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Flashcards in Regional Pain syndromes and psychology Deck (38)
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1

Wrist tendon problems (6)

Flexor tenosynovitis Trigger finger/thumb
De Quervains tenosynovitis Dorsal Tenosynovitis
Tendon ganglion Dupuytren's contracture

2

Flexor tenosynovitis

Tendon sheath inflammation causing stiffness or pain
--> leads to thickening of the the tendon sheaths in the palm

3

Trigger finger/thumb

Can occur spontaneously or be linked to RA or diabetes (F>M)
Palpable nodule which moves with flexor tendon
Will present with local pain or 'triggering' - snapping or locking of the digit (most commonly thumb, middle or ring finger)

4

De Quervains tenosynovitis

Pain around the radial styloid related to overuse -- local swelling and tenderness of the abductor pollicis longus & extensor pollicis brevis -- more common in women -- treat with activity alterations, splinting and steroid injections

5

Dorsal Tenosynositis

Extensor tendon sheath inflammation -- similar to Flexor tenosynovitis

6

Tendon ganglion

A bulge, tear or cyst in the synovial joint or tendon lining - often asymptomatic and often resolve spontaneously. Most common on the dorsum of the hand, (1:3/M:F)

7

Dupuytren's contracture

Painless thickening of the palmar aponeurosis -- can be caused by a number of conditions
Pulling one or more fingers into flexion

8

Nodal osteoarthritis

Rare before the age of 45yrs -- OA of the 1st CMC joint ('square hand') and heberden's and Bouchard's nodes

9

Carpal tunnel syndrome (7)

Commonest cause of nocturnal hand pain -- pain, swelling, paraesthesia, dysaethesia & weakness in the median nerve distribution (thenar wasting)
Causes: Flexor tenosynovitis, RA, oedema, pregnancy
Commonest in middle aged women
treat --> surgery, splinting, steroid injections
Positive Tinels, phalen's and reverse phalen's signs

10

Raynaud's phenomenon

Vasospastic digital arteries -- can be primary or secondary
Very common in young women

11

Mechanical neck pain

Acute spasms of neck muscles are common -- link to bad posture -- degenerative changes are only painful when very severe

12

Whiplash

Front, side or rear collisions in an RTA -- develops hours/days after the injury
Investigations are normal but significant ROM

13

Neck pain

Common and usually mechanical --
Inflammatory --cervical spondylosis - osteophytes can cause root pressure and myelopathy
Traumatic (whiplash, occupational, assault)
Rare - infection, tumours, referred pain (heart disease)

14

Shoulder pain

Usually soft tissue (capsulitis, rotator cuff) not articular
Can be referred, commonly from the neck or rarely from chest/abdomen (shoulder tip pain from peritonitis)

15

Conditions which refer to the shoulder

Cervical spondylosis (30-50yrs) or lung tumours, subphrenic abscesses or peritonitis

16

Articular lesions of the shoulder

Glenohumeral instability (under 30yrs)
Inflammatory arthritis (30yrs plus)
Glenohumeral OA or polymyalgia (over 50yrs)

17

Soft tissue disorders of the shoulder

Rotator cuff tendinitis (under 30yrs)
Capsulitis & calcific rotator cuff tendinitis (30-50yrs)
Rotator cuff tears (over 50yrs)

18

Rotator cuff diseases

Tendinitis -- painful arc of abduction, passive movement is full and pain free
Calcific tendinitis -- detectable calcification of usually the supraspinatus tendon
Tears -- Occur spontaneously in elderly or traumatically in young, associated with immediate loss of active abduction

19

Frozen shoulder (adhesive capsulitis)

Initially pain which resolves leaving global movement restriction -- usually resolves within 1-2yrs

20

Shoulder impingement

Humeral head impinges on ACJ due to loss of supraspinatus or ACJ osteophytes

21

Management of shoulder injuries (5)

MRI if needed
Analgesia, physiotherapy
Steroid injections and surgery if unresolved

22

Elbow pain

Can be referred from the shoulder or neck
Can be affected by arthritidies but rarely
Common disorders are Lateral and medial epicondylitis and olecranon bursitis

23

Diabetic stiff hand

Stiff painful hand in diabetic patient
Positive prayer sign

24

Chronic pain syndromes

Chronic widespread pain (CWP or fibromyalgia)
Chronic fatigue syndrome (CFS or ME)
TMJ dysfunction syndrome
Chronic regional pain syndrome type 1(sympathetic reflex dystrophy) Chronic (or work related) upper-limb pain syndrome (RSI)

25

Chronic widespread pain (fibromyalgia)

A diagnosis of exclusion when there is >3months pain above and below the waist --> Diagnosed by tender trigger points --> effects middle aged people (F>M) who often still work (1-11% incidence)
Impacts sleep and interpersonal relations

26

Clinical Features of Chronic widespread pain (fibromyalgia)

Widespread, unremitting and acting discomfort --> very commonly co-exists with IBS, CFS, tension headaches, PMS, anxiety and depression --> tests will be normal and this may further frustrate the patient

27

Cause of Chronic widespread pain (fibromyalgia)

Certainly there is a psychological element and the beliefs and coping strategies the pt develops to deal with their pain are important --> can be considered a pain amplification syndrome due to changes in the descending inhibitory pathways in spinal cord
Should be considered within a biopsychosocial model

28

Treatment of Chronic widespread pain (fibromyalgia)

Sympathetic and supportive approach must be taken -->pts should be reassured the pain often improves.
Graded aerobic exercise regimen is safe and effective
Psychological help is often useful but the use of addictive anxiolytics should be avoided

29

Medication for Chronic widespread pain (fibromyalgia)

NSAIDs can help but should only be used intermittently
Gabapentin and preglabalin useful but risk of drowiness
Low-doses of sedatives antidepressants (amitriptyline or dosulepin) are helpful if taken before bed (sedating and increase descending inhibition) but explanation should focus on analgesic rather than antidepressant properties

30

Injections for Chronic widespread pain (fibromyalgia)

Trigger point injections of LAs, corticosteroids or acupunture can be useful but oral corticosteroids are not helpful