5. Soft tissue diseases

Question 1

What are the red flags for severe disease?

Answer 1

Fever
Unexplained weight loss
History of carcinoma 
Immunosuppression 
Ill health or presence of other medical illness
Severe night pain/progressive pain 
Persistant mono-arthritits

Question 2

What are yellow flags?

Answer 2

These are factors that increase pain and the risk of developing or perpetuating long term disability and work loss associated with persistent pain

Question 3

What is meant by the ‘enthesis’?

Answer 3

This is the area of the ligamentous attachment to bone - where the tendon sheath inserts into the bone

Question 4

What is ‘tendonitis’ characterised by?

Answer 4

Characterised by pain on resisted movement

Question 5

What is De Quervain’s tenosynovitis?

Answer 5

Inflammation of the tendons on the side of the wrist at the base of the thumb

Type of tendonitis

Question 6

Where is pain felt in De Quervain’s tenosynovitis?

Answer 6

Around the thumb, at the base of the thumb and at the wrist

Question 7

Which tendons are affected in De Quervain’s tenosynovitis? x3

Answer 7

Extensor pollicis brevus
Abductor pollicis longus
Extensor pollicis longus

Question 8

Other than pain, how does De Quervain’s tenosynovitis present?

Answer 8

Crepitus on movement

Question 9

How is De Quervain’s tenosynovitis treated?

Answer 9

Topical anti-inflammatory medication e.g. ibuprofen

Question 10

How is De Quervain’s tenosynovitis tested? x3

Answer 10

Pain on resisted movement (!)
Crepitus
Finkelstein’s test

Question 11

What is trigger finger?

Answer 11

Nodule on the relevant flexor/tendon forms - gets stuck passing through the tendon sheath of the palm

Question 12

How is trigger finger treated?

Answer 12

Topical anti-inflammatories

Question 13

What is carpal tunnel syndrome?

Answer 13

Compression of the median nerve in the carpal tunnel

Question 14

How does carpal tunnel syndrome present?

Answer 14

Presents as pain and parasthesia due to sensory loss first thing in the morning

Question 15

What is the effect of advanced carpal tunnel syndrome?

Answer 15

Atrophy of the thenar eminence

Question 16

What other conditions are closely associated with carpal tunnel syndrome?

Answer 16

Hypothyroidism
RA
Diabetes
Pregnancy 
Acromegaly

Question 17

Name the two tests used to diagnose carpal tunnel syndrome

Answer 17

Tinel’s test

Phalen’s test

Question 18

What is Tinel’s test?

Answer 18

Tap/percuss on the medial nerve

Should illicit sensation of tingling over the distribution of the nerve

Question 19

What is Phalen’s test?

Answer 19

Push the wrists into complete and forced flexion

Question 20

How can you treat carpal tunnel syndrome?

Answer 20

Immobilise the joint
Inject steroids to release inflammation

All treatment is aimed at decompression of the median nerve

Question 21

What is dupuytren’s contracture?

Answer 21

Fibrosis of the palmar aponeurosis causing the fingers to bend inwards

Question 22

In whom is dupuytren’s contracture most common?

Answer 22

Men
Heavy drinkers
Smokers
Diabetics

Question 23

What is tennis elbow?

Answer 23

Inflammation of the enthesis where of the extensor muscles of the forearm at the lateral epicondyle of the humerus

Question 24

What is tennis elbow also known as?

Answer 24

Lateral epicondylitis

Question 25

How is tennis elbow diagnosed?

Answer 25

Local tenderness | Pain at resisted wrist extension

Question 26

What is the treatment for tennis elbow?

Answer 26

Rest/topical NSAID Massage Injection In severe cases - surgery

Question 27

What is the dermatomal distribution of true shoulder pain? What is not affected by this pain?

Answer 27

C5 The elbow

Question 28

What is the other name for frozen shoulder?

Answer 28

Adhesive capsulitis

Question 29

What is frozen shoulder?

Answer 29

Capsulitis - the capsule of the shoulder joint becomes thickened and very adherent - glues up - becomes sticky and gooey

Question 30

What happens to the size of the joint capsule of the shoulder in frozen shoulder?

Answer 30

The whole capsule shrinks and there is a reduced area of space for movement

Question 31

What is the cause of frozen shoulder?

Answer 31

Idiopathic

Question 32

What is the treatment for frozen shoulder?

Answer 32

Re-assurance/education Analgesia Injection Physiotherapy

Question 33

What is rotator cuff tendinitis?

Answer 33

Impingement of the rotator cuff muscles between the greater tuberosity and the acromium- common in young athletes where there is overuse

Question 34

How does rotator cuff tendinitis present?

Answer 34

Painful arc on active abduction | Pain on resisted abduction

Question 35

What is the treatment for rotator cuff tendinitis?

Answer 35

Physiotherapy Steroid injection Surgery may be considered if this does not settle

Question 36

What is meralgia paraesthetica?

Answer 36

This is the hip equivalent of carpal tunnel syndrome

Question 37

What is 'march fracture'?

Answer 37

This is a fatigue/stress fracture of the distal third of the metatarsal due to recurrent stress (marching)

Question 38

What is mortons neuroma?

Answer 38

Benign neuroma at the planter nerve of the foot

Question 39

Meralgia paraesthetica - compression of which nerves?

Answer 39

Lateral cutaneous nerves