Soft Tissue Injuries Flashcards
How do you differentiate between articular and periarticular pain? List their respective features (periarticular 3).
Articular pain:
- Pain at joint line
- Tenderness on palpation of joint line
Periarticular pain:
- Point of maximal tenderness away from joint line
- Pain on active movement > passive movement
- Pain is maximal in certain lines of muscle pull
What is a sprain?
- Stretch or tear of ligaments, which connect ends of bones
What are the 3 types of sprains, their features and their respective management options?
1) Mild stretch or microtear
- Mild pain, swelling and tenderness
- Minimal pain on bearing weight and ambulation
- Self-limiting, rest is usually sufficient
2) Partial rupture
- Moderate pain, swelling, tenderness, ecchymosis
- Pain on bearing weight and ambulation (limp)
- Moderate instability (joint feels like giving way); some restriction in motion and function
- PRICE +/- analgesics
3) Complete rupture
- Severe pain, swelling, tenderness, ecchymosis
- Cannot bear weight and ambulate
- Severe instability; loss of joint motion and function
- Refer to ED
What is the most common cause of sprains? And list the mechanism of injury.
Lateral ankle sprain due to trauma/injury from sports via INVERSION of foot
Define tendonitis and its hallmark features (3)
Acute inflammation and irritation of tendon, which connects muscle to bone
Features:
- Local pain and dysfunction on active use (typically dull ache) and only occurs in certain direction of pull
- Pain on active movement; unlikely on passive movement
- Inflammation, but swelling likely not visible
What are the common causes of tendonitis? (3 key, 2 optional)
1) Overuse (mechanical loading)
2) Injury (from sports)
3) Drug-induced (FQs, statins; more FQ rather than statin)
Others:
- Inflammatory diseases (e.g. RA)
- Calcium apatite deposition
What are the common sites of tendonitis? (total 5, 3 more impt)
1) Shoulder (rotator cuff and bicepital tendonitis)
2) Elbow
- Golfer’s elbow (inside = medial epicondylitis)
- Tennis elbow (outside = lateral)
3) Ankle (Achilles heel)
Less commonly: lateral hip (gluteus medius/minimus) and wrist (radialis/ulnaris tendonitis)
When should a case of tendonitis be referred?
Pain lasts more than weeks
Define bursitis and how the pain from bursitis occurs
Inflammation of bursa, a fluid-filled saclike structure lined by synovial membrane that surrounds joints (helps to cushion muscles and tendons from adjacent bones)
Pain occurs when adjacent bursa are compressed to the point that intrabursal pressure increases
State the 2 broad types of bursitis and their corresponding causes (3 per type).
1) Acute bursitis - pain when fully flexing joint
- Infection (septic bursitis)
- Gouty bursitis
- Trauma/injury
2) Chronic bursitis - more swelling/thickening, less pain
- Overuse
- Prolonged pressure (kneeling/leaning)
- Systemic diseases (e.g. RA, spondylarthritis)
List the common sites of bursitis (superficial and deep). (5)
Superficial sites
- Knee cap (prepatellar)
- Elbow (olecranon)
- Posterior upper thigh (Ischial)
Deep sites
- Shoulder (subacromial)
- Hip (trochanteric)
What are the management options for bursitis?
TOP NSAIDs are the DOC, especially for superficial bursitis
Intrabursal glucocorticoids can be considered for deep bursitis that cannot be reached by TOP NSAIDs
Define plantar fasciitis
Inflammation of the plantar fascia, a fibrous structure that connects heel to base of toes
Most common cause of heel pain
What are the common causes of plantar fasciitis? (2 key, 6 optional)
1) Prolonged standing/jumping/running on hard surfaces
2) Flat/highly-arched feet
Others:
- Obesity
- Lower SES
- Impaired physical/mental health
- Tight hamstring –> increased load on forefoot
- Reduced ankle dorsiflexion (poor calves/ankle injury)
- Systemic rheumatic diseases
What are the hallmark features of plantar fasciitis? (3)
- Heel pain
- Pain increases when walking/running (esp in the morning or after a period of inactivity)
- Pain lessens with increased activity, but worsens at the end of the day
