Soft Tissue Diseases

Question 1

What is the prevalence of inflammatory disorders?

Answer 1

1%

Question 2

What is the prevalence of OA?

Answer 2

5%

Question 3

What is the prevalence of back pain?

Answer 3

15%

Question 4

What is the prevalence of soft tissue disorders?

Answer 4

5%

Question 5

What are the four sources of musculoskeletal pain?

Answer 5

Referred/central
Bone
Joint
Soft tissue

Question 6

What does a musculoskeletal history provide?

Answer 6

Information on pathologic process/diagnosis

Question 7

What does a musculoskeletal examination provide?

Answer 7

Defines anatomic site of the problem

Question 8

What does a musculoskeletal history AND examination provide?

Answer 8

Determines disability

Question 9

What are some red flags? (6)

Answer 9

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

Question 10

What affects symptom reporting and disability?

Answer 10

Environmental factors and constitutional factors, as well as tissue pathophysiology

Question 11

Define ‘yellow flags’.

Answer 11

Factors that increase pain and the risk of developing, or

perpetuating long term disability and work loss associated with persistent pain.

Question 12

List some psychosocial ‘yellow flags’. (6)

Answer 12

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

Question 13

What does peri-articular mean?

Answer 13

From around the joints

Question 14

Local pain can be either…?

Answer 14

Peri-articular or articular

Question 15

Articular pain can be either…?

Answer 15

Inflammatory or degenerative

Question 16

What is an enthesis?

Answer 16

A ligamentous attachment to bone.

Question 17

What is the characteristic clinical feature of tendinopathies/enethesitis?

Answer 17

Pain on resisted movement

Question 18

Name four causes of soft tissue pain in the wrist and hand.

Answer 18

De Quervains tenosynovitis
Trigger finger
Carpal tunnel syndrome
Duputren’s contracture

Question 19

What is De Quervain’s tenosynovitis?

Answer 19

Tendonitis of thumb extensors and abductor (extensor pollicis brevis, extensor pollicis longus, abductor pollicis longus)

Question 20

What can be seen on examination with De Quervain’s tenosynovitis? (3)

Answer 20

Pain on resisted movement
Crepitus
Finkelstein’s test

Question 21

How is De Quervain’s tenosynovitis treated?

Answer 21

Put in splint, give ibuprofen – sorted in a week

Question 22

What is trigger finger also called?

Answer 22

Flexor tendinosis

Question 23

What is trigger finger?

Answer 23

Nodule on flexor tendon, gets stuck going in/out of discontinuous tendon sheath.

Question 24

How is trigger finger treated?

Answer 24

Treat with topical anti-inflammatories or can inject around nodule

Question 25

What are the differential diagnoses for carpal tunnel syndrome? (3)

Answer 25

Cx radiculopathy Diabetic neuropathy MS

Question 26

What is prevalence of carpal tunnel syndrome in women vs men?

Answer 26

3% compared to 2%

Question 27

What is associated with carpal tunnel syndrome? (8)

Answer 27

``` Hypothyroidism Rheumatoid arthritis Diabetes Pregnancy Amyloidosis Acromegaly Use of vibrating tools Computer use (?) ```

Question 28

How is carpal tunnel syndrome diagnosed? (5)

Answer 28

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

Question 29

What nerve is compressed in carpal tunnel syndrome?

Answer 29

Median nerve

Question 30

How is carpal tunnel syndrome treated?

Answer 30

Injection of steroid

Question 31

What structures are affected by carpal tunnel syndrome?

Answer 31

Thumb and first two fingers | Can get atrophy of thenar muscles

Question 32

What is Dupuytren’s contracture?

Answer 32

Fibrosis of palmar aponeurosis

Question 33

Dupuytren’s contracture is more common in... (4)

Answer 33

Men Heavy drinkers Smokers Diabetics

Question 34

What are the causes of pain at the elbow?

Answer 34

``` Referred pain (neck, shoulder) Peri-articular pain (epicondylitis, bursitis) Articular pain (trauma, OA) ```

Question 35

What is tennis elbow also called?

Answer 35

Lateral epicondylitis

Question 36

What are the signs/symptoms of tennis elbow?

Answer 36

Local pain on side of the elbow, tenderness, pain on resisted movement (wrist extension)

Question 37

How is tennis elbow treated?

Answer 37

Rest / topical NSAIDs Massage Injection Surgery

Question 38

Give some examples of wwellings & rashes over the extensor surface of the elbow. (5)

Answer 38

``` Olecronon bursitis Rheumatoid nodule Gouty tophus Psoriatic plaques Vasculitic rash ```

Question 39

List some causes of pain in the shoulder. (5)

Answer 39

``` Rotator cuff tendinitis Bicipital tendinitis Frozen shoulder Subacromial bursitis Degenerative arthritis (acromioclavicular joint) ```

Question 40

What is frozen shoulder?

Answer 40

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.

Question 41

What movements (in what order) are lost in frozen shoulder?

Answer 41

External rotation lost first, then internal rotation and then abduction.

Question 42

How is frozen shoulder treated? (4)

Answer 42

Re-assurance / education Analgesia Injection Physiotherapy

Question 43

What is seen with rotator cuff tendonitis on abduction?

Answer 43

Painful arc and pain on resisted abduction

Question 44

How is rotator cuff tendonitis treated? (3)

Answer 44

Physiotherapy Steroid injection Surgery

Question 45

What are the causes of pain in the hip? (3)

Answer 45

``` Referred pain (pelvis, spine, meralgia paraesthesia) Articular pain (OA, inflammatory arthritis, irritable hip) Peri-articular pain (trochanteric bursitis, ischial bursitis, adductor tendinopathy, bone disease) ```

Question 46

What is meralgia paraesthetica?

Answer 46

This is like carpal tunnel but in the hip. It is the lateral cutaneous nerve that is compressed.

Question 47

Name causes of pain in the foot/ankle. (4)

Answer 47

Achilles tendinopathy Plantar fasciitis March fracture (hairline fracture in metatarsal) Morton’s neuroma (from wearing tight shoes)