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3154 MSK > soft tissue injury > Flashcards

soft tissue injury Flashcards

1
Q

articular joint pain

A

gout, RA, OA, bone

  • Relate to joint structure, pain at joint line when palpate
  • Pain on both active and passive movement
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2
Q

non articular joint pain

A

□ Ligaments, tendons, muscles
□ Features:
* On palpation: paint near joint, (maximal tenderness)
* Pain on active movement > passive
* Pain maximal at certain lines of muscle pull

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3
Q

causes of articular joint pain

A

1) visceral pain (pancreatitis, gallstone, kidney, UTI)
2) tissue pain (DVT, ischemia, infection)
3) neuropathic pain (nerves, prolapsed intervertebral disc)
4) bone pain (fracture, trauma)

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4
Q

features of soft tissue injury (self-limiting)

A

□ Consequences of chronic repetitive low-grade trauma/ overuse
- Microtear, microinflamm (may not be visible to eye)
□ Focal and non-systemic (can point to location)
□ Self-limiting (can heal by itself)
□ Conversative measures (RICE, supportive)

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5
Q

urgent referral for soft tissue injury

A

□ Fractures
□ Ligament rupture
□ Infection-related causes (prevent sepsis, spread of damage)
□ Malignancy/ metastasis (lower back pain, esp for prior hx)
□ Relate to underlying visceral conditions (lower back pain)

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6
Q

tx management

A

1) non pharm RICE
2) pain relief (TOP -> PO NSAIDS/ paracetamol, CS)
* avoid opioids

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7
Q

tx goal

A
  • reduce pain
  • reduce freq
  • prevent future injury
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8
Q

types of non-articular soft tissue injury

A
  • ligament
  • tendon
  • bursae
  • fascia
  • muscle
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9
Q

sprain pathophysiology

A
  • ligament (Bone-bone connective tissue)
  • stretch/ partial/ complete rupture
  • ***anterior talofibular ligament

(may affect 1st, 2nd ligaments which cause significant ankle instability)

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10
Q

features of sprain

A

○ Sudden onset of pain and swell after POP sound
○ Swell, tenderness

○ II, III: ecchymosis (bruise)
○ III: cannot bear weight or ambulate (loss of motion and function, unable to limp)

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11
Q

cause of sprain

A
  • sport
  • inversion of foot (land on the outer part of feet)
  • child, adol > adults
  • F > M
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12
Q

tx of sprain

A
  • protect
  • rice
  • PO pharmacotherpay

III: refer to ER

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13
Q

tendonitis pathophysiology

A

tendon connects bone and muscle
inflammation, irritation

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14
Q

tendinopathy disease progression

A

(tendonitis / inflam–> rupture –> tendinosis/ degen)

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15
Q

features of tendonitis

A
  • Local pain
  • Dysfunction
  • Inflamm –> Degeneration
  • Pain in particular direction and pull (When tendon stretched )
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16
Q

common sites of tendonitis

A
  • Shoulder: rotator cuff tendinopathy
  • Elbow
    ○ Outside: Tennis
    ○ Inside: Golfer’s
  • Wrist
    ○ Flexor carpi radialis/ ulnaris tendinitis
  • Hip (lateral)
    ○ Gluteus medius/ minimus tendinopathy
  • Ankle
    ○ Achilles tendinopathy (jumping sports/ running over hilly terrain)
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17
Q

tendonitis causes

A
  • Overuse, overload
  • Sports injury
  • Inflamm rheumatic disease
    ○ FH, PMH, recurrence
  • Ca apatite deposition (metabolic disturbances)
  • Drug induced — FQ, statins (myalgia)
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18
Q

bursitis pathophysiology

A

inflamm of bursae (Fluid-filled sacs around joints that cushions tendons/ muscles from adj bones)

Lined by synovial mem in clefts b. mobile structures

  • Pain occurs when motion compresses adj bursa to point where intrabursal P. icnr
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19
Q

features of bursitis (acute vs chronic)

A

Acute bursitis
○ Pain when joints fully flexed
○ Active & passive
Chronic bursitis
○ More swelling, thickening
○ Minimal pain (hardened)
○ 2* changes of contracture muscle atrophy – immobility

20
Q

causes of bursitis

A
  • Trauma/ injury
  • Crystal-induced process (gouty bursitis)
  • Infection (septic bursitis)
  • Overuse
  • Prolonged pressure —– Kneel/ lean on hard surface
  • Inflam arthritis ——– RA, spondylarthritis (spine)
21
Q

tx of bursitis

A
  • Superficial (cushions skin & bone)
    = TOPICAL NSAID
  • Deep (reduce friction of muscles as they glide over each other/ bone prominences)
    = Intrabursal glucocorticoid
22
Q

superficial joint

A
  • Olecranon (elbow)
  • Prepatellar (knee cap)
  • Ischial (post upper thigh region b. gluteus maximus & ischial tuberosity)
23
Q

deep joint

A

Trochanteric (hip)
Subacromial (shoulder)

24
Q

plantar fasciitis pathophysiology

A

inflamm of fasciitis (Fibrous attachment connecting heel bone to base of toes)

heel pain – Incr stress on plantar fascia (pressure, inflamm)

25
Q

features of plantar fasciitis

A
  • Pain worse when walk/ run (esp after period of inactivity)
  • Pain lessens with incr activity. Worse at END OF DAY (prolonged weight-bearing)
26
Q

causes of plantar fasciitis

A
  • Prolonged standing/ jumping/ running hard surfaces
  • Flat feet/ high arched feet
  • Tight hamstring (warmup)
    • Decr knee extension
    • Incr load of forefoot
    • Incr stress on fascia
  • Reduced ankle dorsiflexion (calf muscle/ ankle injury??)
  • Obesity
  • Lower SES, impaired physical/ mental health
  • Systemic rheumatic diseases
27
Q

shoulder pain pathophysiology

A

Not fully understood (refer if MARKED loss of motion)

affects adhesive capsulitis
Involve stiffness and pain in shoulder joint

28
Q

shoulder pain features

A
  • Non-dominant side, but other side may be affected within 5yrs
    • Limited reaching overhead, to side, across chest + limited rotation
      - Reduced function: unable to scratch back, put on coat, unhook bra
29
Q

progression shoulder pain

A

Initial (2-9mnths)
○ Severe disabling shoulder pain
○ Worse at night
○ Incr stiffness

Intermediate (4-12mnths)
○ Stiffness & severe loss of shoulder motion
○ Pain gradually lessen

Recovery (5-24mnths)
○ Gradual return of range of motion

5yrs: bilateral

30
Q

causes of shoulder pain

A
  • Idiopathic or 2nd to shoulder injuries
  • Assoc w/:
    • Presence of DM
    • Hypothyroidism
    • Dyslipidemia
    • Prolonged immobilisation
31
Q

tx of shoulder pain

A
  • Analgesics for pain
    • Paracetamol, NSAIDs, weak opioids
  • Range of motion exercises
  • Intraarticular glucocorticoids (deep)
  • Physical therapy (consistent exercises)
32
Q

lower back pain pathophysiology

A

Lumbar, sacral region strain

33
Q

lower back pain features

A

Non-specific, self-limiting “strain” ep (10-14 days)
Presence (or absence) of radicular sx – neuro

* Lower extremity pain, paresthesia
* Weakness 
* Nerve root impingement
34
Q

duration of lower back pain

A

Acute: <4wks

refer for further investigation if no improvement
Subacute: 4-12wks
Chronic: >12

35
Q

differential dx of lower back pain

A

1) Mechanical
○ Lumbar strain
○ Degenerative disease (OA)
○ Spondylolisthesis
○ Herniated disc (Spinal cord/ cauda equina compression)
○ Spinal stenosis
○ Osteoporosis
○ Fractures

2) Nonmechanical
○ Malignancy
○ Infection (TB/ Osteomyelitis, septic discitis, paraspinous abscess, epidural abscess)

3) Visceral disease
○ Pelvic organs, renal disease, aortic aneurysm, GI disease

36
Q

tx for acute and subacute lower back pain

A

Non-pharm + NSAID/ SMR (skeletal muscle relaxant)
○ ANAREX: orphenadrine (muscle relaxant)
○exercise
○HEAT

37
Q

tx for chronic LBP

A
  • Non-pharm exercise
  • NSAID
  • Tramadol/ duloxetine
38
Q

general counselling for LBP

A
  • Improvement in pain & function from tx may be small
  • Reassure acute/ subacute is self-limiting
  • Remain active as tolerated
  • Avoid potential harmful & costly tests and tx
  • Heat, massage (caution)
  • Engage in low-impact core strengthening exercises to improve spine stability
    ○ Swim, stat. bike, brisk walk
  • Correct lifting and moving techniques
    ○ Squat to lift (X bend and lift)
    ○ Get help
  • Maintain correct posture when sit/ stand
  • Quit smoking
    ○ Risk for atherosclerosis can harden arteries, cause low back pain
  • Avoid stressful situations
    ○ Muscle tensions
  • Maintain healthy weight
    ○ Reduce strain on lower back
39
Q

myalgia features

A

Myalgia = muscle pain, soreness, stiffness
Myopathy = muscle disease
Myositis = muscle inflamm

can be diffused vs focal

40
Q

differential for myalgia

A
  • Infection
    ○ Viral: dengue, influenza, COVID-19
  • Noninflamm pain syndrome (fibromyalgia)
  • Medications
    ○ Ciprofloxacin (FQ)
    ○ Bisphosphonates
    ○ Aromatase inhibitors
41
Q

urgent myalgia

A

1) infection-related (endocarditis, sepsis)
* diffuse, fever, chills, tired

2) med toxicity
* statin-induced rhabdomyolysis
* muscle pain, weak – proximal
* myoglobinuria, nocturnal cramp, stiff

42
Q

tx for statin induced

A

□ Anytime (most within 6mnths
□ Tx: discontinue if intolerable sx/ CK >10x ULN
* Large amt of fluids for RENAL excretion of myoglobin (prevent renal failure)
* Resolve DDI
* Restart at lower dose/ alt day dose
* Switch to pravastatin, fluvastatin

43
Q

tx for overuse myalgia

A

Acute
- RICE
- Topical NSAIDs

Prevention
- Proper warm up before exercise

44
Q

shoulder pain

A

tendonitis (rotator cuff), biceps tendonitis
* refer pain > days/ wks

frozen shoulder (adhesive capsulitis)
* marked decr in range of motion/ function
* fever, PMH malignancy, trauma

45
Q

elbow pain

A

tendonitis (lateral OUT- tennis/ medial IN - golf)
bursitis (olecranon)
* acute onset, pain, trauma, fever, PMH inflam dx

46
Q

knee

A

sprain (ACL)
tendonitis (patella/ quadriceps)

47
Q

ankle/ heel

A

sprain (lateral ankle sprain)
* cannot bear weight, loss of motion/ function, sig instablity

tendonitis (Achilles)

fasciitis (plantar)
* acute onset, pain, trauma, fever, PMH inflam dx

3154 MSK (9 decks)

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