Soft Tissue Diseases Flashcards
What is the prevalence of inflammatory disorders?
1%
What is the prevalence of OA?
5%
What is the prevalence of back pain?
15%
What is the prevalence of soft tissue disorders?
5%
What are the four sources of musculoskeletal pain?
Referred/central
Bone
Joint
Soft tissue
What does a musculoskeletal history provide?
Information on pathologic process/diagnosis
What does a musculoskeletal examination provide?
Defines anatomic site of the problem
What does a musculoskeletal history AND examination provide?
Determines disability
What are some red flags? (6)
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
What affects symptom reporting and disability?
Environmental factors and constitutional factors, as well as tissue pathophysiology
Define ‘yellow flags’.
Factors that increase pain and the risk of developing, or
perpetuating long term disability and work loss associated with persistent pain.
List some psychosocial ‘yellow flags’. (6)
History of numerous episodes Duration of symptoms Intensity of symptoms Anxiety / depression Locus of control (not able to look after their lives/accept responsibility for their illness) Catastrophizing
What does peri-articular mean?
From around the joints
Local pain can be either…?
Peri-articular or articular
Articular pain can be either…?
Inflammatory or degenerative
What is an enthesis?
A ligamentous attachment to bone.
What is the characteristic clinical feature of tendinopathies/enethesitis?
Pain on resisted movement
Name four causes of soft tissue pain in the wrist and hand.
De Quervains tenosynovitis
Trigger finger
Carpal tunnel syndrome
Duputren’s contracture
What is De Quervain’s tenosynovitis?
Tendonitis of thumb extensors and abductor (extensor pollicis brevis, extensor pollicis longus, abductor pollicis longus)
What can be seen on examination with De Quervain’s tenosynovitis? (3)
Pain on resisted movement
Crepitus
Finkelstein’s test
How is De Quervain’s tenosynovitis treated?
Put in splint, give ibuprofen – sorted in a week
What is trigger finger also called?
Flexor tendinosis
What is trigger finger?
Nodule on flexor tendon, gets stuck going in/out of discontinuous tendon sheath.
How is trigger finger treated?
Treat with topical anti-inflammatories or can inject around nodule
What are the differential diagnoses for carpal tunnel syndrome? (3)
Cx radiculopathy
Diabetic neuropathy
MS
What is prevalence of carpal tunnel syndrome in women vs men?
3% compared to 2%
What is associated with carpal tunnel syndrome? (8)
Hypothyroidism Rheumatoid arthritis Diabetes Pregnancy Amyloidosis Acromegaly Use of vibrating tools Computer use (?)
How is carpal tunnel syndrome diagnosed? (5)
History - pain and paraesthesia, sensory loss, tingling
Phalen’s test - hyperflexes the wrist, mechanical compression
Tinel’s test
Nerve conduction studies - to classify it as mild or severe
FBC, ESR, T4, RF
What nerve is compressed in carpal tunnel syndrome?
Median nerve
How is carpal tunnel syndrome treated?
Injection of steroid
What structures are affected by carpal tunnel syndrome?
Thumb and first two fingers
Can get atrophy of thenar muscles
What is Dupuytren’s contracture?
Fibrosis of palmar aponeurosis
Dupuytren’s contracture is more common in… (4)
Men
Heavy drinkers
Smokers
Diabetics
What are the causes of pain at the elbow?
Referred pain (neck, shoulder) Peri-articular pain (epicondylitis, bursitis) Articular pain (trauma, OA)
What is tennis elbow also called?
Lateral epicondylitis
What are the signs/symptoms of tennis elbow?
Local pain on side of the elbow, tenderness, pain on resisted movement (wrist extension)
How is tennis elbow treated?
Rest / topical NSAIDs
Massage
Injection
Surgery
Give some examples of wwellings & rashes over the extensor surface of the elbow. (5)
Olecronon bursitis Rheumatoid nodule Gouty tophus Psoriatic plaques Vasculitic rash
List some causes of pain in the shoulder. (5)
Rotator cuff tendinitis Bicipital tendinitis Frozen shoulder Subacromial bursitis Degenerative arthritis (acromioclavicular joint)
What is frozen shoulder?
Adhesive capsulitis - the capsule becomes thickened and adherent. There is loss of movement. It produces a lot of night pain. The pain can last up to 1.5 years, but stiffness goes on for even longer.
What movements (in what order) are lost in frozen shoulder?
External rotation lost first, then internal rotation and then abduction.
How is frozen shoulder treated? (4)
Re-assurance / education
Analgesia
Injection
Physiotherapy
What is seen with rotator cuff tendonitis on abduction?
Painful arc and pain on resisted abduction
How is rotator cuff tendonitis treated? (3)
Physiotherapy
Steroid injection
Surgery
What are the causes of pain in the hip? (3)
Referred pain (pelvis, spine, meralgia paraesthesia) Articular pain (OA, inflammatory arthritis, irritable hip) Peri-articular pain (trochanteric bursitis, ischial bursitis, adductor tendinopathy, bone disease)
What is meralgia paraesthetica?
This is like carpal tunnel but in the hip. It is the lateral cutaneous nerve that is compressed.
Name causes of pain in the foot/ankle. (4)
Achilles tendinopathy
Plantar fasciitis
March fracture (hairline fracture in metatarsal)
Morton’s neuroma (from wearing tight shoes)
