Pros) Able to reach deeper regions - e.g hip injury.
- (Cons) Has more side effects
What are the 4 common types of soft tissue injury that we learnt in this IC?
- Sprain
- Tendonitis
- Bursitis
- Plantar fasciitis
What are the definition of the 4 soft tissue injuries?
- Sprain
- Tendonitis
- Bursitis
- Plantar fasciitis
- Sprain - 3 types of sprains –> (1)stretching, (2)partial rupture, (3)complete rupture of ligament (bone-to-bone connective tissue)
- Tendonitis - inflammation of tendonitis (muscle-to-bone connective tissue)
- Bursitis - inflammation of bursae (fluid filled sacs around joints that cushion tendons / muscles from adjacent bones)
- Plantar fasciitis - inflammation of plantar fascia (fibrous attachment connecting heel bone to base of toes)
What is the most common type of sprain?
Lateral ankle sprain.
- Can be inversion or eversion of foot
Sprain is an injury involving ligaments.
What are 2 risk factors of sprain?
- Adult females > males
- Children & adolescents > adults
There are 3 grades of sprains - Grade I, Grade II, Grade III.
What is the severity of the injury that each grade represents?
Grade 1 - mild stretching of the ligament
Grade 2 - Incomplete tear of the ligament
Grade 3 - Complete tear of the ligament
What is the main characteristic of a Grade 3 tear?
Cannot bear body weight or move
What is tendonitis and what causes it?
Tendonitis - inflammation of the tendon.
It is often caused by:
- Overuse of the tendon (most common)
- Injury
- Drug induced (e.g fluoroquinolones, statins)
Where are the common sites for tendonitis?
- Shoulders
- Elbows
- Ankles
What is the best treatment for tendonitis?
Rest.
Other treatment can be topical or oral anti-inflammatory NSAIDs.
What is bursitis and what causes it?
Bursitis - the inflammation of the bursa
Causes of acute bursitis are:
- Trauma / injury
- Gout
- Infection
Causes of chronic bursitis:
- Overuse
- Prolonged pressure
- Inflammatory arthritis (e.g rheumatoid arthritis)
What are telltale signs of bursitis?
Pain and pressure arises when joints are bent, resulting in compression of the bursae.
What is plantar fasciitis and what causes it?
Plantar fasciitis - inflammation of plantar fascia
Causes of plantar fasciitis:
- Prolonged standing, jumping, running on hard surfaces
- Flat feet / high arched feet
What are the signs & symptoms of plantar fasciitis?
- Pain worsens when walking / running
- Pain lessens w increased activity, but worsens at the end of the day
What are the red flags of plantar fasciitis?
- Numbness & pins and needles
- Nocturnal pain
- Trauma
- Fever
- Constant pain
- Sudden onset
- History of inflammatory condition
- Erythema
What is adhesive capsulitis (aka frozen shoulder)?
Adhesive capsulitis - an inflammatory condition characterized by shoulder stiffness, pain, and significant loss of passive range of motion.
What are the risk factors of adhesive capsulitis?
- 50+ years old
- DM
- Hypothyroidism
- Dyslipidaemia
- Prolonged immobilization
What are the S&S of adhesive capsulitis?
- Unilateral
- Reduced function of the shoulders (e.g cannot put on shirt)
- Self-limiting
- Worse at night
- Stiffness & severe loss of shoulder motion
What are the red flags of adhesive capsulitis?
- Systemic symptoms of infection
- Malignancy
- Associated chronic illness
What is the treatment for adhesive capsulitis?
- Paracetamol / NSAIDs / Weak opioids
- Range of motion exercises
Majority of lower back pain are non-specific and self-limiting strains.
What are the red flags to look for in lower back pain?
Red flags of lower back pain are:
- Chronic pain
- Worse at night
- Unintended weight loss
- History of previous malignancy
Which causes of lower back pain requires referral?
- Herniated disc
- Osteoporotic fractures
- Malignancy / metastatic cancer
- Infection
What are the treatments for:
- Acute & subacute lower back pain?
- Chronic lower back pain?
Acute & subacute lower back pain:
- Heat therapy + NSAIDs
Chronic lower back pain:
- Exercise + NSAIDs
What are some counselling points for pt w lower back pain?
- Do low-impact core strengthening exercises
- Use correct lifting & moving techniques
- Maintain correct posture when sitting/standing
- Quit smoking
- Reduce stress
- Maintain healthy weight
What are some S&S of Statin Associated Muscle Symptoms (SAMS)?
- Onset can occur at anytime
- Muscles weakness
- Nocturnal cramping, stiffness, tendon pain, fatigue & tiredness
When would you consider discontinuing statins in SAMS?
- When Sx becomes intolerable
- CK > 10x ULN
Summary on when you need to refer for the following conditions:
- Sprains
- Tendonitis
- Bursitis
- Plantar fasciitis
- Adhesive capsulitis
- Sprains
- Cannot bear weight
- Loss of motion/function
- Significant instability - Tendonitis
- Pain for days or weeks - Bursitis
- Acute onset
- Severe pain
- Prior trauma
- PMH of inflammatory conditions - Plantar fasciitis
- Acute onset
- Severe pain
- Prior trauma
- Fever
- PMH of inflammatory conditions - Adhesive capsulitis
- decrease in range of motion
- Fever
- PMH of malignancy
- Trauma / history of fractures
- Neurological sx (e.g pins & needles, muscle weakness, loss of bowel & urine function)
