Soft Tissue Rheumatism and Fibromyalgia

Question 1

Anatomy of Tendon:

Answer 1

Question 2

What are common sites of tendonitis?

Answer 2

• Supraspinatus tendonitis
• Biceps tendinitis
• Achilles tendonopathy

Question 3

What is meant by soft tissue rheumatism?

Answer 3

Soft tissue rheumatism: Is the aggregate of clinical problems related to tendons, ligaments, fascia and bursae. They often present as a regional problem.

Question 4

Enthesis means

Answer 4

Where the tendon attaches the muscle onto the bone

Question 5

Enthesitis

Answer 5

Inflammation where tendon or ligaments join to bone.

Question 6

What are common points of enthesitis?

Answer 6

– Achilles enthesitis

– Ankylosing spondylitis

– Medial / Lateral epicondylitis

Question 7

Fasciitis

Answer 7

Inflammation around fascial planes.

Question 8

Examples of fasciitis:

Answer 8

• Dupytrens contracture
• Plantar fasciitis

Question 9

Plantar fasciitis

Answer 9

Plantar fasciitis is inflammation of the plantar fascia, a part of your foot that connects your heel bone to your toes.

Question 10

What are the symptoms of plantar fasciitis?

Answer 10

Symptoms of plantar fasciitis include pain around the heel and arch of your foot. It may be worse in the morning.

Question 11

Dupuytren’s contracture

Answer 11

Dupuytren’s contracture is when 1 or more fingers bend in towards your palm.

Question 12

Bursitis

Answer 12

Treated with steroids injected into the site.

Question 13

Summary of shoulder problems:

Answer 13

Question 14

Frozen shoulder – adhesive capsulitis

Answer 14

Frozen shoulder is where your shoulder is painful and stiff for months, sometimes years.

Treatment for frozen shoulder includes painkillers and exercises to help you get movement back in your shoulder.

Question 15

Rotator cuff syndrome

Answer 15

Rotator cuff impingement syndrome is a condition where your rotator cuff tendons are intermittently trapped and compressed during shoulder movements. Impingement causes injury to the shoulder tendons and bursa, resulting in painful shoulder movements.

Question 16

What is ACJ osteoarthritis?

Answer 16

Acromioclavicular osteoarthritis is a type of shoulder arthritis that involves degenerative changes to the cartilage and other structures in the acromioclavicular joint—leading to pain, stiffness, and weakness in the front of the shoulder.

Question 17

Subacromial bursitis

Answer 17

Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of the four tendons of the rotator cuff).

Question 18

These are all examples of what?

– Carpal Tunnel

– Meralgia parasthetica

– Tarsal Tunnel

– Cubital fossa syndrome

Answer 18

Nerve entrapment disorders

Question 19

Meralgia paresthetica

Answer 19

Meralgia paresthetica is a condition characterized by tingling, numbness and burning pain in the outer part of your thigh. The condition is caused by compression of the lateral femoral cutaneous nerve, which supplies sensation to your upper leg.

Question 20

Cubital tunnel syndrome involves which nerve?

Answer 20

Ulnar

Question 21

What is CRPS?

Answer 21

Complex regional pain syndrome is a chronic pain condition that most often affects one limb - usually after an injury.

Question 22

Complex regional pain syndrome presentation:

Answer 22

• It is usually characterized clinically by: exquisite burning pain.
• oedema
• allodynia
• abnormal sweat gland (sudomotor) activity
• hyperaesthesia in the limb, which may feel cold or hot
• may change colour
• Localised bone demineralization.

Question 23

Fibromyalgia:

Answer 23

1. Widespread pain – tender spots > 7
2. Somatic symptoms including muscle pain, IBS, Dysmenorrhoea, Tingling
3. Fatigue
4. Waking un-refreshed

Question 24

What is the main principle when prescribing NSAIDS?

Answer 24

Prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) at the lowest effective dose for the shortest possible duration.

Normally 3-5 days recommendation.

Question 25

What are the side effects of NSAID’s?

Answer 25

– GI Bleeding top and bottom

– IHD

– Stroke

– Asthma

– Acute Kidney Injury (AKI)

Question 26

Fibromyalgia pathophysiology:

Fibromyalgia is associated with increased activity in which three regions of the brain?

Answer 26

• Fibromyalgia (FM) is considered to be a disorder of pain regulation, classified often under the term central sensitization.
• Functional MR scanning demonstrate increased activity in somatosensory cortex, insula and anterior cingulate cortex.

Question 27

How is fibromyalgia managed?

Answer 27

• Exercise graded
• CBT – psychotherapy
• Class work
• Pharmacological approach

– Simple analgesia

– Tricyclic antidepressants

– amitriptyline - regulates sleep pattern.

• duloxetine - anti depressant

– Anticonvulsants

– pregabalin - used for treating epilepsy

– gabapentin - used for treating epilepsy

– Do NOT use opiates

Question 28

Hypermobility

Answer 28

Hypermobility is the term used to describe the ability to move joints beyond the normal range of movement.

Question 29

What is the criteria used to determine hypermobility?

Answer 29

The Beighton Criteria: is a score set of manoeuvres used to judge if there is evidence of joint hypermobility. There are 9 points, and a score of 4 or more is considered a sign of there likely being generalised joint hypermobility present.

Question 30

Hypermobility syndrome presents with what symptoms?

Answer 30

• Often associated with striae – stretch marks
• Easing bruising
• Rarely Pots syndrome

Note: Hypermobility syndrome is similar to ehlers danlos (Alice camp).

Question 31

Pots syndrome

Answer 31

Postural tachycardia syndrome (PoTS) Postural tachycardia syndrome (PoTS) is an abnormal increase in heart rate that occurs after sitting up or standing. Some typical symptoms include dizziness and fainting.

Question 32

Marfan’s syndrome:

Answer 32

• Ghent nosology
• Tall and slender build.
• Disproportionately long arms, legs and fingers.
• A breastbone that protrudes outward or dips inward.
• A high, arched palate and crowded teeth.
• Heart murmurs. • Extreme nearsightedness.
• An abnormally curved spine.
• Flat feet.
• Autosomal dominant - 25% new mutation.

Marfan’s is a disorder of the connective tissue.

Question 33

What is the major complication in marfan’s syndrome?

Answer 33

In a person with Marfan syndrome or some related disorders, the aorta may become enlarged (aortic dilation) or the walls of the aorta may bulge (aortic aneurysm). These are very serious problems because a significantly enlarged aorta is at risk for tearing or rupture (aortic dissection).

Question 34

Aortic dissection

Answer 34

An aortic dissection is a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect).

Question 35

Anti-dsDNA antibodies =

Answer 35

SLE

Question 36

HLA-B51 is associated with what?

Answer 36

HLA-B51 is associated with Behçet’s disease.