Flashcards in Bone and Joint Disorders Deck (55):
What are ex of bone and joint disorders?
4. De Quervain’sTenosynovitis
5. Flexor tenosynovitis
Painful inflammation of tendon(s)
Muscle attaches to bone
What is the etiology of tendonitis?
1. Overuse – Most common
2. Inadequate warm-ups
3. Injury – falling, throwing
What is the pathophys of tendonitis?
1. Intrinsic & Extrinsic Mechanisms
A. Inflammation usually results from strain
-Sudden forceful contraction of muscle under stretch overloads its tensile strength muscle / tendon micro-tears inflammation
-Granulation tissue & collagen grow in area of injury
-New tissue fuses with surrounding tissue
muscle or tendon injury
What are the extrinsic mechanisms of injury for tendonitis?
Compressive forces exerted by surrounding structures can injure rotator cuff
Acromion, coracoacromial ligaments, acromioclavicular joint, osteoarthritis
What are the most common areas of tendonitis?
A. Rotator cuff: supraspinatus
2. Biceps brachii
3. Achilles tendon
4. Patellar tendon
What are the risk factors for supraspinatus tendinitis?
1. Repetitive overhead activity
A. Swimming, tennis, throwing, weight lifting, gymnastics, painting, electricians
2. Older age
A. Aging tendons develop microtears, calcification and fibrovascular proliferation
3. Instability GHJ
What is the function of the supraspinatus?
1. Abd & ER of shoulder
A. compresses humeral head in glenoid fossa
B. assisted by subscapularis and teres minor
What are the sxs of rotator cuff tendinitis?
1. Shoulder pain w/ overhead activity
2. Painful daily activities
3. Pain @ nite, esp. when lying on affected shoulder
4. Atrophy supraspinatus / infraspinatus muscles
5. Asymmetric movement of scapula
6. Tenderness overlying affected muscles
7. Painful AROM and dec ROM
8. Normal PROM w/ pain
What is a painful arc sign?
1. Pain w/ Active abduction beyond 90deg (ie, painful arc sign) -> rotator cuff tendinopathy
A. Most useful when combined w/ other rotator cuff tests
What is the empty can sign? What does it assess?
1. Assess Supraspinatus function
A. Straight arm in ~90deg abduction & 30deg forward flexion , then internally rotate shoulder completely
B. Attempt to adduct the arm while the patient resists
C. Pain w/o weakness: tendinopathy
D. Pain w/ weakness: tendon tear
What are 2 tests for shoulder impingement?
1. Neer test: PROM
2. Hawkins-Kennedy Test
3. Cross Arm test
4. Apley scratch test
What diagnostic tests are used to assess shoulder tendinitis?
1. X-ray shoulder
A. Oblique, lateral, AP
2. +/- MRI
What is the rx for shoulder tendinitis?
1. Avoid overhead reaching/lifting and behind back
4. +/- glucocorticoid steroids
What is the rx for a rotator cuff tear?
Right shoulder arthroscopy, rotator cuff repair
Define bicipital tendinitis?
1. Inflammation of long head of biceps tendon -> bicipital groove proximal humerus
2. Usually occurs with rotator cuff inflammation
What is the function of the biceps brachii muscle?
1. Flexes and supinates the forearm @ elbow
2. Long head of tendon stabilizes superior aspect of GHJ
How can the pain from a rotator cuff injury and biceps tendinitis be differentiated?
1. Sxs of biceps tendonitis pain radiating to biceps, pain w/ IR
2. Pain over bicipital groove
3. Yergason’s test
4. Speed’s test
What are the sxs of bicipital tendinitis?
1. Anterior shoulder pain aggravated by:
B. Carrying objects like shopping bags
C. Overhead reaching
2. Dramatic lump just above antecubital fossa suggest long head biceps tendon rupture
A. Proximal biceps tendon
B. Distal biceps tendon
What are the dx tests for bicipital tendinitis?
1. MRI to differentiate tendinitis from tear
A. Used to confirm ruptured tendon
-Absence of biceps tendon in groove
How is bicipital tendinitis treated?
Avoid aggravating activity
How is bicipital tear treated?
1. Referral to Orthopedics
2. Proximal- no treatment, become asymp. After 4-6wk
3. Distal- Surgery
What is lateral epicondylitis?
1. “Tennis elbow”
2. Most common overuse injury of elbow
3. Involvement of tendinous insertion of extensor carpi radialis brevis (ECRB)
What are the sxs of lateral epicondylitis?
1. Pain on lifting objects
A. Primarily when arm is in prone position
2. Tenderness lateral epicondyle
When is imaging performed for lateral epicondylitis?
1. Not necessary unless tendon disruption suspected
How is lateral epicondylitis treated?
1. Stop aggravating activity
A. MOST IMPORTANT TREATMENT !
2. Modify lifting
3. Tennis elbow braces
4. PT / OT
6. Steroid injection
Define medial epicondylitis
1. Golfer’s elbow or baseball elbow
2. Affects flexor-pronator muscles at origin, ant. to medial epicondyle
What are the sxs of medial epicondylitis?
1. Hx repetitive stress to joint
2. Tenderness medial epicondyle
3. Pain is reproduced by resisted pronation or flexion of wrist
When is imaging performed for medial epicondylitis?
Not indicated unless suspected ulnar nerve entrapment
What is the rx for medial epicondylitis?
1. Avoid aggravating activity
A. MOST IMPORTANT TREATMENT !
2. Elbow Compression strap
4. PT / OT
5. Steroid injection
Inflammation of the lining of the sheath that surrounds tendons
What is the etiology of tenosynovitis?
Define De Quervain’s Tenosynovitis. Who gets it?
1. Middle-aged women, new moms, grandmothers
2. Inflammation of synovial sheath surrounding tendons in addition to those tendons
A. The first dorsal compartment of the wrist includes the tendon sheath that encloses the abductor pollicis longus and the extensor pollicis brevis tendons at the lateral border of the anatomic snuffbox.
Define trigger finger. Who gets it?
1. Volar flexor tenosynovitis
2. Any finger, commonly, thumb or ring fingers
3. Most common
A. Middle-aged women
B. Diabetic pts
4. Locking of involved finger in flexion is followed by sudden release – “Trigger Finger”
A. Hand pain radiates to fingers
5. May require passive manipulation to re-gain extension
What are the sxs of De Quervain's tenosynovitis?
1. Hx repetitive pinching motion of thumb & fingers
A. Assembly line work
B. Driving in screws
2. Pain in radial aspect wrist
A. Worse w/ activity
B. Better w/ rest
3. Pain with PROM thumb
A. Finklestein's test
What is the treatment for De Quervain's tenosynovitis?
1. Thumb spica splint
3. Peritendinous lidocaine/corticosteroid injection
4. Refer to Orthopedics if conservative treatment fails
What are the volar flexor tenosynovitis sxs?
1. Tenderness @ proximal end of tendon sheath in distal palm
2. Catching of tendon when finger is flexed
How is volar flexor tenosynovitis treated?
2. Peritendinous lidocaine/corticosteroid injection
4. Refer to Orthopedics if conservative tx fails
bursal sac w/ small amounts synovial fluid that facilitate motion/reduces friction of muscles and tendons over bony prominences
What is the pathophys of bursitis?
Inflammation leads to excessive fluid production in bursal sac -> bursa becomes gritty and rough -> presses on sensory nerve endings -> painful and irritating to area
What are common types of bursitis?
A. popliteal bursitis/ Baker’s cyst
5. Prepatellar (most common)
A. “housemaid’s knee”
What is the etiology of bursitis?
1. Repetitive overuse injury
2. Often blunt trauma
3. Arthritic conditions
A. OA, RA, Gout
4. Infection (septic bursitis)
How is bursitis different from arthritis?
Bursitis is more likely than arthritis to cause focal tenderness and swelling and less likely to affect ROM of adjacent joint
What are the sxs of bursitis?
1. Focal tenderness & swelling over bursa
2. Site specific:
A. Subacromial bursitis – limited arm abduction
B. Prepatellar bursitis – pain when climbing stairs, knee flexion
C. Trochanteric bursitis – pain when climbing, squatting, crossing legs, lying on affected side
3. May have co-existing infection- more common:
How is subacromial bursitis treated?
1. Avoid repetitive reaching overhead and above shoulder level
3. +/- cortisone injection into subacromial space
How is olecranon bursitis treated?
1. R/O co-existing infection- septic olecranon bursitis
2. Avoid leaning on elbows
3. Compression wrap / Heelbo
What are the sxs of trochanteric bursitis?
1. Point tenderness
over greater trochanter
2. May radiate to lateral
knee down to ankle,
confused with sciatica
3. External snapping hip syndrome
What is the treatment for trochanteric bursitis?
1. Avoid lying on affected side
2. Iliotibial band stretching exercises
3. Foam roller
4. If exquisitely tender to palpate, responds excellent to lidocaine/cortisone injection into bursa (very painful injection for patient)
What is a "Baker's cyst"?
Not a real cyst;
What is the treatment for Baker's Cyst/Semimembranosus bursitis?
1. Tx underlying cause, usually OA of knee
3. +/- lidocaine/cortisone injection into knee joint
What is the treatment for prepatellar bursitis?
1. Avoid kneeling
3. Aspiration of bursal area NOT DONE
True/False: Imaging is always necessary for bursitis
False, imaging is NOT necessary