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PR3154 > IC15 Management of soft tissue injuries > Flashcards

IC15 Management of soft tissue injuries Flashcards

1
Q

What are the 2 types of joint pain?

A
  1. Articular
  2. Non-articular

Articular pain - pain from the joint
Articular pain is most painful at the joint line.

Non-articular pain - pain that is due to musculoskeletal
Pain is not at the joint. The pain on active movement and not passive movement.

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2
Q

A type of non-articular pain is periarticular pain.

Periarticular sources of pain originate in structures surrounding the joint.

What are these structures?

A
  1. Ligaments
  2. Tendons
  3. Muscles
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3
Q

What are the characteristics of soft tissue injuries?

A
  1. A consequence of chronic overuse / repetitive low-grade trauma
  2. Focal & non-systemic
  3. Self-limiting
  4. Responds to conservative measures / non-pharmacotherapy
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4
Q

What are some soft tissue injuries that require urgent referrals to the emergency department?

A
  1. Ligament rupture
  2. Infection-related causes
  3. Malignancy / metastasis
  4. Associated w lower back pain
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5
Q

What are the 3 main treatment goals for soft tissue disorders?

A
  1. Reduce pain
  2. Regain function
  3. Prevent future injury
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6
Q

Another type of treatment goal goes by the acronym RICERHARM.

What does RICERHARM represent?

A

R - rest
I - ice
C - compression
E - elevate
R - referral
H - no heat
A - no alcohol
R - no reinjury
M - no massage

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7
Q

If patient were to use ice for their injury, how should they go about doing it?

A

Patient should not put ice directly on the skin.

Wrap the ice around some cloth or plastic.

Ice the area for 10-15 mins. If it is still very painful, ice the area again.

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8
Q

What are the top 3 agents to use for pain relief in non-lower back pain?

A

For acute non-lower back pain:
1. PO paracetamol (not as effective)
2. Topical NSAIDs
3. Oral NSAIDs

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9
Q

What are the pros and cons of topical and oral NSAIDs?

A

Topical NSAIDs:
- (Pros) Fewer side effects as compared to oral NSAIDs
- (Cons) Unable to reach deeper regions

Oral NSAIDs:
- (Pros) Able to reach deeper regions - e.g hip injury.
- (Cons) Has more side effects

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10
Q

What are the 4 common types of soft tissue injury that we learnt in this IC?

A
  1. Sprain
  2. Tendonitis
  3. Bursitis
  4. Plantar fasciitis
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11
Q

What are the definition of the 4 soft tissue injuries?

  1. Sprain
  2. Tendonitis
  3. Bursitis
  4. Plantar fasciitis
A
  1. Sprain - 3 types of sprains –> (1)stretching, (2)partial rupture, (3)complete rupture of ligament (bone-to-bone connective tissue)
  2. Tendonitis - inflammation of tendonitis (muscle-to-bone connective tissue)
  3. Bursitis - inflammation of bursae (fluid filled sacs around joints that cushion tendons / muscles from adjacent bones)
  4. Plantar fasciitis - inflammation of plantar fascia (fibrous attachment connecting heel bone to base of toes)
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12
Q

What is the most common type of sprain?

A

Lateral ankle sprain.
- Can be inversion or eversion of foot

Sprain is an injury involving ligaments.

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13
Q

What are 2 risk factors of sprain?

A
  1. Adult females > males
  2. Children & adolescents > adults
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14
Q

There are 3 grades of sprains - Grade I, Grade II, Grade III.

What is the severity of the injury that each grade represents?

A

Grade 1 - mild stretching of the ligament

Grade 2 - Incomplete tear of the ligament

Grade 3 - Complete tear of the ligament

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15
Q

What is the main characteristic of a Grade 3 tear?

A

Cannot bear body weight or move

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16
Q

What is tendonitis and what causes it?

A

Tendonitis - inflammation of the tendon.

It is often caused by:
- Overuse of the tendon (most common)
- Injury
- Drug induced (e.g fluoroquinolones, statins)

17
Q

Where are the common sites for tendonitis?

A
  1. Shoulders
  2. Elbows
  3. Ankles
18
Q

What is the best treatment for tendonitis?

A

Rest.

Other treatment can be topical or oral anti-inflammatory NSAIDs.

19
Q

What is bursitis and what causes it?

A

Bursitis - the inflammation of the bursa

Causes of acute bursitis are:
- Trauma / injury
- Gout
- Infection

Causes of chronic bursitis:
- Overuse
- Prolonged pressure
- Inflammatory arthritis (e.g rheumatoid arthritis)

20
Q

What are telltale signs of bursitis?

A

Pain and pressure arises when joints are bent, resulting in compression of the bursae.

21
Q

What is plantar fasciitis and what causes it?

A

Plantar fasciitis - inflammation of plantar fascia

Causes of plantar fasciitis:
- Prolonged standing, jumping, running on hard surfaces
- Flat feet / high arched feet

22
Q

What are the signs & symptoms of plantar fasciitis?

A
  1. Pain worsens when walking / running
  2. Pain lessens w increased activity, but worsens at the end of the day
23
Q

What are the red flags of plantar fasciitis?

A
  1. Numbness & pins and needles
  2. Nocturnal pain
  3. Trauma
  4. Fever
  5. Constant pain
  6. Sudden onset
  7. History of inflammatory condition
  8. Erythema
24
Q

What is adhesive capsulitis (aka frozen shoulder)?

A

Adhesive capsulitis - an inflammatory condition characterized by shoulder stiffness, pain, and significant loss of passive range of motion.

25
Q

What are the risk factors of adhesive capsulitis?

A
  1. 50+ years old
  2. DM
  3. Hypothyroidism
  4. Dyslipidaemia
  5. Prolonged immobilization
26
Q

What are the S&S of adhesive capsulitis?

A
  1. Unilateral
  2. Reduced function of the shoulders (e.g cannot put on shirt)
  3. Self-limiting
    - Worse at night
    - Stiffness & severe loss of shoulder motion
27
Q

What are the red flags of adhesive capsulitis?

A
  1. Systemic symptoms of infection
  2. Malignancy
  3. Associated chronic illness
28
Q

What is the treatment for adhesive capsulitis?

A
  1. Paracetamol / NSAIDs / Weak opioids
  2. Range of motion exercises
29
Q

Majority of lower back pain are non-specific and self-limiting strains.

What are the red flags to look for in lower back pain?

A

Red flags of lower back pain are:
- Chronic pain
- Worse at night
- Unintended weight loss
- History of previous malignancy

30
Q

Which causes of lower back pain requires referral?

A
  1. Herniated disc
  2. Osteoporotic fractures
  3. Malignancy / metastatic cancer
  4. Infection
31
Q

What are the treatments for:
- Acute & subacute lower back pain?
- Chronic lower back pain?

A

Acute & subacute lower back pain:
- Heat therapy + NSAIDs

Chronic lower back pain:
- Exercise + NSAIDs

32
Q

What are some counselling points for pt w lower back pain?

A
  1. Do low-impact core strengthening exercises
  2. Use correct lifting & moving techniques
  3. Maintain correct posture when sitting/standing
  4. Quit smoking
  5. Reduce stress
  6. Maintain healthy weight
33
Q

What are some S&S of Statin Associated Muscle Symptoms (SAMS)?

A
  1. Onset can occur at anytime
  2. Muscles weakness
  3. Nocturnal cramping, stiffness, tendon pain, fatigue & tiredness
34
Q

When would you consider discontinuing statins in SAMS?

A
  1. When Sx becomes intolerable
  2. CK > 10x ULN
35
Q

Summary on when you need to refer for the following conditions:

  1. Sprains
  2. Tendonitis
  3. Bursitis
  4. Plantar fasciitis
  5. Adhesive capsulitis
A
  1. Sprains
    - Cannot bear weight
    - Loss of motion/function
    - Significant instability
  2. Tendonitis
    - Pain for days or weeks
  3. Bursitis
    - Acute onset
    - Severe pain
    - Prior trauma
    - PMH of inflammatory conditions
  4. Plantar fasciitis
    - Acute onset
    - Severe pain
    - Prior trauma
    - Fever
    - PMH of inflammatory conditions
  5. Adhesive capsulitis
    - decrease in range of motion
    - Fever
    - PMH of malignancy
    - Trauma / history of fractures
    - Neurological sx (e.g pins & needles, muscle weakness, loss of bowel & urine function)

PR3154 (19 decks)

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