Soft tissues Flashcards
What is fibrous tissue?
Scar tissue
What is bursae?
Small sacs of fibrous tissue that are lined with synovial membrane which secrete synovial fluid
What is the function of bursae?
Reduce friction where ligaments and tendons pass over bone
What is bursitis?
Inflammation of the bursa, which can be idiopathic (unknown reason) or part of a systemic inflammatory disease, or due to gout or infection
Name the 3 common types of bursitis?
- Olecranon bursitis
- Prepatellar bursitis
- Trochanteric bursitis
What is olecranon bursitis caused by?
-excessive friction at the elbow, for example by resting the elbow on elbow flexion
When are idiopathic and traumatic olecranon bursitis cases usually painful
When pressure is applied
What are the clinical symptoms of bursitis and what is the management?
Clinical symptoms
- tender and distended (enlargement)
Management:
- bursal fluid should be aspirated to exclude infection and improve symptoms
- Local corticosteroid injections is effective in non- septic
Who is prepatellar or infrapatellar bursitis most common in and what are the symptoms?
How is it investigated?
What is the treatment?
- carpet fitters who spend a lot of time kneeling
- hot, red, swollen patella
- joint aspiration: to exclude infection or gout
- Treatment: rest but in recurrent episodes surgical intervention might be needed, antibiotics should be given for septic arthritis
What happens if the infected bursitis does not go away with antibiotics?
- formal incision and drainage might be needed
What is trochanteric bursitis and what are the symptoms?
What is the treatment?
How is it investigated?
- trochanteric bursa is located lateral to the greater trochanter of the femurs and allows motion of the fascia lata over the trochanter
- Symptoms: hip pain in trochanter rather than groin area
- Treatment: physiotherapy, steroidal injections in severe cases and in very persistent cases: surgery
- By examination and history trochanteric bursitis can be identified
What is carpal tunnel syndrome?
- a syndrome that results from the compression of the median nerve as it passes through the carpal tunnel at the wrist
- carpal tunnel is formed by the space between the carpal ligaments and carpal bones
How common is CTS?
- common
- more prevalent in women and the elderly
What is the usually cause of CTS?
- idiopathic but can be associated with several underlying conditions
What are the clinical features of CTS?
- pain
- paraesthesia in the median nerve distribution and can these symptoms can radiate to the elbow
- pain is often worse at night and they classically wake up from sleep
- muscle wastage is possible in advanced disease
Name some conditions that predispose you to carpal tunnel syndrome?
- Diabetes mellitus
- Hyperthyroidism
- Pregnancy
- Rheumatoid arthritis
- Trauma
- Acromegaly (pituitary gland produces too much growth hormone during adulthood)
How to you examine patients with carpal tunnel syndrome?
- strength muscles should be tested by the thenar test
- the opponens pollicis muscle is tested by thumb and little finger and resist attempts to separate the two
What investigation can be taken for CTS?
- serum glucose and thyroid function tests should be performed to exclude underlying medical conditions
How is CTS managed? `
- surgical decompression of the carpal tunnel by division of the transverse carpal ligament.
- very effective procedure and can be performed under local anaesthesia
- less severe cases wrist splints may help nocturnal symptoms
- corticosteroids might provide some relief
What is chronic fatigue syndrome?
Long term illness with a wide range of symptoms mainly extreme fatigue
What is the other name cfs (chronic fatigue syndrome is referred to)
ME
- myalgic encephalomyelitis
What is the epidemiology of CFS?
- can affect everyone and also children
- more common in women and tends to develop between mid -20s and mid 40s
Name some symptoms of CFS
- sleep problems
- muscle or joint pain
- headaches
- flu like symptoms
- feeling dizzy or sick
- fast or irregular heartbeats
- problems thinking
How is CFS investigated/diagnosed?
- no specific test but it is diagnosed based on history and ruling out other conditions
- blood and urine test can be used (to rule out for example anaemia, underreactive thyroid and liver/kidney problems) etc.
How is CFS treated?
- cognitive behavioural therapy
- structured exercise programme called graded exercise therapy
- medicine to control pain, nausea, and sleeping problems
What are the causes of CFS?
- viral infections
- bacterial infections e.g pneumonia
- problems with immune system
- hormone imbalance
- mental health trauma such as stress or emotional trauma
- your genes
Name the 3 main pathologies that affect tendons
- tendinopathy (tendon pain)
- tenosynovitis
- rupture
Name the most common sites and symptoms of tendinopathy
Sites: - shoulder - elbow - Achilles Tendon Symptoms: - pain worsened by active movement - tenderness over tendon - soft tissue swelling
Name some examples of tendinopathy
- Rotator cuff (beneath the acromion is the subacromial space and if this space becomes narrowed, irritation of supraspinatus can occur > leads to tendinopathy
- Tennis elbow (lateral epicondyle is tender and pain is exacerbated by resisted wrist extension
- Golfer’s elbow - common flexor origin at the medial epicondyle is tender and exacerbated by wrist flexion