Applied Rheumatology Made Simple (A.R.M.S.)
(Part 3)
CAUSES OF SOFT TISSUE RHEUMATISM
What are the causes of soft tissue rheumatism? Studies show that the following are the causes of soft tissue rheumatism: Overuse or injury, Incorrect posture, Structural abnormalities e.g. polio, scoliosis, associated with arthritides e.g. RA, gout, OA occasionally from an infection and very often unknown.
According to the study, there are several causes of soft tissue rheumatism. Discerning the exact cause instances, does not usually alter treatment decisions – except in cases of infection, or rare instances, and does not usually alter treatment decisions – except in cases of infection, or rare instance of malignancy.
Stenosing tenosynovitis or “trigger finger” involves inflammation of the sheaths of the flexor digitorum tendons. This is frequently seen in those who tend to overuse their hands, or in conjunction with osteoarthritis or rheumatoid arthritis of the hands.
De Quervain’s tenosynovitis involves the abductor pollicis longus and extensor pollicis brevis. This frequently results from repetitive activity of the thumb and wrist. A positive Finkelstein’s test is a characteristic.
What we call as the carpal tunnel syndrome, is the most common cause of paresthesias in the hands, involving compression of the median nerve through the osseous fibrous carpal tunnel. A positive Tinel’s or Phalen’s sign may be present, with reproduction of the symptoms of numbness or paresthesias along the median nerve distribution – consistently sparing the 5th finger. This condition may occur more commonly during pregnancy, in those with underlying endocrine disorders, or systemic rheumatic diseases.
Lateral epicondylitis or “tennis elbow”, is a common condition in those who overuse their arms e.g. lifting heavy objects. Localized tenderness over the lateral epicondyle is a hallmark. The equivalent of this at the medial aspect of the elbow is called medial epicondylitis or “golfer’s elbow’:
Shoulder pain is a common musculoskeletal complaint. True arthritis of the shoulder is rare, and shoulder pain is most likely due to involvement of any of the numerous structures surrounding the glenohumeral joint.
SHOULDER PAIN SYNDROMES
• Impingement syndrome (rotator cuff tendonitis)
• Subacromial tendonitis
• Bicipital tendonitis
• Myofascial pain
Terminologies for soft tissue rheumatism involving the shoulder include the following: impingement syndrome or rotator cuff tendonitis, subacromial tendonitis, bicipital tendonitis, myofascial pain, among others. Frequently, multiple conditions may be present in the same shoulder.
This shoulder radiograph illustrates a calcific line of density (calcific bursitis) sometimes seen in chronic shoulder problems. Except in rare instances e.g. suspicious infection or malignancy, a shoulder x-ray may not be necessary in the usual patient with shoulder complaints.
Although common, trochanteric bursitis is frequently undiagnosed. characteristic is the point tenderness–, over the trochanteric area. Associated conditions include OA of the lumbar spine or hip, and scoliosis.
Several soft tissue structures surrounding the knee joint are potential sources of pain. Tendinitis and bursitis are commonly seen in association with knee OA, or other underlying arthritides such as RA. Examples include popliteal or “Baker’s” cysts, anserine bursitis, and prepatellar bursitis or “housemaid’s knee”. Sometimes, it becomes important to rule out an infection especially when marked signs of inflammation e.g. warmth and redness are present.
Ankle and foot pain syndromes usually result from trauma, being overweight, athletic overactivity, or improperly fitting shoes. Overt swelling may or may not be present.
ANKLE and FOOT PAIN SYNDROMES
• Achilles tendonitis
• Calcaneal bursitis
• Plantar fasciitis
These are some terminologies for localized ankle and foot pain syndromes. Calcaneal bursitis commonly presents as) heel pain on initial steps in the morning.