Soft Tissue Disease Flashcards by Sarah-Louise Watson

what is the prevalence of back pain

15%

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What is the prevalence of osteoarthritis

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what is the prevalence of soft tissue disorders

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What is the prevalence of inflammatory disorders

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what are the sources of musculoskeletal pain

Referred
Joint
Bone
Soft tissue

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what does the history and examination of musculoskeletal pain show us

History : provides information on pathologic process

Examination: defines anatomic site of the problem

History & examination: determine disability

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What should you take in a history

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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what are the 5 key questions when taking a musculoskeletal history

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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what are the red flags for musculoskeletal disease

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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What are yellow flags

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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name some yellow flags

History of numerous episodes

Duration of symptoms

Intensity of symptoms

Anxiety / depression

Locus of control

Catastrophizing

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what is periarticular

situated or referred around the joint

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what is articular

in the joint

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What can go wrong with per articular soft tissue

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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What is the enthesis

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

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what is a frequent site of trauma

Enthesis

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name 4 causes of pain in the wrist and hand

De Quervains tenosynovitis

Trigger finger

Carpal tunnel syndrome

Duputren’s contracture

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name some other pain caused in the wrist and hand

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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what is De Quervains Tenosynovitiis

affects the extensor an adduct tendons of the thumb

- can also cause pain on resistive movement

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how do you treat De Quervains Tenosynovitiis

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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What is trigger finger

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

what nerve is compressed in carpal tunnel syndrome

Median nerve

what is the prevalence of carpal tunnel syndrome

3% women

2% men

what is the range of age for caporal tunnel syndrome

40 - 60 yrs

what increases your risk of carpal tunnel syndrome

Idiopathic Pregnancy – common in pregnancy Hypothyroidism Rheumatoid arthritis Diabetes Vibrating tools Computer use

Symptoms of carpal tunnel

- atrophy of the thumb | - loss of sensation

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

How do you treat carpal tunnel syndrome

injecting it with a steroid

What is dupuytren's contracture

- fibrosis of palmar aponeurosis

what is dupuytren's contracture more common in

man, heavy drinkers smokers diabetics

where does dupuytren's contracture feature

sole of feet, Garrod’s pads, Peyronie’s disease

What is the cause of peri-articular pain in the elbow

epicondylitis bursitis

what is the cause of articular pain in the elbow

trauma | OA

what is tennis elbow

- effects the lateral epicondylie | - causes lateral epicondylitis

what two things do you look for in tennis elbow

local tenderness pain resisted wrist extension

what are the treatments for tennis elbow

Rest / topical NSAIDs Massage Injection (Surgery)

name some swellings and rashes over the extensor surface of the elbow

gouty tophus psoriatic plaques vasculitic rash olecranon bursitis rheumatoid norudle

What are the causes of pain in the shoulder

Rotator cuff tendinitis Bicipital tendinitis Frozen shoulder Subacromial bursitis Degenerative arthritis - acromioclavicular joint

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

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

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

How do you treat frozen shoulder

re-assurance / education analgesia injection physiotherapy

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

what are the signs of rotator cuff tenditits

painful arc on active abduction pain on resisted abduction

how do you treat rotator cuff tendinitis

physiotherapy steroid injection surgery

what are causes of referred pain in the hip

pelvis spine / SIJ’s meralgia paraesthetica

What are the causes of articular pain in the hip

OA Inflammatory arthritis Irritable hip (children

What are the periarticular pain in the hip

trochanteric bursitis ischial bursitis adductor tendinopathy bone disease

What is achilles tendiopathy

- when the achilles becomes inflamed and swollen

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

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Soft Tissue Disease Flashcards

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