IC15 Soft Tissue Injury Flashcards
What are the characteristics of soft tissue injury?(general)
- usually low-grade trauma (micro tears/inflammation) / overuse
- Focal & non-systemic
- Self-limiting
- Responds to non-pharm well e.g. RICE
What are the red flags for serious / life threatening differentials needing urgent referral?
- Fracture / trauma
- Ligament rupture
- Infection
- Malignancies (lower back pain)
- Relating to underlying visceral conditions (lower back pain)
- Neurological issues
What are the non-pharm for soft tissue injury? What are the don’ts?
- RICE
a. Rest
b. Ice – cold compress sprays / ice wrapped in towel / use cold pack –> Maintain internal bruising and swelling and ↓ pain too (swelling can occur without bleeding, when plasma protein leaks out, maybe also due to full ↑ in plasma vascular permeability, when endothelial cells loosen e.g. anaphylaxis, can cause hypotension, faint)
c. Compression – using bandage
d. Elevate – less blood flow, ↓swelling
e. Guard / Braces - Don’ts
a. No heat
b. No alcohol
c. No massage
d. No re-injury (rest)
What are the general pharm to use for soft tissue injuries?
- Topical NSAIDs e.g. Diclofenac patch, kefenTech, Fastum gel (ketoprofen)
- PO NSAIDs e.g. Naproxen (BD), Ibuprofen (QDS), Celecoxib
- PO Paracetamol
- PO Opioids e.g. tramadol (v sev, and the above are not sufficient)
What are the goals of treatment?
Goals of treatment:
- Reduce pain
- Regain function
- Prevent future injury
What are the possible causes of non-articular pain? What are the signs and symptoms of non-articular pain?
Non-articular
- Referred visceral pain e.g. due to MI
- Tissue pain e.g. due to infection, DVT, ischemia
- Neuropathic Pain e.g. prolapsed disc
- Periarticular Pain e.g. relating to ligament, tendons, muscles
- Bone Pain e.g. Fractures
^everything refer except for the bolded one
S&S:
- NO pain on palpitation of joint line
- Pain on active mvt > passive mvt
- Pain is max. when certain lines of muscles are pulled
Explanation + Common Causes + Symptoms of sprains.
What is the most common type of sprain?
What are the different stages of sprains?
- stretching, partial, complete rupture of ligament (bone-bone)
Lateral Ankle sprain:
- inversion of foot
- anterior talofibular ligament
S&S:
1) sudden onset of pain & swelling after “pop” sound
2) ecchymosis
Causes:
- sports
Mild: mild S&S, able to bear weight & move
Mod: mod S&S, painful weight bearing & ambulation, some restriction to range of motion & function)
Sev: sev S&S, cannot bear weight or move, loss of motion & function, sign. instability
When to refer for sprain?
Where to refer dr or A&E?
Sev: sev S&S, cannot bear weight or move, loss of motion & function, sign. instability
Refer to the A&E
What is the management of sprains?
Mild:
1) self-limiting
Mod:
1) Non-pharm: RICE + Protect
2) Pharm: TOP NSAIDs
Sev: REFER to A&E
Explanation + Common Causes + Symptoms of tendonitis.
Tendonitis
e.g. shoulder, golfers elbow (medial),
tennis elbow (lateral), Achilles tendinopathy
- inflammation of tendons (muscles-bone)
S&S:
1) local pain & dysfunction on active use
2) inflammation (less visible swelling)
3) Degeneration
Cause:
- overloading
- sports (running, jumping for achilles)
- rheumatic diseases
- metabolic disturbances
- fluoroquinolones & statins
When to refer for tendonitis?
1) Drug-induced e.g. fluoroquinolone, statins
2) pain >7days
What is the management of tendonitis?
1) Non-pharm: RICE + Protect
2) Pharm: TOP NSAIDs
Explanation + Common Causes + Symptoms of bursitis?
What are are the types of bursitis and their causes?
Bursitis
e.g. elbow, kneecap, hip, shoulder
- inflammation of bursae (cushion btw tendons/muscles & bones)
S&S:
1) Pain when compress bursae
Causes:
Acute (pain when fully flex)
1) Trauma
2) Crystal-induced e.g. gouty
3) Infection
Chronic (min. pain, more swelling, more immobility)
1) overuse
2) Prolonged pressure e.g. kneeling
3) Inflammatory arthritis e.g. RA / spondyloarthritis
When to refer for bursitis?
1) Acute onset e.g. trauma, infection, gouty
2) severe pain
3) prior trauma
4) infection
5) Inflammatory disease (spondyloarthritis)
What is the management of bursitis?
1) Non-pharm: RICE + Protect
2) Pharm: TOP NSAIDs
Deep bursitis (hip, shoulder):
- intra-bursal glucocorticoid
Explanation + Common Causes + Symptoms of plantar fasciitis.
Plantar Fasciitis
- inflammation of plantar fascia (heel to base of toes)
S&S:
1) Pain when walking /running
2) Pain lessens with ↑ activities but worsen at end of the day
Causes:
- Running/standing/jumping on hard surfaces
- flat feet/high arched feet
When to refer for plantar fasciitis?
1) Sudden rupture of plantar fascia
2) trauma
3) Infection
4) Malignancies
5) Inflammation disease (Spondyloarthritis)
6) neurological (paresthesia, numbness, nocturnal sx, radiating pain from leg to heel)
What is the management of plantar fasciitis?
1) Non-pharm: RICE + Protect
2) Pharm: TOP NSAIDs
Explanation + Common Causes + Symptoms of frozen shoulder / adhesive capsulitis?
- Common in >50y/o
S&S:
1) unilateral
2) limited reaching overhead, to side, across chest, rotation
Initial: sev pain, ↑stiffness
Intermediate: sev stiffness, loss of motion, ↓pain
Recovery: gradual return of motion
Causes:
- idiopathic
- secondary to shoulder injuries
When to refer for frozen shoulder / adhesive capsulitis?
1) Marked loss of motion
2) trauma
3) Infection
4) Malignancies
5) Osteoporotic fractures
6) Inflammation disease (Spondyloarthritis)
7) neurological
How to manage for Frozen Shoulder / Adhesive Capsulitis?
Self-limiting
1) Non-pharm: range of motion exercises + physical therapy
2) Pharm: TOP NSAIDs/ PO paracetamol/intra-articular glucocorticoids
What are the causes and symptoms of lower back pain?
What are the types of back pain?
S&S:
1) pain & strain
Acute: <4wks
Subacute: 4-12wks
Chronic: >12wks
When to refer for lower back pain?
1) Subacute
2) Chronic
3) herniated disc
4) infection
5) Malignancies
6) Inflammation disease (Spondyloarthritis)
7) Trauma (fracture)
8) Degenerative → OA
How to manage lower back pain?
Self -limiting in 10-14days
Acute + Subacute:
Non-pharm: heat, physio
Pharm: NSAIDs/SMR (anarex)
Chronic:
Non-pharm: heat, exercise
Pharm: NSAIDs
See non-pharm below
