soft tissue injuries Flashcards
differentiate the types of joint pain
articular
- OA, RA, gout, osteoporosis
non-articular
- tissue injury, bone pain (fractures, dislocation), referred visceral pain, neuropathic pain, periariticular pain (tendon, ligament)
what is the likely presentation of articular joint pain
swelling, erythematous, tender on palpation of joint, restricted motion
what is the likely presentation of non-articular joint pain
point of maximal tenderness not at joint line on palpation, pain on active movement more than passive movement, pain maximal in certain lines of muscle pull
list types of soft tissue injuries and define each of them
sprains
- stretching, partial rupture or complete rupture of ligament (bone-to-bone connective tissue)
tendonitis
- inflammation of the tendon (muscle-to-bone connective tissue)
bursitis
- inflammation of the bursa (fluid filled sacs around the joint that cushions tendons/ muscles from adjacent bones)
plantar fasciitis
- inflammation of the plantar fascia (fibrous attachment connecting heel bone to base of toes)
what are the key features of soft tissue injuries
- consequence of chronic repetitive low grade trauma or overuse
- focal and non-systemic, self-limiting
- responsive to conservative measures
what is the presentation of sprains and how would you classify sprains
sudden onset of pain and swelling after a pop sound
grade I (mild stretching and microscopic tears)
- mild swelling and tenderness, able to bear weight
grade II (incomplete tear of ligament)
- moderate pain, swelling and tenderness, ecchymosis (bruising), painful weight bearing and ambulation
- mild to moderate joint instability, some restriction in joint motion and function
grade III (complete tear of ligament)
- severe pain, swelling, tenderness and ecchymosis, unable to bear weight
- significant joint instability, loss of joint motion and function
what is the presentation of tendonitis
local pain and dysfunction, inflammation, degeneration
what are the common etiology of tendonitis
- overuse
- sports injury
- inflammatory rheumatic disease
- calcium apatite deposition from metabolic disturbances
- drug induced (FQ, statins)
what are the common sites that tendonitis occurs at
- shoulder
- wrist
- elbow
- hip
- ankle
what is the presentation of bursitis
pain occurs when motion compresses adjacent bursa to the point where intrabursal pressure increases
what are the common etiology of acute and chronic bursitis
acute
- crystal-induced
- trauma/ injury
- infection (septic bursitis)
chronic
- overuse
- prolonged pressure
- inflammatory arthritis
what are the common sites for superficial and deep bursitis
superficial (those that cushions skin and bones)
- elbow
- knee cap
- posterior upper thigh
deep (those that decreases friction of muscles as they glide over each other/ bone prominences)
- hip
- shoulder
what is the presentation of plantar fasciitis
pain worsens when walking/ jumping/ running, esp after a period of inactivity/ in the morning, pain lessens on activity but worse at end of the day
what are the common etiology of plantar fasciitis
- prolonged standing/ jumping/ running on hard surfaces
- flat/ high arched feet
- reduced ankle dorsiflexion
- tight hamstring muscle leads to decreased knee extension thus increasing loading of forefoot and increase stress on plantar fascia
what are the differentials of heel pain and their associated red flags
neurologic
- paresthesia and numbness
- nocturnal sx
- radiating pain from posterior aspect of leg to heel
skeletal
- prior trauma
- nocturnal sx
- fever
- constant pain
soft tissue
- sudden onset (may be suggestive of a rupture)
inflammatory
- PMHx or FHx of inflammatory disorders
- erythema nodosum (skin inflammatory disorder characterised by tender red nodules or lumps)
what are other red flags and situations for urgent referral
- infection-related
- fracture
- ligament rupture
- malignancy/ metastasis
- relating to underlying visceral conditions
what is the initial management approach for soft tissue injuries
- exclude systemic diseases as it is a criteria for referral
- if appropriate for self-care,
- eliminate aggravating factors
- explain the illness
- provide self-help strategies (RICE)
- provide pain relif
- explain prognosis (for mild/ acute, a few weeks; for moderate to severe, 4-6w; 1-2w for mild sprain)
- strategies to prevent future recurrences (awareness, proper warmup and cooldown, proper technique and form, gradual progression and rest)
what are the goals of therapy for management of soft tissue injuries
- reduce pain
- regain function
- prevent future injury
what is the presentation of adhesive capsulitis
- unilateral (usually non-dominant side but other side becomes affected in 5yrs)
- limited reaching overhead, across chest and sideways, with limited rotation (refer if marked loss)
- self-limiting but through three very long phases
what are the three phases of adhesive capsulitis
initial (2-9m)
- diffuse severe disabling shoulder pain that is worse at night, stiffness
intermediate (4-12m)
- stiffness and severe loss of motion, pain gradually lessens
recovery (5-24m)
- gradual return of range of motion
what are the common etiology of adhesive capsulitis
- shoulder injury
- associated with presence of DM (chronic hyperglycemia and metabolic disturbances increases inflamm, impairs tissue healing and causes collagen deposition), hypothyroidism (THs important for regulation of metabolism and tissue repair), dyslipidemia (elevated lipids causes increase in inflamm and oxidative stress) and prolonged immobility (stiffness and contracture of surrounding tissues)
what are the differentials of shoulder pain
inflammatory
- RA
- PsA
- gout
- pseudogout
degenerative
- OA
infection
- septic arthritis
- osteomyelitis
trauma
- fracture
- dislocation
- ligamentous injury
connective tissue disorders
- inflamm myositis
- systemic vasculitis
soft tissue rheumatism
- rotator cuff syndrome
- adhesive capsulitis
- bursitis
tumors
what is the pharmacological management of adhesive capsulitis
analgesics
- NSAIDs
- paracetamol
- IA GC (plus physiotherapy)
what is the non-pharmacological management of adhesive capsulitis
range of motion exercises
- abduction
- external rotation
- internal rotation
