Soft Tissue Disease Flashcards
what is the prevalence of back pain
15%
What is the prevalence of osteoarthritis
5%
what is the prevalence of soft tissue disorders
5%
What is the prevalence of inflammatory disorders
1%
what are the sources of musculoskeletal pain
- Referred
- Joint
- Bone
- Soft tissue
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
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
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
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
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
name some yellow flags
History of numerous episodes
Duration of symptoms
Intensity of symptoms
Anxiety / depression
Locus of control
Catastrophizing
what is periarticular
situated or referred around the joint
what is articular
in the joint
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
What is the enthesis
The enthesis (plural entheses) is the connective tissue between tendon or ligament and bone
what is a frequent site of trauma
Enthesis
name 4 causes of pain in the wrist and hand
De Quervains tenosynovitis
Trigger finger
Carpal tunnel syndrome
Duputren’s contracture
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
what is De Quervains Tenosynovitiis
affects the extensor an adduct tendons of the thumb
- can also cause pain on resistive movement
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
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
