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3154 MSK > soft tissue injury > Flashcards

soft tissue injury Flashcards

(47 cards)

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1
Q

articular joint pain

A

gout, RA, OA, bone

  • Relate to joint structure, pain at joint line when palpate
  • Pain on both active and passive movement
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2
Q

non articular joint pain

A

□ Ligaments, tendons, muscles
□ Features:
* On palpation: paint near joint, (maximal tenderness)
* Pain on active movement > passive
* Pain maximal at certain lines of muscle pull

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3
Q

causes of articular joint pain

A

1) visceral pain (pancreatitis, gallstone, kidney, UTI)
2) tissue pain (DVT, ischemia, infection)
3) neuropathic pain (nerves, prolapsed intervertebral disc)
4) bone pain (fracture, trauma)

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4
Q

features of soft tissue injury (self-limiting)

A

□ Consequences of chronic repetitive low-grade trauma/ overuse
- Microtear, microinflamm (may not be visible to eye)
□ Focal and non-systemic (can point to location)
□ Self-limiting (can heal by itself)
□ Conversative measures (RICE, supportive)

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5
Q

urgent referral for soft tissue injury

A

□ Fractures
□ Ligament rupture
□ Infection-related causes (prevent sepsis, spread of damage)
□ Malignancy/ metastasis (lower back pain, esp for prior hx)
□ Relate to underlying visceral conditions (lower back pain)

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6
Q

tx management

A

1) non pharm RICE
2) pain relief (TOP -> PO NSAIDS/ paracetamol, CS)
* avoid opioids

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7
Q

tx goal

A
  • reduce pain
  • reduce freq
  • prevent future injury
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8
Q

types of non-articular soft tissue injury

A
  • ligament
  • tendon
  • bursae
  • fascia
  • muscle
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9
Q

sprain pathophysiology

A
  • ligament (Bone-bone connective tissue)
  • stretch/ partial/ complete rupture
  • ***anterior talofibular ligament

(may affect 1st, 2nd ligaments which cause significant ankle instability)

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10
Q

features of sprain

A

○ Sudden onset of pain and swell after POP sound
○ Swell, tenderness

○ II, III: ecchymosis (bruise)
○ III: cannot bear weight or ambulate (loss of motion and function, unable to limp)

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11
Q

cause of sprain

A
  • sport
  • inversion of foot (land on the outer part of feet)
  • child, adol > adults
  • F > M
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12
Q

tx of sprain

A
  • protect
  • rice
  • PO pharmacotherpay

III: refer to ER

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13
Q

tendonitis pathophysiology

A

tendon connects bone and muscle
inflammation, irritation

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14
Q

tendinopathy disease progression

A

(tendonitis / inflam–> rupture –> tendinosis/ degen)

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15
Q

features of tendonitis

A
  • Local pain
  • Dysfunction
  • Inflamm –> Degeneration
  • Pain in particular direction and pull (When tendon stretched )
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16
Q

common sites of tendonitis

A
  • Shoulder: rotator cuff tendinopathy
  • Elbow
    ○ Outside: Tennis
    ○ Inside: Golfer’s
  • Wrist
    ○ Flexor carpi radialis/ ulnaris tendinitis
  • Hip (lateral)
    ○ Gluteus medius/ minimus tendinopathy
  • Ankle
    ○ Achilles tendinopathy (jumping sports/ running over hilly terrain)
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17
Q

tendonitis causes

A
  • Overuse, overload
  • Sports injury
  • Inflamm rheumatic disease
    ○ FH, PMH, recurrence
  • Ca apatite deposition (metabolic disturbances)
  • Drug induced — FQ, statins (myalgia)
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18
Q

bursitis pathophysiology

A

inflamm of bursae (Fluid-filled sacs around joints that cushions tendons/ muscles from adj bones)

Lined by synovial mem in clefts b. mobile structures

  • Pain occurs when motion compresses adj bursa to point where intrabursal P. icnr
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19
Q

features of bursitis (acute vs chronic)

Study These Flashcards
A

Acute bursitis
○ Pain when joints fully flexed
○ Active & passive
Chronic bursitis
○ More swelling, thickening
○ Minimal pain (hardened)
○ 2* changes of contracture muscle atrophy – immobility

20
Q

causes of bursitis

Study These Flashcards
A
  • Trauma/ injury
  • Crystal-induced process (gouty bursitis)
  • Infection (septic bursitis)
  • Overuse
  • Prolonged pressure —– Kneel/ lean on hard surface
  • Inflam arthritis ——– RA, spondylarthritis (spine)
21
Q

tx of bursitis

Study These Flashcards
A
  • Superficial (cushions skin & bone)
    = TOPICAL NSAID
  • Deep (reduce friction of muscles as they glide over each other/ bone prominences)
    = Intrabursal glucocorticoid
22
Q

superficial joint

Study These Flashcards
A
  • Olecranon (elbow)
  • Prepatellar (knee cap)
  • Ischial (post upper thigh region b. gluteus maximus & ischial tuberosity)
23
Q

deep joint

Study These Flashcards
A

Trochanteric (hip)
Subacromial (shoulder)

24
Q

plantar fasciitis pathophysiology

Study These Flashcards
A

inflamm of fasciitis (Fibrous attachment connecting heel bone to base of toes)

heel pain – Incr stress on plantar fascia (pressure, inflamm)

25
features of plantar fasciitis
* Pain worse when walk/ run (esp after period of inactivity) * Pain lessens with incr activity. Worse at END OF DAY (prolonged weight-bearing)
26
causes of plantar fasciitis
* Prolonged standing/ jumping/ running hard surfaces * Flat feet/ high arched feet * Tight hamstring (warmup) * Decr knee extension * Incr load of forefoot * Incr stress on fascia * Reduced ankle dorsiflexion (calf muscle/ ankle injury??) * Obesity * Lower SES, impaired physical/ mental health * Systemic rheumatic diseases
27
shoulder pain pathophysiology
Not fully understood (refer if MARKED loss of motion) affects adhesive capsulitis Involve stiffness and pain in shoulder joint
28
shoulder pain features
* Non-dominant side, but other side may be affected within 5yrs * Limited reaching overhead, to side, across chest + limited rotation - Reduced function: unable to scratch back, put on coat, unhook bra
29
progression shoulder pain
Initial (2-9mnths) ○ Severe disabling shoulder pain ○ Worse at night ○ Incr stiffness Intermediate (4-12mnths) ○ Stiffness & severe loss of shoulder motion ○ Pain gradually lessen Recovery (5-24mnths) ○ Gradual return of range of motion 5yrs: bilateral
30
causes of shoulder pain
* Idiopathic or 2nd to shoulder injuries * Assoc w/: * Presence of DM * Hypothyroidism * Dyslipidemia * Prolonged immobilisation
31
tx of shoulder pain
* Analgesics for pain * Paracetamol, NSAIDs, weak opioids * Range of motion exercises * Intraarticular glucocorticoids (deep) * Physical therapy (consistent exercises)
32
lower back pain pathophysiology
Lumbar, sacral region strain
33
lower back pain features
Non-specific, self-limiting "strain" ep (10-14 days) Presence (or absence) of radicular sx -- neuro * Lower extremity pain, paresthesia * Weakness * Nerve root impingement
34
duration of lower back pain
Acute: <4wks refer for further investigation if no improvement Subacute: 4-12wks Chronic: >12
35
differential dx of lower back pain
1) Mechanical ○ Lumbar strain ○ Degenerative disease (OA) ○ Spondylolisthesis ○ Herniated disc (Spinal cord/ cauda equina compression) ○ Spinal stenosis ○ Osteoporosis ○ Fractures 2) Nonmechanical ○ Malignancy ○ Infection (TB/ Osteomyelitis, septic discitis, paraspinous abscess, epidural abscess) 3) Visceral disease ○ Pelvic organs, renal disease, aortic aneurysm, GI disease
36
tx for acute and subacute lower back pain
Non-pharm + NSAID/ SMR (skeletal muscle relaxant) ○ ANAREX: orphenadrine (muscle relaxant) ○exercise ○HEAT
37
tx for chronic LBP
- Non-pharm exercise - NSAID - Tramadol/ duloxetine
38
general counselling for LBP
* Improvement in pain & function from tx may be small * Reassure acute/ subacute is self-limiting * Remain active as tolerated * Avoid potential harmful & costly tests and tx * Heat, massage (caution) * Engage in low-impact core strengthening exercises to improve spine stability ○ Swim, stat. bike, brisk walk * Correct lifting and moving techniques ○ Squat to lift (X bend and lift) ○ Get help * Maintain correct posture when sit/ stand * Quit smoking ○ Risk for atherosclerosis can harden arteries, cause low back pain * Avoid stressful situations ○ Muscle tensions * Maintain healthy weight ○ Reduce strain on lower back
39
myalgia features
Myalgia = muscle pain, soreness, stiffness Myopathy = muscle disease Myositis = muscle inflamm can be diffused vs focal
40
differential for myalgia
* Infection ○ Viral: dengue, influenza, COVID-19 * Noninflamm pain syndrome (fibromyalgia) * Medications ○ Ciprofloxacin (FQ) ○ Bisphosphonates ○ Aromatase inhibitors
41
urgent myalgia
1) infection-related (endocarditis, sepsis) * diffuse, fever, chills, tired 2) med toxicity * statin-induced rhabdomyolysis * muscle pain, weak -- proximal * myoglobinuria, nocturnal cramp, stiff
42
tx for statin induced
□ Anytime (most within 6mnths □ Tx: discontinue if intolerable sx/ CK >10x ULN * Large amt of fluids for RENAL excretion of myoglobin (prevent renal failure) * Resolve DDI * Restart at lower dose/ alt day dose * Switch to pravastatin, fluvastatin
43
tx for overuse myalgia
Acute - RICE - Topical NSAIDs Prevention - Proper warm up before exercise
44
shoulder pain
tendonitis (rotator cuff), biceps tendonitis * refer pain > days/ wks frozen shoulder (adhesive capsulitis) * marked decr in range of motion/ function * fever, PMH malignancy, trauma
45
elbow pain
tendonitis (lateral OUT- tennis/ medial IN - golf) bursitis (olecranon) * acute onset, pain, trauma, fever, PMH inflam dx
46
knee
sprain (ACL) tendonitis (patella/ quadriceps)
47
ankle/ heel
sprain (lateral ankle sprain) * cannot bear weight, loss of motion/ function, sig instablity tendonitis (Achilles) fasciitis (plantar) * acute onset, pain, trauma, fever, PMH inflam dx

3154 MSK (9 decks)

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