Understanding Soft Tissue Rheumatisms
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ScribdTranslationsUnderstanding Soft Tissue Rheumatisms
Translated by
ScribdTranslationsDEPARTMENTS OF RHEUMATISMS
BLANDAS
Dr. Veronica Lencina
SOFT TISSUE RHEUMATISMS
Group of conditions, characterized by
by:
Compromise structures
musculoskeletal (tendons,
ligaments, bursae, capsule, enthesis) that
surround the joint.
Frequent cause of consultation.
Benign
They remit over time, once
controlled the triggering factor
The doctor should be familiar with...
...with the anatomy of the affected segment.
...with the most common mechanisms of injury.
...with the physical demand generated by certain
activities.
...with the different therapeutic options, which
they will allow the patient's reintegration into their
daily activities.
ETIOLOGY
Traumatic processes, unique or repeated, that
they occur as a consequence of excessive use or
unaccustomed to a joint, either
in the work or sports level.
Diseases of the locomotor system, such as
rheumatoid arthritis, osteoarthritis, arthritis
crystalline.
ANATOMICAL CLASSIFICATION OF SOFT TISSUE RHEUMATISMS
SHOULDER KNEE
Rotator cuff tendinopathy anserine bursitis
Subacromial bursitis Pre- and infrapatellar bursitis
Adhesive capsulitis Patellar tendinitis
THORACIC WALL Popliteal cyst
CODO Costochondritis
Sdme de Tietze
Epicondylitis / Epitrochleitis
Nerve entrapment syndrome
cubital PIE
olecranon bursitis HIP AND PELVIS Achilles tendonitis
Painful SDME of the region Plantar fasciitis
trochanteric Infracalcaneal bursitis
HAND retrocalcaneal and retroachilles
Ileopectineal bursitis
Stenosing digital tenosynovitis Iliac bursitis Metatarsalgia
De Quervain's tenosynovitis Meralgia paresthetica Sesamoiditis
Dupuytren's disease Copeman's nodules Morton's neuroma
Carpal tunnel syndrome Saphenous tunnel of the tarsus
Bicipital Tendinitis
It usually occurs associated with rotator cuff injury.
glenohumeral instability or bicipital tendon subluxation.
Related to activities that generate repeated stress on the
tendon.
CC: pain in the anterior region of the shoulder, which may radiate towards
the lateral side of the arm, following the path of the biceps.
•EF: pain on palpation, thickened tendon, Yergason test, Sign of
Speed
•Dx: clinical, Ultrasound
Treatment: rest, NSAIDs, physical therapy, eventual infiltration.
Identify underlying causes.
Tendinopathy of the
Rotator Cuff
It is the most common cause of shoulder pain.
Tendinous commitment and occasionally, of the subacromial bursa.
Multifactorial causes: hyperactivity with repeated attraction of
muscle, presence of osteophytes, disruption of the glenoid capsule,
joint instability, crystals, etc, etc
CC: deep shoulder pain, often with nighttime exacerbations.
EF: pain on resisted mobility during abduction, external rotation and
internal. Weakness. Painful arch test.
•Dx: clinical, Ultrasound, MRI
Treatment: rest, NSAIDs, physiotherapy, possible infiltration. Identify
underlying causes. Exercises. Surgery.
Subacromial Bursitis
SUBACROMIAL BURSA:
limited below by the rotator cuff, above by the
acromion, coracoacromial ligament and deltoid, laterally
it extends beneath the deltoid, originating the bursa
subdeltoid
Bursa distension due to excess joint fluid.
Causes: trauma, degenerative changes, calcifications.
•EF: pain in the shoulder, which extends to the upper third of the arm with abduction. DIFFICULT TO
DIFFERENTIATE FROM SUPRASPINATUS TENDINITIS
•Dx: clinical, X-ray, ultrasound.
Treatment: rest, NSAIDs, physiotherapy, possible infiltration, exercises.
Adhesive Capsulitis
Shoulder periarthritis
Known as frozen shoulder.
PAIN AND RESTRICTION of shoulder joint movements
in all its planes.
Causes: idiopathic, secondary to systemic diseases (diabetes, thyroid diseases,
neoplasias, cervical radiculopathy), or be the final pathway of various
shoulder disorders.
EF: pain and resistance to active and passive mobility.
•Dx: clinical, X-ray (focal demineralization).
Treatment: relieve pain, reduce muscle spasms, restore
ROM. Anes, physiotherapy, possible infiltration. Treatment of underlying diseases.
Olecranon Bursitis
Superficial bursa.
Causes: microtraumas, infections, diseases
through crystals, inflammatory arthropathies.
EF: painless mass at the elbow apex
general related to trauma or pain
sharp with erythema and local heat, associated with
inflammatory diseases or infections.
•Dx: clinical, puncture and study of the fluid
synovial (crystals, bacteria).
Treatment: NSAIDs, antibiotics, eventual
infiltration.
Cubital nerve entrapment syndrome
At the level of the epitrochleoolecranean canal, below the arcuate ligament.
•Causes: external compressions, space-occupying lesions (synovitis,
ganglion, hematomas, nodules), anatomical variations (thickening
of the arcuate ligament).
EF: Pain, paresthesia in the ulnar region of the hand and forearm, atrophy in
advanced stages. Tinel's sign.
•Dx: clinical, EMG.
Treatment: NSAIDs. Decompressive surgery with proper rehabilitation
post-surgical, as recovery is slow.
The ulnar nerve can also be compressed at the Guyon's canal.
in the wrist due to various causes: ganglia, RA, OA.
Lateral epicondylitis
Tennis elbow.
Associated activities of daily living and manual work that
they demand the elbow and wrist. (Tendinosis due to overuse)
Commitment at the level of the insertion of the common extensor of the
fingers at the level of the epicondyle. Causes: microtraumas,
infections, crystal-related diseases, inflammatory arthropathies.
EF: pain in the epicondyle, of progressive intensity, that
radiates to the forearm and back of the hand. Pain caused to the
pressure of the epicondyle, or when resisting wrist extension.
•Dx: clinical. MRI/Echo.
Treatment: NSAIDs, rest, physiotherapy, exercises, eventual
infiltration.
Medial epicondylitis
Tendinopathy at the insertion site of
the flexor muscles of the wrist at the level
of the epitrochlea
EF: pain in the epitrochlea, which is
exacerbates when resisting wrist flexion
and the pronation of the forearm.
•Dx: clinical. MRI / Echo.
Treatment: NSAIDs, rest,
physiotherapy, exercises, occasional
infiltration.
De Quervain's Tendinitis
Tendinosis of the long abductor tendons and
short extensor of the thumb, as it passes through the
distal end of the radius.
Repetitive strain, manual tasks, AR, Aps.
EF: pain in the radial side of the wrist and at the base of
thumb (grip and strength), Finkelstein test.
•Dx: clinical / Echo.
Treatment: limit activity
desencadenante, Aines, hielo, fisioterapia,
eventual infiltration.
FLEXOR TENDON SYNOVITIS
Tendinopathy at the entrance site
tendon in the flexor digital sheath.
•2nd floor to repeated traumas, AR, APS,
DBT, amyloidosis, TBC, sarcoidosis.
•EF: trigger finger, thickening
nodular.
•Diagnosis: clinical. MRI / Echo.
Treatment: limit activity
desencadenante, hielo, eventual
infiltration.
Dupuytren's Disease
Nodular thickening of the palmar fascia
(fibrous cords). Palmar retraction and
digital contractures.
Family predisposition, epilepsy, alcoholism,
DBT, EPOC, DSR.
Clinical diagnosis.
•Tratamiento: fisioterapia, ejercicios, infiltración,
surgery.
Carpal tunnel
Nerve compression neuropathy
medium.
•Embarazo, endocrinopatías, DBT,ETC,
labor activities.
•EF: pain, paresthesias. Weakness and
gradual atrophy of the muscles of the
thenar eminence. Tinel's maneuver and
Phalen
•Dx: clinical, EMG.
•Treatment: triggering cause,
physiotherapy, valves, infiltration, surgery.
Trochanteric bursitis
Bursa located between the gluteus maximus and
trochanter.
Isolated presentation, scoliosis, OA,
difference in length of lower limbs, obesity.
deep pain / burning sensation.
Mechanic and when leaning on that side
•Dx: clinical. (Rx)
•Treatment: predisposing causes,
exercises, physiotherapy, eventual
infiltration.
Iliopectineal bursitis
Located between the anterior surface of the
hip joint and the psoas muscle
iliac.
•1st degree result of a trauma, or 2nd degree to
hip involvement: OA, RA, infections
Asymptomatic. Pain in the groin area.
cystic mass in the inguinal region.
•Diagnosis: clinical, ultrasound, CT, MRI.
Treatment: NSAIDs, rest, eventual
infiltration / surgery.
Meralgia Paresthetica
Compression of the femoral cutaneous nerve (L2-
L3). More frequent at the exit level of
the pelvis, behind the inguinal ligament,
half to the EIAS.
Predisposing factors: obesity,
pregnancy, DBT.
burning pain and paresthesia in
anterolateral region of the thigh.
•Dx: clinical, EMG.
Treatment: avoid associated facts,
physiotherapy, possible infiltration.
anserine bursitis
At the level of the tibial insertion of the
tendons of the sartorius and rectus muscles
internal and semitendinosus.
Associated factors: obesity, OA,
alignment alterations.
•EF: pain > with ambulation, when climbing
stairs. Pain in the inner region of
knee.
Clinical diagnosis.
Treatment: weight loss, NSAIDs,
rest, infiltration. Exercises.
Prepatellar and infrapatellar bursitis
•Bursas located between the portion
inferior of the patella and the ligament
labeling.
Associated with microtraumas
repeated, emphasis on crystal deposition,
inflammatory arthritis, infections.
•EF: dolor,tumefacción, flexión
painful.
•Dx: clinical, Eco. Aspirate synovial fluid
Treatment: NSAIDs, rest, ice.
Baker's cyst
Distension of the bursa that separates the
tendon of the semimembranous of the twin
internal, behind the femoral condyle
internal.
• Increase of joint fluid (AR,
OA, SPA, crystal art, etc)
asymptomatic or pain with swelling
of the popliteal fossa. Rupture
pseudophlebitis
•Dx: clinical, ultrasound.
•Treatment: treatment of the underlying disease,
eventual infiltration.
Tarsal Tunnel Syndrome
Entrapment neuropathy of
posterior tibial nerve, located
behind and below the malleolus
internal.
EF: pain and paresthesia in the face
inside of the fingers and sole of the
foot. Tinel maneuver.
•Dx: clinical, EMG.
Treatment: NSAIDs, ice,
physiotherapy, possible injection.
Achilles tendinitis
Associated with: repeated traumas
(sports), inadequate footwear, EASN
AR, gout, DLP, use of quinolones
EF: spontaneous pain or when walking.
dorsiflexion of the foot. Tendon
embossed.
•Diagnosis: clinical. Ultrasound. MRI
•Tratamiento: Aines, reposo,
physiotherapy, exercises.
Infiltration is not recommended.
Retrocalcaneal bursitis
Located behind the calcaneus and in front
of the Achilles tendon.
It can coexist with Achilles tendinitis.
EN SPA, drop, microtraumas.
EF: pain in heel, worsening with dorsiflexion
from the ankle. Swelling that surpasses the tendon.
•Diagnosis: clinical. Echo. MRI
Treatment: NSAIDs, rest, physiotherapy
exercises, eventual infiltration under guidance
ultrasound.
Retroachilles bursitis
Subcutaneous. Pain and swelling at the site that
corresponds to the shoe's sole. Erythema and
hyperkeratosis
Plantar fasciitis
Inflammation of the plantar fascia in its
insertion in the calcaneus.
Associated factors: obesity,
microtraumas, diseases
inflammatory.
•EF: heel pain when loading
weight.
•Dx: clinical. Ultrasound.
Treatment: modify factors
predisposing factors, rest, physiotherapy
exercises, possible infiltration.
Morton's interdigital neuroma
Interdigital nerve entrapment
(3rd-4th MT), under the ligament
transverse metatarsal.
Associated factors: alteration of the
biomechanics, inadequate footwear.
•EF: burning, paroxysmal pain,
anesthesia, paresthesias.
•Diagnosis: clinical. Ultrasound. MRI
Treatment: modify factors
predisposing factors, eventual infiltration.
Concepts for daily practice...
It is essential to understand the anatomy of the affected segment.
Question about the most common mechanisms of injury.
Síntomas: dolor mecánico, inflamación.
Dx: clinical, specific maneuvers. Ultrasound. MRI.
Tratamiento: AINEs, hielo, fisioterapia, infiltraciones, cirugía en
certain cases.