Soft Tissue Disease Flashcards

1
Q

what is the prevalence of back pain

A

15%

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2
Q

What is the prevalence of osteoarthritis

A

5%

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3
Q

what is the prevalence of soft tissue disorders

A

5%

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4
Q

What is the prevalence of inflammatory disorders

A

1%

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5
Q

what are the sources of musculoskeletal pain

A
  • Referred
  • Joint
  • Bone
  • Soft tissue
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6
Q

what does the history and examination of musculoskeletal pain show us

A

History : provides information on pathologic process

Examination: defines anatomic site of the problem

History & examination: determine disability

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7
Q

What should you take in a history

A

Evolution of the problems: is it acute or chronic

	- onset (acute, chronic; progression)
	- triggering event (infections, trauma, drugs)
	- treatments

Current symptoms

- pain
- stiffness
- swelling

Involvement of other systems

Impact on the patient

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8
Q

what are the 5 key questions when taking a musculoskeletal history

A

Does the problem arise from the joint

Is the condition acute or chronic

Is the condition inflammatory or non-inflammatory

What is the pattern of the affected joints

What is the impact of the condition on the patient’s life

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9
Q

what are the red flags for musculoskeletal disease

A

fever or unexplained weight loss

history of carcinoma

immuno-supression

ill health or presence of other medical illness

severe night pain / progressive pain

persistent mono-arthritis – persistant localised joint pain

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10
Q

What are yellow flags

A
Yellow flags are factors 
that increase pain and 
the risk of developing, or 
perpetuating long term 
disability and work loss 
associated with persistent 
pain
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11
Q

name some yellow flags

A

History of numerous episodes

Duration of symptoms

Intensity of symptoms

Anxiety / depression

Locus of control

Catastrophizing

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12
Q

what is periarticular

A

situated or referred around the joint

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13
Q

what is articular

A

in the joint

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14
Q

What can go wrong with per articular soft tissue

A
  • Capsule of the joint fibrous lining
  • ligaments and tendons around the joint
  • bursa
  • synovial lining and sac allows muscles and tendons to slide without friction over the bone
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15
Q

What is the enthesis

A

The enthesis (plural entheses) is the connective tissue between tendon or ligament and bone

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16
Q

what is a frequent site of trauma

A

Enthesis

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17
Q

name 4 causes of pain in the wrist and hand

A

De Quervains tenosynovitis

Trigger finger

Carpal tunnel syndrome

Duputren’s contracture

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18
Q

name some other pain caused in the wrist and hand

A

Ganglion – swelling of the rest

Inflammatory arthritis / OA

Raynaud’s phenomenon – fingers go white due to spasm of the artery

Reflex sympathetic dystrophy – overreaction of the autonomic nerve sytem that interfaces with the pain system leading to local pain post trauma
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19
Q

what is De Quervains Tenosynovitiis

A

affects the extensor an adduct tendons of the thumb

- can also cause pain on resistive movement

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20
Q

how do you treat De Quervains Tenosynovitiis

A
  • rest the thumb

- if it doesn’t settle dow you can cut the tendon sheath and operate but in rare occasion s

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21
Q

What is trigger finger

A

This is a nodule on one of the extensor tendons and the finger gets tuck and they have to manually exert to push the finger up

The tendon gets stuck as the tendon comes in and out of the sheath

22
Q

what nerve is compressed in carpal tunnel syndrome

A
  • Median nerve
23
Q

what is the prevalence of carpal tunnel syndrome

A

3% women

2% men

24
Q

what is the range of age for caporal tunnel syndrome

A

40 - 60 yrs

25
what increases your risk of carpal tunnel syndrome
Idiopathic Pregnancy – common in pregnancy Hypothyroidism Rheumatoid arthritis Diabetes Vibrating tools Computer use
26
Symptoms of carpal tunnel
- atrophy of the thumb | - loss of sensation
27
What are the tests you do for the diagnosis of carpal tunnel syndrome
History Phalen’s test Tinel’s test Nerve conduction studies FBC, ESR, T4, RF
28
How do you treat carpal tunnel syndrome
injecting it with a steroid
29
What is dupuytren's contracture
- fibrosis of palmar aponeurosis
30
what is dupuytren's contracture more common in
man, heavy drinkers smokers diabetics
31
where does dupuytren's contracture feature
sole of feet, Garrod’s pads, Peyronie’s disease
32
What is the cause of peri-articular pain in the elbow
epicondylitis bursitis
33
what is the cause of articular pain in the elbow
trauma | OA
34
what is tennis elbow
- effects the lateral epicondylie | - causes lateral epicondylitis
35
what two things do you look for in tennis elbow
local tenderness pain resisted wrist extension
36
what are the treatments for tennis elbow
Rest / topical NSAIDs Massage Injection (Surgery)
37
name some swellings and rashes over the extensor surface of the elbow
gouty tophus psoriatic plaques vasculitic rash olecranon bursitis rheumatoid norudle
38
What are the causes of pain in the shoulder
Rotator cuff tendinitis Bicipital tendinitis Frozen shoulder Subacromial bursitis Degenerative arthritis - acromioclavicular joint
39
What is there referred pain patterns in the arm
Acromoclavicualr joint is anterior pain Neck pain classically refers posteriorly into he upper trapezius and down the arm True shoulder pathology refers to the deltoid area to the elbow
40
What is frozen shoulder
A condition where the capsule becomes thickened and fibrotic and shrinks down The capacity of the shoulder to move is just reduced Therefore there is no movement possible Characteristic feature is limited movement due to the capsule becoming shrunk
41
describe the pain and limitation of frozen shoulder
Extremely pain for 9 months to a year or more And limited movement can continue for 2 years
42
How do you treat frozen shoulder
re-assurance / education analgesia injection physiotherapy
43
what is shoulder impingement
As the shoulder abducts the supraspinatus becomes squashed between the under surface of the acrominoum and the top surface of the humerus The net result is as you abduct the shoulder the supraspinatus muscle gets squashed
44
what are the signs of rotator cuff tenditits
painful arc on active abduction pain on resisted abduction
45
how do you treat rotator cuff tendinitis
physiotherapy steroid injection surgery
46
what are causes of referred pain in the hip
pelvis spine / SIJ’s meralgia paraesthetica
47
What are the causes of articular pain in the hip
OA Inflammatory arthritis Irritable hip (children
48
What are the periarticular pain in the hip
trochanteric bursitis ischial bursitis adductor tendinopathy bone disease
49
What is achilles tendiopathy
- when the achilles becomes inflamed and swollen
50
what are other food issues
Plantar fasciitis March fracture = get asymptomatic fracture metatarsal pain, callus has to form that the diagnosis is made Mortons neuroma = Neuroma on the interplanted nerves producing paraethesia or local pain