Soft tissue disorders Flashcards
What is tendinopathy?
- strain or injury to tendons and their insertions to bone
- enthesitis refers to inflammation of tendon/ligament insertion into the bone
What are the 2 main ways in which tendinopathy can occur?
- injury from overuse
- or as part of a systemic inflammatory condition
- (most cases are idiopathic)
What are the 3 most common sites of tendinopathy and what are the clinical features?
- Common sites: shoulder, elbow, Achilles tendon
- Symptoms: pain (worse with movement especially against resistance), tenderness of tendon and insertion point
What is frozen shoulder, what are the clinical features, and what is the management?
- painful, stiff shoulder caused by adhesive capsulitis
- symptoms: gradual onset pain and stiffness in shoulder, reduced mobility (external rotation mainly), unclear pathophysiology
- management: analgesia (NSAIDs), physio/exercise, local intra-articular injection
What is rotator cuff tendinopathy (aka. subacromial bursitis)?
- beneath the acromion is the subacromial space
- if this space becomes narrowed, irritation of supraspinatus can occur giving rise to tendinopathy
What is tennis elbow?
- lateral epicondylitis
- pain is exacerbated by resisted wrist extension
What is golfer’s elbow?
- medial epicondylitis
- pain is exacerbated by resisted wrist flexion
Tennis elbow and Golfer’s elbow diagram…
What is the management for tendinopathy?
- REST
- NSAIDs
- physio
- local corticosteroid injection (if needed)
What is tenosynovitis?
- inflammation of the synovial lining of a tendon sheath
What is De Quervain’s tenosynovitis?
- inflammation of the abductor pollicis longus and extensor pollicis brevis tendons
- presentation: pain at base of thumb (exacerbated by abduction of thumb, gripping, and ulnar movement of wrist), associated with people who carry out repetitive thumb abduction (office workers, musicians)
- treatment: splint and analgesia
What is trigger finger?
- occurs as a result of mechanical impingement of the A1 pulley (affects flexor tendons)
- results in locking or catching of the affected digit
De Quervains tenosynovitis diagram…
Trigger finger diagram…
What is the management for tenosynovitis?
- Rest
- Splintage
- Local corticosteroid injection
(surgical decompression of the sheath may be required)
What are the 2 main causes of tendon rupture?
- chronic inflammation or degeneration (eg. rupture of extensor tendons of fingers seen in RA)
- trauma
What are the clinical features of a tendon rupture?
- loss of movement at the joint to which the tendon provides power
- deformity and sometimes swelling
- Popeye sign: rupture of the long head of the biceps tendon
- Mallet finger: extensor tendon rupture at the distal phalanx
What causes mallet finger?
- usually occurs after a direct blow to the fingertip, causing aggressive flexion of the DIP joint
- it results in an inability to extend the flexed DIP joint
Popeye sign…
What is the management for tendon ruptures?
- usually self-limiting with a splint and adequate analgesia
- surgery if tendon repair is needed or a tendon transfer
What is the pathology of bursitis?
- Bursitis = inflammation of a bursa
- bursae are small sacs of fibrous tissue that are lined with synovial membrane and secrete synovial fluid (they reduce friction where ligaments and tendons pass over bone)
- can be due to systemic inflammatory disease, injury, or idiopathic
What are the 3 most common types of bursitis?
- Olecranon bursitis
- Prepatellar bursitis
- Trochanteric bursitis
What is olecranon bursitis caused by and what is the management?
- caused by excessive friction at the elbow
- infection can occur in addition to olecranon bursitis
- bursa usually tender but no pain on movement
- Management: NSAIDs and rest (local corticosteroid injection if needed), aspirate if infected and course of antibiotics
Why should you avoid aspiration of bursae if possible?
- risk of chronic sinus and chronic infection
What are the clinical features of prepatellar bursitis (housemaid’s knee)?
- inflammation and swelling of the pre-patellar bursa, located anterior to the patella
- symptoms: localised pain and swelling of anterior knee, common in people who spend a lot of time kneeling (eg. carpet fitter)
Prepatellar bursa and infrapatellar bursa diagram…
What does tenderness over the trochanter indicate?
- trochanteric bursitis
What is Dupuytren contracture?
- result of progressive, fibrotic thickening of the palmar fascia
What are the clinical features of Dupuytren contracture?
- fixed flexion deformity of 4th and 5th digits, and contraction of MCP and IP joints
- no pain
- positive tabletop test: palm of hand cannot be placed flat on a table
What is Achilles tendonitis (definition), what are the clinical features, and what is the management?
- inflammation of the tendon sheath
- clinical features: posterior ankle pain, pain on palpation of Achilles tendon, swelling of Achilles tendon
- management: conservative; rest, analgesia (NSAIDs)
What is a Baker’s cyst and what can sometimes occur?
- an extension of the knee synovium between the medial head of gastrocnemius and the semi-membranous muscle
- the cyst may occasionally rupture, resulting in sharp pain, swelling and calf redness. It is essential to rule out a VT in these cases
What is patella tendonitis?
- aka. ‘jumpers knee’
- inflammation of the patella tendon at the tibial tuberosity, commonly occurs as a result of jumping
- symptoms: anterior knee pain (exacerbated by movement)
What is plantar fasciitis?
- inflammation of the plantar fascia associated with repeated micro trauma to the sole of the foot
- pain in plantar of foot
What is trochanteric bursitis?
- inflammation of the bursa overlying the grater trochanter of the femur
- symptoms: tenderness over greater trochanter
What is the general management for soft tissue injuries?
- RICE
- analgesia (NSAIDs)
- if needed: corticosteroid injections
