Soft Tissue Injuries Flashcards
What do ligaments do?
stabilize joints
What do tendons do?
move joints. they connect bone to muscle.
What is the bursae/ menisci?
reducers friction between moving parts- helps smooth the movements
Acute soft tissue injuries include what?
Sprain (ligaments) Strain (tendons) (these are d/t acute trauma)
Chronic soft tissue injuries include what?
Tendonitis (better term is tendinopathy) Bursitis (these are d/t overuse)
What is tendinopathy?
Repetitive mechanical load without sufficient time for healing (chronic overuse) —> micro-tears—> improper healing (insufficient time for healing)—> degenerative changes (loss of collagen, disorganized collagen) —> tear
Soft tissue injuries presentation- of acute injuries
- Clearly defined cause/ onset - Localized pain w/activities and at rest - “Pop” sensation (if tear) - Edema, ecchymosis
Soft tissue injuries presentation- of chronic injuries
- Gradual onset/ no clearly defined cause - Localized pain w/ specific movements (late stages at rest) No edema
General approach to diagnosis of soft tissue injuries
Most syndromes are diagnosed CLINICALLY
Best initial test for soft tissue injuries?
X-ray (best initial test) is indicated in some acute injuries or in chronic injuries if there is no improvement for 6 weeks. X-ray done r/o fracture, tumor, arthritis.
Most accurate test for soft tissue injuries?
MRI is the most accurate diagnostic test for soft tissues injuries
What is the best test for peripheral mono- neuropathy?
Nerve conduction study is the most accurate diagnostic test for peripheral mono-neuropathy
Treatment of ACUTE soft tissue injuries ?
RICE for the first 2-3 days + short course NSAIDs: Rest (mobility devices) Ice (20 min at a time) Compression (elastic bandage) Elevation When acute pain and swelling subsides (s/p 1 week)—> recommend physical therapy to prevent chronic instability and recurrent injury
Treatment of CHRONIC soft tissue injuries ?
- Relative rest. Braces or orthotics if exacerbating activities cannot be fully avoided 2. Pain control (a trial of NSAIDs, short course) 3. Physical therapy (stretching and muscular strengthening) 4. Corticosteroid injections ( if no response to pain control and relative rest for 6 weeks) 5. Surgery (if no response to conservative therapy for 6 months): debridement of degenerative tissues. Surgery is a last resort
Rotator cuff tondonitis s/s?
Pain with overhead activities, (+) Neer’s test, (+) Hawkins; common in painters, swimmers, volley ball players since they are always doing overhead activity- joint will sustain degenerative changes
Rotator cuff tear s/s?
Pain and weakness on abduction, (+) open can, drop arm tests
Adhesive capsulitis of the shoulder s/s?
aka frozen shoulder. Pain and limitation of ROM (active and passive)
Osteoarthritis s/s?
Pain with activity relieved by rest, crepitus, limited active and passive ROM. Pain gets worse as day goes by- worse with use
Cervical radiculopathy s/s?
(+) pain neck, shoulder and forearm (poorly localized) (+) sensory (numbness/ parasthesia) (+) motor deficits very rare (+) reduced DTRs : C5-C6 biceps C7-C8 triceps
Every pt with shoulder/ back/ neck pain, ask about?
about h/o cancer, HIV, IV drug use, fever, chills, immunosuppression
If cord compression is suspected, what do you do?
MRI in ER ASAP (only emergent reason you can get MRI in ED)
Hyperreflexia signifies?
problem with spine- much more serious, also unstable gait, loss of bladder control, weakness
Olecranon bursitis s/s?
Minimally tender fluctuant swelling, NO limitations in ROM
Septic olecranon bursitis s/s?
Tender, red, warm, full active and passive ROM
Lateral epicondylitis s/s?
aka tennis elbow. Pain over the lateral aspect of the elbow with wrist extension ( backhand stroke, forceful gripping, painting, lifting, gardening)
Median epicondylitis s/s?
aka Golfer’s elbow. Pain over the median aspect of the elbow with wrist flexion (lifting, forceful gripping)
to check hand motor function?
rock/paper/scissors Paper —>radial Scissors —> ulnar Rock, OK —> median
Carpal tunnel syndrome s/s?
Numbness/pain 1st, 2nd, 3rd fingers, (+) Tinel, (+) Phalen, thenar atrophy (thenar is the bulge by your thumb- if flat –>atrophy)
tx for carpal tunnel?
Splint in neutral position for carpal tunnel syndrome
De Quiervain’s tendinitis s/s?
aka washerwoman’s thumb; Pain over radial side of the hand exacerbated by thumb movements, (+) Finkelstein
Acute infectious tenosynovitis s/s?
s/p puncture wound, symmetric swelling of the digit “sausage-like”, pain with passive extension and slightly flexed digit at rest
Scaphoid fracture s/s?
s/p fall on outstretched hand, (+) snuff box tenderness
tx for scaphoid fracture?
Thumb Spica cast/ splint for scaphoid fracture
Trochanteric bursitis s/s?
Lateral hip pain worse with direct pressure, unaffected by weight bearing, no limitations in ROM, (+) trochanteric tenderness
Hip osteoarthritis s/s?
Insidious onset of anterior /groin pain worse with weight bearing or walking relieved by rest. Pain at rest when disease progresses. Patients > 50 y. (+) crepitus, (+) limited ROM
Avascular necrosis of the hip (osteonecrosis, ischemic necrosis) s/s?
Anterior hip / groin pain worse with weight-bearing and walking relived by rest. Pain at rest when disease progresses. (+) limited ROM. Patients with chronic alcohol use, steroid use and sickle cell disease Compromised vascular supply —> necrosis of the proximal femur —> collapse
Lumbosacral radiculopathy s/s?
(commonly L5 and S1) Posterior hip ( buttocks) pain extending to the knee accompanied by back pain, parasthesia Normal hip ROM, (+) straight leg, (+) motor /sensory deficits, reduced reflexes: S1 –ankle
Ligamentous injury ( sprain) (of knee) s/s?
History of trauma, “popping sound” in the knee, the knee is “giving away” Pain and swelling , laxity (NO END POINT) on stretch tests
Meniscal tear s/s?
s/p vigorous sport activity. Lateral or medial knee pain exacerbated by twisting movements. Sensation of “locking” or “ giving away”, (+) McMurray test
Patellar tendonitis/ patellar bursitis s/s?
Anterior knee pain exacerbated by activity (repetitive knee flexion)
Osgood-Schlatter disease s/s?
Pain and swelling of the tibial tubercle exacerbated by activity and relieved by rest, in young athletes 9-14 years of age who have undergone a rapid growth spurt
Slipped capital femoral epiphysis s/s?
Chronic or intermittent pain in the hip or knee exacerbated with activity, painful limp. No hx of trauma. In obese children 12-14 y/o. On exam limited ROM, leg maybe externally rotated
Ankle sprain s/s?
S/p acute inversion/ eversion injury. Pain and swelling , maybe “pop” sensation, (+) laxity on the stretch tests anterior drawer ankle test
Achilles tendon strain/tear s/s?
s/p injury, pain in the back of the ankle, may feel “popping” sensation, (+) Thompson test.
Achilles tendon tear from?
Forceful ankle dorsiflexion
Plantar fasciitis s/s?
Chronic heel (plantar surface) pain with a few steps in the morning or periods of inactivity. Pain gets better with more walking , common in runners and pt with inappropriate footwear. (+) heel tenderness
Morton neuroma s/s?
Burning pain ( “walking on pebbles”) in the ball of the foot and numbness between 3rd and 4th toes, ass with high heel and narrow box shoes, (+) squeeze metatarsal joints test
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