KCP: Soft Tissue Injuries

Question 1

Four types of soft tissue injury

Answer 1

1. Tendon
2. Ligament
3. Bursitis
4. Muscle/musculotendinous tear

Question 2

The following are common example of what?
2. Tennis elbow
2. Golfer’s elbow
3. Achilles tendinopathy

Answer 2

Tendon injuries

Question 3

A shoulder rotator cuff tear is a common example of which group if injuries?

Answer 3

Musculotendinous tears

Question 4

An ankle sprain is an example of which group of injuries?

Answer 4

Ligament injury

Question 5

What is tennis elbow?

Answer 5

It is a tendon injury affecting the tendon which attaches the extensor carpi radialis brevis to the lateral epicondyle caused by overuse of this muscle.

Commonly asscociated with tennis and repetitive manual work

Question 6

Three muscles other than the extensor carpi radialis brevis that can be affected by tennis elbow?

Answer 6

1. Extensor carpi ulnaris
2. Extensor digitorum
3. Extensor carpi radialis longus
4. Supernator

Question 7

Tennis elbow is also known as what?

Answer 7

Lateral epicondylitis

This can be a good way to remember the muscle groups that attach to the

Question 8

4 examination methods for tennis elbow

Answer 8

1. Tenderness at the lateral epicondyle when pressed with the elbow flexed at 90°
2. Pain when wrist extension is resisted with an extended elbow
3. Pain when supination is resisted
4. Pain during a passive wrist stretch, known as Mill’s test

Question 9

Tennis elbow treatment

Answer 9

• Paracetamol or NSAIDs
• Ice
• Strengthening exercises

Question 10

What are rotator cuff tears?

Answer 10

Generally consists injured tendons around the rotator cuff

Can be split into two types:

1. Chronic degenerative tears
2. Acute traumatic tears

Question 11

Presentationof rotator cuff tear

Answer 11

• Primarily weakness of the shoulder
• Secondarily pain

Question 12

Rotator cuff muscles?

Answer 12

1. Subscapularis
2. Infraspinatus
3. Teres minor
4. Supraspinatus

Question 13

Examination for supraspinatus tear?

Answer 13

Resited shoulder abduction with thumbs down to defunct deltoid

Known as Jobe’s test

Question 14

Examination for teres minor and subspinatus tear?

Answer 14

Resisted external rotation

Question 15

Examination for subscapularis tear

Answer 15

Resisted internal rotation

Question 16

Investigations for rotator cuff tear?

Answer 16

1. X-ray - shoulder trauma series to exclude fracture or dislocation
2. Ultrasound or MRI - confirms cuff tear and it’s dimensions

Question 17

Management of acute shoulder cuff tear in younger people <50

Answer 17

Surgical repair

Question 18

Managment of acute shoulder cuff tear in older patients >50

Answer 18

• Ice
• NSAIDs
• Exercises

Question 19

Management of chronic shoulder cuff tear

Answer 19

• Ice
• Exercises
• NSAIDs
• Corticosteroid injection

Question 20

Activity associations with an achilles tendon rupture?

Answer 20

• Sudden unexpected dorsi-flexion
• Strong plantar-flexion with simultaneous knee extension and calf contraction
• Sudden pain and a pop

Question 21

Diagnosis of achilles tendon rupture?

Answer 21

• No/ reduced plantar-flexion (thompson test)
• Pain and bruising around heel
• Ultrasound can confirm

Question 22

Management of ruptured achilees tendon

Answer 22

Short term:
* Ice
* Rest/Imobilization
* Moonboot / air cast with slight plantar-flexion
* Analgesia

Long term:
* Surgery
* Functional rehabilitation

Question 23

Ligaments often affected by an ankle sprain

Answer 23

Lateral ligament complex

Question 24

Signs of ankle sprain pain

Answer 24

• Unable to weight bare
• Tenderness on posterior malleolus

Question 25

Management of ankle sprain

Answer 25

• Ankle motion controlled in a brace for 48h
• Analgesia
• Physio

Question 26

Describe the Thompson test

Answer 26

Squeeze the calf of the patient while the lower limb is fully relaxed. This should engage the achilles tendon and result in plantar-flexion. If no plantar flexion occurs then this is a strong indication of achilles tendon rupture