Regional Periarticular Pain Flashcards

Question

what patient population is most commonly affected by trigger finger

Answer 1

women over 40

Answer 2

RA | Diabetes

Answer 3

Look – potential flexion at PIP/DIP joint Feel – can feel triggering of the tendon if finger placed on palm whilst patient flexes finger, a nodule may also be felt at the base of the finger Move – jerky/hesitant extension/flexion of the finger No test

Answer 4

``` Conservative Usually resolves spontaneously Activity modification NSAIDS Tendon sheath corticosteroid injection ``` Surgical Release of the A1 pulley Most proximal insertion of the flexor tendon Tenosynovetomy in RA patients (Excision of the tendon sheath of the wrist)

Answer 5

Painless progressive thickening of the palmar fascia causing flexion deformity and functional interference usually little and ring finger contracted

Answer 6

M>F Nordic race Fhx Trauma Diabetes Cirrhosis Phenytoin Alcoholism

Answer 7

Conservative No impairment = do nothing ``` Surgical Needle aponeurotomy Enzymatic fasciotomy Fasciotomy Fasciectomy Dermofasciectomy ```

Answer 8

pain on pinching/gripping + swelling/deformity of CMCJs

Answer 9

Conservative – as for any OA patient ``` Surgical Denervation Trapeziectomy Basal thumb arthroplasty Joint fusion ```

Answer 10

medial epicondylitis - tendinopathy of the common flexor-pronator origin

Answer 11

pain on resisted flexion of the hand

Answer 12

Subacute pain occuring from weeks to months, with exacerbation on use and relief on rest Pain can be very severe, and radiate up and down the arm – especially when flexor/pronator muscles are in use, such as carrying a tray On examination – tenderness around medial epicondyle and pain triggered by resisted flexion of the hand Normal range of movements, and no neurological symptoms (tingling/numbness) - otherwise suspect cubital tunnel syndrome

Answer 13

Simple analgesia and activity modification (NSAIDS + rest) Physiotherapy referral (strengthening exercises) Epicondylar clasp If all of these are unsuccessful – X-ray the joint to make sure it isnt OA Surgical option - golfers elbow release (80% success)

Answer 14

lateral epicondylitis - inflammation of the common extensor origin

Answer 15

Obesity Smoking Carpal tunnel syndrome and other tendinopathies Repetitive gripping/grasping movements

Answer 16

pain on resisted wrist extension

Answer 17

Simple analgesia and activity modification (NSAIDS + rest) Physiotherapy referral (strengthening exercises) Epicondylar clasp If all of these are unsuccessful – X-ray the joint to make sure it isnt OA Surgical option - tennis elbow release (80% success)

Answer 18

PAINLESS enlargening of the bursa due to increased use

Answer 19

articular pathology = more global symptoms

Answer 20

Pain in shoulder, characteristically worse at night and when elevating/abducting the arm Tenderness below anterior edge of acromion Painful arc at 60-120 degrees Less pain when passively abducted Power is normal despite pain – separates it from a tear

Answer 21

NSAID analgesia Corticosteroid injections + physio if severe If that fails to control symptoms Arthroscopic decompression of the rotator cuff can take place This is the excision of the coraco-acromial ligament and any osteophytes

Answer 22

Sprain of shoulder Limited abduction after the event O.E Tenderness over acromion Arm may be lifted above shoulder and held there by deltoid, but as soon as it lowers it drops (abduction paradox)

Answer 23

as partial tears regain abduction movement once the pain has been abolished whereas full tears cannot move thee arm properly

Answer 24

Local anaesthetic Heat Exercises Longer term treatment After 3 weeks the extent of the rupture can be assessed Complete tears in young are usually surgically repaired Partial tears are conservatively treated to allow natural healing

Answer 25

increasing stiffness of the shoulder

Answer 26

Initial progressive deep pain that stops the patient sleeping on their side Starts to subside after a few months Then increasing stiffness over 6-12 months Resolution after about 18 months

Answer 27

limited external rotation

Answer 28

Reassurance - resolves in 18 months NSAIDS Intra-articular steroid injections

Answer 29

burning pain worse when lifting arm over head stiffness when abducting arm

Answer 30

mainly clinical but MRI/USS used to rule out tendon rupture/rotator cuff tears

Answer 31

Dependent on mechanism – trauma (days-weeks) usually heals sooner than overuse injuries (several weeks)

Answer 32

Non-surgical NSAIDS Avoid exacerbating movements

Answer 33

Impingement due to articular causes leads to pain in both active and passive movements Impingement due to peri-articular causes leads to less pain in passive movements – as the muscle (which is the issue) isn't contracting as much)

Answer 34

inflammation of the bursa between the greater trochanter and the fascia lata, caused by acute or repetitive trauma

Answer 35

Hip pain radiating down lateral aspect of thigh to knee Worse at night/with use or when lying on affected side Point tendernesss when palpating the greater trochanter Simple test is to get them to adduct a slightly flexed leg at the hip and knee over the midline to the other side, tightening the fascia lata over the inflamed bursa causing more pain

Answer 36

Corticosteroid injection If patient is presenting after a total hip replacement injections should be done in a laminar flow theatre Physio After initial presentation and injection if they don’t work Involves stretching fascia lata 2/3 improve with this regimen Rarely, refractory disease leads to surgical relief of the fascia lata and excision of the bursa

Answer 37

Traction injury of patellar ligament on the growth plate, leading to a prominent and tender tibial tuberosity

Answer 38

common in active adolescents

Answer 39

Recovery is spontaneous and takes time (few weeks to months), restriction of activity is wise

Answer 40

twisting on a flexed weight-bearing knee

Answer 41

Variable immediate pain, followed by swelling hours later Swelling subsides with rest but may recur with trivial injury The loose tag of meniscus from the tear may get into the intercondylar notch, causing mechanical irritation leading to these symptoms (Locking of the knee, Spontaneous giving way) O.E Effusion, swelling with fixed leg deformity and medial joint line tenderness

Answer 42

X-ray Lateral, AP and skyline essential Will be normal – but required to exclude fractures/OA MRI Mainstay of imagine Picks up 90% of tears

Answer 43

Arthroscopic repair is reccomended if tolerated Repair is especially important as small avascular tears may propagate a secondary arthritis Tears in vascular zone are amenable to repair Avascular zone repair surgery tends to be a partial meniscectomy to prevent mechanical symptoms Full meniscectomy avoided due to high risk of secondary OA In degenerative tears secondary to OA, treating conservatively is appropriate due to poor response to debridement

Answer 44

swelling within the first hour

Answer 45

No firm stop point, only a soft one as the soft tissues stop the force Partial tears do not give increased mobility, but give pain on testing For ACL pathology, lachmans test is much more sensitive than the anterior draw test

Answer 46

X-ray Lateral, AP, skyline Shows displacement, fractures and any OA MRI Gold standard diagnosis Diagnostic arthroscopy Required if there is clinical ACL dysfunction but MRI is normal

Answer 47

Diagnostic arthroscopy | Required if there is clinical ACL dysfunction but MRI is normal

Answer 48

Conservative Sprains/partial tears will heal with physiotherapy Adhesions will complicate this process if the joint is rested so active movement with a brace is encouraged Prolonged physio and patient education about activity limitation can be used in older patients, or patients with a low physical requirement Always initial option for treatment unless there is multi-ligament pathology ``` Surgery ACL Arthroscopic tendon graft repair Hamstring or semitendinosus tendon used as graft Graft secured by two bone screws ```

Answer 49

prepatellar bursitis

Answer 50

infrapatellar bursitis

Answer 51

excessive unaccustomed kneeling

Answer 52

anterior knee pain and fluctuant knee swelling

Answer 53

Avoid kneeling Corticosteroid Injections for troublesome symptoms

Answer 54

Pain and a bursa in the insertion of the MCL into the upper tibia Pain worse on standing/stressing MCL

Answer 55

obesity breast stroke swimmers

Answer 56

Physio Corticosteroid injection

Answer 57

Bursa between semimembranous and gastrocnemius becomes enlarged, presenting as a painless bump on the back of the knee

Answer 58

Bulging of the posterior capsule of the knee with synovial herniation leading to a swelling In the popliteal fossa

Answer 59

if non ruptured aspiration and injection of corticosteroid

Answer 60

inflammation of the insertion of the plantar fascia tendon in the calcaneum causing midline pain on walking/standing

Answer 61

Reduced walking Heel pads Splinting of foot in dorsiflexed position to stretch tendon

Answer 62

tends spontaneously recovers ina year once treatment is done

Answer 63

pressure induced bursa in the heel often due to tight shoes

Answer 64

pressing heel pads causes pain pain on walking/standing

Answer 65

Raising shoe heel to reduce pain Low pressure corticosteroid injection near enthesis

Answer 66

Abnormal neuroinflammatory response to trauma Commonly occurs after surgery

Answer 67

Allodynia Persistent pain in area affected Stiffness Swelling Abnormal hair/nail changes

Answer 68

Pain team Psychologist Physiotherapy Focus is preventing such syndromes at the time of injury with adequate analgesia and immbolisation

Regional Periarticular Pain Flashcards

(97 cards)