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PR3154 MSK IC1,10-18 > IC15 Soft Tissue Injury > Flashcards

IC15 Soft Tissue Injury Flashcards

1
Q

What are the characteristics of soft tissue injury?(general)

A
  • usually low-grade trauma (micro tears/inflammation) / overuse
  • Focal & non-systemic
  • Self-limiting
  • Responds to non-pharm well e.g. RICE
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2
Q

What are the red flags for serious / life threatening differentials needing urgent referral?

A
  1. Fracture / trauma
  2. Ligament rupture
  3. Infection
  4. Malignancies (lower back pain)
  5. Relating to underlying visceral conditions (lower back pain)
  6. Neurological issues
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3
Q

What are the non-pharm for soft tissue injury? What are the don’ts?

A
  1. 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
  2. Don’ts
    a. No heat
    b. No alcohol
    c. No massage
    d. No re-injury (rest)
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4
Q

What are the general pharm to use for soft tissue injuries?

A
  1. Topical NSAIDs e.g. Diclofenac patch, kefenTech, Fastum gel (ketoprofen)
  2. PO NSAIDs e.g. Naproxen (BD), Ibuprofen (QDS), Celecoxib
  3. PO Paracetamol
  4. PO Opioids e.g. tramadol (v sev, and the above are not sufficient)
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5
Q

What are the goals of treatment?

A

Goals of treatment:

  1. Reduce pain
  2. Regain function
  3. Prevent future injury
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6
Q

What are the possible causes of non-articular pain? What are the signs and symptoms of non-articular pain?

A

Non-articular

  1. Referred visceral pain e.g. due to MI
  2. Tissue pain e.g. due to infection, DVT, ischemia
  3. Neuropathic Pain e.g. prolapsed disc
  4. Periarticular Pain e.g. relating to ligament, tendons, muscles
  5. Bone Pain e.g. Fractures

^everything refer except for the bolded one

S&S:

  1. NO pain on palpitation of joint line
  2. Pain on active mvt > passive mvt
  3. Pain is max. when certain lines of muscles are pulled
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7
Q

Explanation + Common Causes + Symptoms of sprains.
What is the most common type of sprain?
What are the different stages of sprains?

A
  • 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

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8
Q

When to refer for sprain?
Where to refer dr or A&E?

A

Sev: sev S&S, cannot bear weight or move, loss of motion & function, sign. instability

Refer to the A&E

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9
Q

What is the management of sprains?

A

Mild:
1) self-limiting

Mod:
1) Non-pharm: RICE + Protect
2) Pharm: TOP NSAIDs

Sev: REFER to A&E

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10
Q

Explanation + Common Causes + Symptoms of tendonitis.

A

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
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11
Q

When to refer for tendonitis?

A

1) Drug-induced e.g. fluoroquinolone, statins
2) pain >7days

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12
Q

What is the management of tendonitis?

A

1) Non-pharm: RICE + Protect
2) Pharm: TOP NSAIDs

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13
Q

Explanation + Common Causes + Symptoms of bursitis?
What are are the types of bursitis and their causes?

A

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

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14
Q

When to refer for bursitis?

A

1) Acute onset e.g. trauma, infection, gouty
2) severe pain
3) prior trauma
4) infection
5) Inflammatory disease (spondyloarthritis)

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15
Q

What is the management of bursitis?

A

1) Non-pharm: RICE + Protect
2) Pharm: TOP NSAIDs

Deep bursitis (hip, shoulder):

  • intra-bursal glucocorticoid
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16
Q

Explanation + Common Causes + Symptoms of plantar fasciitis.

A

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
17
Q

When to refer for plantar fasciitis?

A

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)

18
Q

What is the management of plantar fasciitis?

A

1) Non-pharm: RICE + Protect
2) Pharm: TOP NSAIDs

19
Q

Explanation + Common Causes + Symptoms of frozen shoulder / adhesive capsulitis?

A
  • 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
20
Q

When to refer for frozen shoulder / adhesive capsulitis?

A

1) Marked loss of motion
2) trauma
3) Infection
4) Malignancies
5) Osteoporotic fractures
6) Inflammation disease (Spondyloarthritis)
7) neurological

21
Q

How to manage for Frozen Shoulder / Adhesive Capsulitis?

A

Self-limiting
1) Non-pharm: range of motion exercises + physical therapy
2) Pharm: TOP NSAIDs/ PO paracetamol/intra-articular glucocorticoids

22
Q

What are the causes and symptoms of lower back pain?
What are the types of back pain?

A

S&S:
1) pain & strain

Acute: <4wks
Subacute: 4-12wks
Chronic: >12wks

23
Q

When to refer for lower back pain?

A

1) Subacute
2) Chronic
3) herniated disc
4) infection
5) Malignancies
6) Inflammation disease (Spondyloarthritis)
7) Trauma (fracture)
8) Degenerative → OA

24
Q

How to manage lower back pain?

A

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

25
Q

What are the non-pharm for back pain?

A

non pharm more impt for Back Pain:

  1. engage in low-impact core strengthening exercises to improve spine stability e.g. yoga, swimming, brisk walking, stationary bicycling
  2. use correct lifting and moving techniques e.g squatting to lift heavy objects, do not bend and lift, get help if too heavy
  3. maintain correct posture when sitting /standing
  4. quit smoking → becos smoking hardens the arteries which can cause low back pain)
  5. avoid stressful situations (cause muscle tension)
  6. maintain healthy weight by doing low impact exercise and cardio, becos extra weight can add strain on the lower back
  7. Heat
26
Q

Explanation + Common Causes + Symptoms of myalgias?

A

Myalgia: pain, soreness, stiffness
Myopathy: disease
Myositis: inflammation

S&S are focal /diffuse

Causes:

  • strain/overuse during exercise
27
Q

When to refer for myalgia?

A

1) Medications e.g. fluoroquinolones, statins, bisphosphonates
→ statins:
STOP if CK >10xULN + drink a lot of water
2) Rhabdomyolysis
3) Infection

28
Q

What is the management of myalgias?
How to prevent future myalgias?

A

1) Non-pharm: RICE + Protect
2) Pharm: TOP NSAIDs
3) prevention: warm up before exercise

PR3154 MSK IC1,10-18 (8 decks)

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