Regional Peri-Articular Pain Flashcards
What is enthesopathy and how does it present?
It is inflammation of the tendinous insertions on to bone.
It presents as pain an stiffness around the joint but not in it. Typically it can present in:
- Heel
- Knee
- Hip
- Elbow
- Toes and fingers
- Sole of the foot
It can be caused by overuse injuries but can often be associated with inflammatory arthritidies:
- Psoriatic
- Rheumatoid
- Ankylosing spondylitis
How are enthesopathies managed?
Treatment is with NSAIDs and treating any underlying inflammatory arthritis.
What is tendinitis and tenosynovitis?
Tendinitis is inflammation of the tendon.
Tenosynovitis is inflammation of the surrounding synovial sheath.
What are the common causes of tendinitis and tenosynovitis?
Overuse conditions often occupational (typing, dentists, surgeons, tailors)
Can be sporting related or gaming (de quervain’s affecting the thumb)
How is tendinitis/tenosynovitis managed?
If it exacerbated by a paticular activity: rest it!
NSAIDs for analgesia.
What is bursitis and what are the areas which can be affected?
A bursa is a small sac of fibrous tissue with a thin synovial lining that is filled with fluid. They are found around joints to reduce friction.
When they become inflamed it is known as bursitis it can be caused by trauma, recurrent minor trauma (housemaids knee) or in infection.
Common areas which it can affect:
- Subacromial (shoulder)
- Trochanteric
- Prepatellar (housemaids)
- Olecranon
- Achilles
- Subcalcaneal
Describe how bursitis is treated?
Non infected:
- Avoid aggravating activities.
- Ice.
- Physiotherapy particularly if there is a reduced range of movement.
- OTC analgesia.
- Can use steroid injections
Infected:
- As above
- Aspirate fluid for culture and cytology
- Antibiotic therapy
- If not improving with abx within 36-48hrs incision and drainage is indicated.
Rarely in recurrent refractive bursitis surgical bursectomy can be performed.
What is medial epicondylitis?
Also known as Golfer’s elbow
It is a tendinopathy of the common flexor tendon which inserts at the medial epicondyle.
It is caused by recurrent microtrauma due to overuse.
Can get shooting pains, paraesthesiae and weakness due to ulnar nn entrapment.
What are the specific examination findings in a patient with medial epincindylitis?
Tenderness over the medial epicondyle.
Increased pain on resisted: wrist flexion or elbow pronation.
What is lateral epicondylitis?
Also known as tennis elbow.
It is a tendiopathy of the common extensor tendon which inserts next to the lateral epicondyle.
It is caused by microtrauma due to overuse.
What are the specific examination findings in lateral epicondylitis?
Tenderness over the lateral epicondyle.
Increased pain on resisted wrist extension/ finger extension
Describe how both medial and lateral epicondylitis are managed?
- Analgesia and rest
- Physiotherapy
- Steroid/anaesthetic injection
- Surgery*
*Tennis/golfer’s elbow release involves excision of the abnormal tissue from the extensor tendon (tennis elbow) or flexor tendon (golfer’s elbow). Only indicated in failed conservative management.
Name the rotator cuff muscles and there functions?
Supraspinatus (shoulder abduction)
Infraspinatus and teres minor (external rotators)
Subscapularis (internal rotator and humeral head depressor)
What are the main causes of rotator cuff tears?
Acute: younger patients likely traumatic high impact injury (Jenkins in rugby)
Chronic: older patients: degenerative disease due to repetive microtrauma common in manual labourers.
Acute on chronic: may have a degree of degeneration followed by an acute traumatic injury causing a tear.
Describe how rotator cuff tears present?
Acute: traumatic event shoulder is painful and there is weakness in one or more of the rotator cuffs.
Chronic: gradual onset of pain, weakness and a marked reduction in function most commonly being able to lift arms above head. (Supraspinatus is most commonly affected)
Pain is usually felt anterioirly and superiorly with no radiation down the arm.
