Soft Tissue Rheumatism and Fibromyalgia Flashcards
Anatomy of Tendon:
What are common sites of tendonitis?
- Supraspinatus tendonitis
- Biceps tendinitis
- Achilles tendonopathy
What is meant by soft tissue rheumatism?
Soft tissue rheumatism: Is the aggregate of clinical problems related to tendons, ligaments, fascia and bursae. They often present as a regional problem.
Enthesis means
Where the tendon attaches the muscle onto the bone
Enthesitis
Inflammation where tendon or ligaments join to bone.
What are common points of enthesitis?
– Achilles enthesitis
– Ankylosing spondylitis
– Medial / Lateral epicondylitis
Fasciitis
Inflammation around fascial planes.
Examples of fasciitis:
- Dupytrens contracture
- Plantar fasciitis
Plantar fasciitis
Plantar fasciitis is inflammation of the plantar fascia, a part of your foot that connects your heel bone to your toes.
What are the symptoms of plantar fasciitis?
Symptoms of plantar fasciitis include pain around the heel and arch of your foot. It may be worse in the morning.
Dupuytren’s contracture
Dupuytren’s contracture is when 1 or more fingers bend in towards your palm.
Bursitis
Treated with steroids injected into the site.
Summary of shoulder problems:
Frozen shoulder – adhesive capsulitis
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.
Rotator cuff syndrome
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.
What is ACJ osteoarthritis?
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.
Subacromial bursitis
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).
These are all examples of what?
– Carpal Tunnel
– Meralgia parasthetica
– Tarsal Tunnel
– Cubital fossa syndrome
Nerve entrapment disorders
Meralgia paresthetica
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.
Cubital tunnel syndrome involves which nerve?
Ulnar
What is CRPS?
Complex regional pain syndrome is a chronic pain condition that most often affects one limb - usually after an injury.
Complex regional pain syndrome presentation:
- 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.
Fibromyalgia:
- Widespread pain – tender spots > 7
- Somatic symptoms including muscle pain, IBS, Dysmenorrhoea, Tingling
- Fatigue
- Waking un-refreshed
What is the main principle when prescribing NSAIDS?
Prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) at the lowest effective dose for the shortest possible duration.
Normally 3-5 days recommendation.
What are the side effects of NSAID’s?
– GI Bleeding top and bottom
– IHD
– Stroke
– Asthma
– Acute Kidney Injury (AKI)
Fibromyalgia pathophysiology:
Fibromyalgia is associated with increased activity in which three regions of the brain?
- 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.
How is fibromyalgia managed?
- 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
Hypermobility
Hypermobility is the term used to describe the ability to move joints beyond the normal range of movement.
What is the criteria used to determine hypermobility?
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.
Hypermobility syndrome presents with what symptoms?
- Often associated with striae – stretch marks
- Easing bruising
- Rarely Pots syndrome
Note: Hypermobility syndrome is similar to ehlers danlos (Alice camp).
Pots syndrome
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.
Marfan’s syndrome:
- 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.
What is the major complication in marfan’s syndrome?
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).
Aortic dissection
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).
Anti-dsDNA antibodies =
SLE
HLA-B51 is associated with what?
HLA-B51 is associated with Behçet’s disease.
