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MSK Conditions & Treatment > IC15: Management of Soft Tissue Injury > Flashcards

IC15: Management of Soft Tissue Injury Flashcards

Clinical presentation & Management

1
Q

State 4 accompanying features of joint pain

A
  • Swelling
  • Erythematous
  • Tender on palpation of joint line
  • Restricted motion
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2
Q

Define active & passive movment

A

Active: Voluntary, muscle contraction initiated by the individual
Passive: Movement produced by external force eg. assistance of someone & does not involve muscle contraction

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3
Q

State the pharmacological treatment(s) used for soft tissue injuries (non-lower back pain)

A
  1. Topical NSAIDs
  2. PO NSAIDs/Coxibs (if topical cannot reach)
  3. PO paracetamol

Opioids eg. tramadol - avoid bc drowsy, abuse potential, dependence,

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4
Q

State at least 3 non-articular causes of joint pain

A
  • Referred visceral pain
    e.g. “shoulder pain” associated with MI
  • Tissue pain e.g. limb pain associated with DVT, ischemia, infection
    (cellulitis, necrotizing fasciitis)
  • Neuropathic pain e.g. relating to prolapsed intervertebral disc
  • Periarticular pain
    e.g. relating to ligaments, tendons, muscles (soft tissues)
  • Bone pain
    e.g. relating to fractures or dislocation from trauma/injury
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5
Q

State 4 situations requiring urgent referrals to the ED

A
  1. Ligament rupture
  2. Infection related causes
  3. Malignancy/metastasis (lower back pain)
  4. Relating to underlying visceral conditions (lower back pain) (eg. GI, liver etc…)
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6
Q

List 4 types of soft tissue injuries

A
  1. Sprains (stretching, partial rupture, complete rupture of ligament)
  2. Tendonitis (inflamamtion of tendon)
  3. Bursitis (inflammation of bursae)
  4. Plantar fasciitis (inflammation of plantar fascia
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7
Q

Sprains involves injury to …

What type of bone structures?

A

Ligaments

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8
Q

What is the most common type of ankle sprains?

State the mechanism, prevelance and onset

A

Lateral ankle sprains.
Mechanism: Inversion (rolling) of foot, usually from sports

In children & adolescents > adults,
Adult F > M

Sudden onset & swelling

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9
Q

Describe the severity of 3 the 3 grades of sprain, clinical presentation, function and management

A

Grade 1:
mild stretching of ligament with microscopic tear.
CP: mild swelling & tenderness. Function: Able to bear weight & ambulate with minimal pain. Mgmt: Medical help not freq sought

Grade 2
Severity: Incomplete tear of ligament
CP: Moderate pain, swelling, tenderness & ecchymosis
Function: Painful weightbearing & ambulation, mild-moderate joint instability, some restriction in ROM & fxn
Mgmt: Protection, rest, ice, compression, elevate +/- analgesics

Grade 3
Complete tear of ligament
CP: severe pain, swelling & tenderness, ecchymosis
Function: Cannot bear weight or ambulate (sf instability, loss of fxn)
Mgmt: Refer to emergency room

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10
Q

State the clinical features of tendonitis

A
  1. local pain & dysfunction on active use (unlikely painful on passive movement)
  2. Inflammation (but unlikely to cause visible swelling)
  3. Degeneration (after chronic duration, >3mth, leading to tendonosis)
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11
Q

State at least 3 etiologies of tendonitis

A

1. Overuse (repeated mechanical loading)
2. Sports injury
3. Drug induced: Fluoroquinolones & statins
4. Inflammatory rheumatic disease
5. Calcium apatite deposition (from metabolic disturbances)

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12
Q

State 5 common sites for tendonitis to occur

A
  1. Shoulder (rotator cuff tendinopathy, bicipital tendinitis)
  2. Elbow (lateral epicondylitis aka tennis elbow ; medial epicondylitis aka golfer’s elbow)
  3. Ankle (Achillies tendinopathy)
  4. Wrist (Flexor carpi radialis/ulnaris tendonitis)
  5. Lateral hip (gluteus madius/minimus tendinopathy)
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13
Q

Describe what is a bursa

A

Fluid filled, sac like structure lined by synovial membrane in clefts between mobile structures

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14
Q

State the causes of acute and chronic bursitis

A
  1. Trauma/injury
  2. Crystal-induced process eg. gouty arthritis
  3. Infection (septic bursitis)
  4. Overuse
  5. Prolonged pressure eg. kneeling, leaning
  6. Inflammatory arthritis eg. RA/spondyloarthritis

1-3 = acute bursitis
4-6 = chronic bursitis

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15
Q

Compare & Contrast the symptoms of acute and chronic bursitis

A

Acute:

  • Pain when joints are fully flexed in active & passive movment (eg. elbow joint)

Chronic:

  • More swelling & thickening, minimal pain,
  • secondary changes of contracture & muscle atrophy relating to immobility
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16
Q

Statethe common locations for bursitis

Superfical & deep locations

A

Superficial
1. Elbow (olecranon)
2. Knee cap (prepatellar)
3. Ischial (posterior upper thigh region bw gluteal maximus & ischial tuberosity)

Deep
1. Hip (trochanteric)
2. Shoulder (subacromial)

17
Q

What treatment option(s) can be given for bursitis in deeper regions?

A

Intrabursal glucocorticoid

18
Q

List at least 2 etiology for plantar fasciitis

A

1. Prolonged standing/jumping/ running on hard surfaces
2. Flat feet/high arched feet
3. Tight hamstring muscle –> dec knee extension, incr loading of forefoot, leading to stress of plantar fascia
4. Reduced ankle dorsiflexion
5. Obesity?
6. Lower SES, impaired physical & mental health?
7. A/W systemic rheumatic diseases

19
Q

Describe the clinical presentation of plantar fasciitis

in relation to physical activity, walking

A
  1. Pain worse when walking/ running esp in morning or after period of inactivity
  2. Pain lessens with increased activity but worse at end of day (prolonged weight bearing)
20
Q

Describe the clinical presentation of Frozen Shoulder

A
  1. Unilateral, usually on nondominant side, but other side might be affected within 5 years
  2. Limited reaching overhead, to side, across chest & limited rotation, leading to reduced function eg. cannot scratch back & wear coats
21
Q

Differentials of shoulder pain

A

referto slide 25

22
Q

When should sprains be referred?

A

Grade III
unable to bear weight or ambulate

23
Q

List & Describe the 3 stages of Frozen Shoulder

A

1. Initial (2-9mth): diffuse, severe disabling soulder pain, worse at night, increasing stiffness
2. Intermediate (4-12mth) stiffness & severe loss of shoulder motion, pain gradually lessen
3. Recovery (5-24mth) Gradual return of motion

24
Q

When to refer for frozen shoulder?

A

When there is marked loss of motion

25
Q

State the pharmacological treatment option(s) for Frozen Shoulder

A

Rmb: ARI
1. Analgesics for pain (Paracetamol/NSAIDs/Weak opioids)
2. Range of motion exercises
3. Intraarticular glucocorticoid + physical therapy

26
Q

State the timeframe for acute, subacute and chronic low back pain

A

Acute: < 4 weeks;
Subacute: 4-12 weeks;
Chronic: > 12 weeks

27
Q

List back pain differentials

A

Inflammatory:spondyloarthrtis
Infection: Tuberculosis, osteomyelitis
Degenerative: osteoarthritis
Trauma: osteoporotic, non-soteoporotic
Malignancy: Metastases, myeloma

28
Q

State the treatment for acute and subacute low back pain

A
  1. Nonpharmacological tx eg. heat therapy
  2. NSAIDs/ Skeletal muscle relaxant (ophenadrine)
29
Q

State the treatment for chronic low back pain

A
  1. Nonpharm eg. exercise
  2. NSAIDs, or alternatives eg. tramadol or duloxetine
30
Q

List down at least 4 counselling points for low back pain

A
  1. Improvement in pain & function from tx may be small
  2. Reassure that acute/ subacute pain is usually self-limiting
  3. Remain active as tolerated
  4. Avoid potentially harmful &
    costly tests & tx
  5. Engage in low-impact core strengthening exercises to improve spine stability e.g. swimming, stationary bicycling, brisk walking
  6. Use correct lifting & moving techniques i.e. Squatting to lift heavy object. Do not bend and lift. Get help if object is too heavy or awkward.
  7. Maintain correct posture when sitting / standing
  8. Quit smoking ** (smoking is a risk factor for arthrosclerosis - hardening of arteries, which can
    cause low back pain & degenerative disc disorders)
    9.     Avoid stressful situations** (these can cause muscle tension)
  9. Maintain a healthy weight (extra weight especially around the midsection can add strain on lower back)
31
Q

State the management for myalgia due to overuse or exercise

A

Exercise myalgia is acute and self limiting

  • RICE (self limiting)
  • Topial NSAIDs? (if pt wants sth for pain relief)
  • Prevention: inform pt to warm up before exercise
32
Q

State 2 scenarios requiring urgent referral for diffuse myalgia

A
  1. Infection related esp bacterial, esp for endocarditis & impending sepsis (CP: diffuse myalgia, fever, chills, arthralgia, fatigue, back pain)
  2. Medication toxicity (esp statins)
    (CP: muscle pain, muscle weakness, red brown tea colured urine)
33
Q

SAMs usually present?

Onset & location

A

Can occur anytime
CP: Usually muscle weakness &/or weakness (hips, calf, RARELY arms), noctural cramping, stiffness, tendon pain, fatigue & tiredness

34
Q

How should SAMs be managed?

A
  1. Discontinue statin if sx intolerable, sx will resolve over days-weeks
35
Q

List 3 statins that less tendency to cause SAMs

A

Pravastatin
Fluvastatin
Rosuvastatin

MSK Conditions & Treatment (6 decks)

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