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54 Finals > IC15 Soft Tissue Injuries > Flashcards

IC15 Soft Tissue Injuries Flashcards

1
Q

Periarticular pain

A

pain in soft tissue surrounding the joints, eg ligaments, tendons, muscles

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2
Q

6 sx of Periarticular pain

A
  • Point of maximal tenderness not at joint line
  • Pain on active movement (move by yourself) > passive (someone help you move) movement
  • Pain maximal in certain lines of muscle pull
  • Focal (pain at the site) — does not radiate
  • Non-systemic — no fever, no loss of weight
  • Responds to conservative measures (non-pharmacological tx works best)
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3
Q

Urgent referrals (emergency department)

A
  • Fracture
  • Ligament rupture
  • Infection
  • Malignancy/ metastasis (differential for lower back pain)
  • Underlying visceral pain/conditions (differential for lower back pain)
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4
Q

Tx goals

A
  1. Reduce pain
  2. Regain function
  3. Prevent future injury
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5
Q

Initial management of soft tissue injury

A

PRICER + No HARM
1. Protect
2. Rest — stop aggravating factors/activities
3. Ice — 10 to 15 mins in the 1st hour after injury → reduce inflammation
4. Compression — use bandages to reduce swelling and inflammation
5. Elevation — elevate higher than heart level to reduce swelling/ pooling of blood
6. Referral
7. no Heat — prevent inflammation from worsening
8. no Alcohol — increase blood circulation with alcohol causes increase inflammation
9. no Reinjury — rest
10. no Massage

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6
Q

Pharm tx

A
  1. Topical NSAIDs — works better than PO NSAIDs and are less likely to cause harm
  2. PO NSAIDs/ coxib
  3. PO paracetamol — lack anti-inflammatory (may be less effective)
    - No opioids or fentanyl recommended unless severe injury — not more effective than NSAIDs but has many SE, dependence, death
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7
Q

Sprains definition

A

stretching, partial rupture, complete rupture of ligament (bone-to-bone connective tissue)

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8
Q

most common sprain and causes

A

inversion of foot (most common: lateral ankle sprains of the anterior talofibular ligament)

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9
Q

which part of the ankle is most likely to sprain

A

anterior talofibular ligament

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10
Q

RF for sprains

A

sports/exercise, children & adolescents > adults, adult females > males

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11
Q

S/S of sprain

A

S/S: sudden onset of pain & swelling

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12
Q

when should sprain be referred?

A

unable to bear weight or ambulate

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13
Q

tendonitis definition

A

inflammation of tendon (muscle-to-bone connective tissue)

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14
Q

5 causes of tendonitis

A
  • Overuse (repeated mechanical loading)
  • Sports injury (eg running over hilly terrain, golf, tennis)
  • Inflammatory rheumatic disease
  • Calcium apatite deposition (from metabolic disturbances)
  • Drug-induced: fluoroquinolone antibiotics & statins
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15
Q

S/S of tendonitis

A
  • Local pain & dysfunction on active use (but unlikely painful on passive movement)
  • Inflammation (but unlikely to cause visible swelling)
  • Degeneration
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16
Q

Common sites for tendonitis

A

shoulder, elbow (tennis, golf), wrist, hip (lateral), ankle (achilles tendinopathy)

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17
Q

bursitis definition

A

inflammation of bursae (fluid-filled sacs around joints that cushions tendons / muscles from adjacent bones)

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18
Q

Causes of bursitis

A
  • Active bursitis
    • Trauma/injury
    • Crystal induced process (eg gouty arthritis)
    • Infection (septic bursitis)
  • Chronic bursitis
    • Overuse
    • Prolonged pressure
    • Inflammatory arthritis
19
Q

Differentiate btw active and chronic bursitis

A
  • Active bursitis (sudden onset) — pain when joints are fully flexed (both active and passive)
  • Chronic bursitis (chronic pain) — more swelling & thickening, minimal pain, secondary changes of contracture & muscle atrophy relating to immobility
20
Q

S/S of bursitis

A

pain occurs when motion compresses adjacent bursa where intrabursal pressure increases (eg fully flexed elbow)

21
Q

Common sites of bursitis

A
  • Superficial: elbow, knee cap, posterior upper thigh region
  • Deep: hip, shoulder — may need intrabursal glucocorticoids for tx
22
Q

plantar fasciitis definition

A

inflammation of plantar fascia (fibrous attachment connecting heel bone to base of toes)

23
Q

Causes of plantar fasciitis

A
  • Prolonged standing, jumping, running on hard surfaces
  • Flat feet/ high arched feet
  • Tight hamstring muscle
  • Reduced ankle dorsiflexion
  • Obesity, low SES, systemic rheumatic diseases
24
Q

S/S of plantar fasciitis

A
  • Most common cause of heel pain, peak prevalence at 40-60 yo (younger peak if runners)
  • Pain worse when walking/running (esp morning or after period of inactivity) — pain on movement/ when no stretching
  • Pain lessens with increased activity but worse at end of day (prolonged weight bearing)
25
Q

Red flags for referral

A
  • Neurologic: paranthesia, numbness, nocturnal sx, radiating pain (pain moves up and down)
  • Skeletal: trauma, fever, constant pain, nocturnal sx
  • Rupture of plantar fascia: sudden onset
  • Inflammatory disorder: PMH/FH of inflammatory disease, erythema nodosum (red bumps on the shin)
26
Q

prevalence of frozen shoulder

A

Peak prevalence among 50+ yo (onset <40yo is rare)

27
Q

S/S of frozen shoulder

A
  • Unilateral (usually non-dominant side, but other side may be affected within 5 years)
  • Reduced function: unable to scratch back, put on coat
28
Q

is frozen shoulder self limiting?

A
  • Self-limiting (but sx progress through 3 very long phases)
    • Initial (2-9mths): diffuse, severe disabling shoulder pain, worse at night, increasing stiffness
    • Intermediate (4-12mths): stiffness & severe loss of shoulder motion, pain gradually lessen
    • Recovery phase (5-24mths): gradual return of range of motion
29
Q

Differential/red flags of shoulder pain

A
  • Inflammatory disorder: PMH/FH of inflammatory disease (RA, gout)
  • Infection
  • Degenerative: OA (usually not at shoulders)
  • Trauma: fractures, dislocation, ligament inhury
  • Tumours
30
Q

Tx mx for frozen shoulder

A
  • Analgesics for pain (paracetamol/ NSAIDs/ weak opioids)
  • Range of motion exercises
  • Intraarticular glucocorticoids + physical therapy → referral
31
Q

Lower back strain sx, how long does it take to recover?

A

non-specific, self-limiting lumbar “strain” episodes (recover in 10-14 days)

32
Q

red flags - mechanical causes of back pain

A
  • Neurologic: motor weakness, fall, gait instability, numbness, loss of bowel/bladder function
  • Osteoporotic fractures: chronic glucocorticoid use, age, trauma, PMH of osteoporotic/traumatic fractures
  • Sharp burning pain from buttocks to posterior leg/heel
  • Trauma — Herniated disc: impact (trauma) + sudden acute onset of pain
33
Q

red flags - non mechanical causes of back pain

A
  • Neoplasia/malignancy: chronic back pain for long periods of time, worse at night, unintended weight loss, hx of previous malignancy
  • Infection: fever, diffused pain, general unwellness
34
Q

should visceral back pain be referred?

A

Visceral pain: widespread pain (eg severe abdominal pain) should be referred - red flag

35
Q

Mx of back pain for acute and subacute back pain

A
  • Acute (<4 weeks), subacute (4-12 weeks) lower back pain:
    • Non-pharmacological: heat therapy
    • Pharmacological: NSAID, skeletal muscle relaxant (eg orphenadrine — Annarex)
36
Q

mx for chronic back pain

A
  • Non-pharmacological: heat therapy, exercise
  • Pharmacological: NSAID, tramadol/duloxetine
37
Q

Counselling for back pain

A
  • Improvement in pain and function from tx may be small
  • Reassure that acute/subacute pain is usually self-limiting
  • Remain active as tolerated
  • Avoid potentially harmful and costly tests and treatment
38
Q

non pharm advice for back pain

A
  • Engage in low-impact core strengthening exercises (swimming, stationary bicycling, brisk walking, no jogging/running)
  • Use correct lifting and moving techniques (ie squatting)
  • Maintain correct posture when sitting/standing
  • Quit smoking (RF for atherosclerosis)
  • Avoid stressful situations
  • Maintain a healthy weight (appropriate exercise)
39
Q

myalgia definition

A

Strain relating to overuse/ exercise (acute, self limiting)

40
Q

S/S of myalgia

A

focal, acute onset

41
Q

Mx of myalgia

A
  • REST (RICE)
  • Topical NSAID
    • if due to exercise, pain likely last 1-2 days due to lactic acid build up, micro-inflammation → no need meds, btr in 1-2 days
  • Prevention: proper warm up before exercise
42
Q

Differentials/red flags - Drug induced myalgia

A

ABCS
Aromatase inhibitors
Bisphosphonates
Ciprofloxacin
Statins

43
Q

S/S of statin induced myalgia

A
  • statins-induced rhabdomyolysis (AnE)
  • muscle pain + muscle weakness (hip, thigh, calf, rarely arms) + red brown tea coloured urine
    • other S/S: nocturnal cramping, stiffness, tendon pain, fatigue and tiredness
    • onset can be anytime, usually within 6mths
44
Q

Mx of SAMS

A
  • discontinue statin if sx are intolerable (sx usually resolves over days to weeks after)
  • rosuvastatin less muscle toxicity

54 Finals (7 decks)

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