Soft tissue rheumatism
There's a wide range of commonly encountered conditions that fall into this category, including tennis elbow, frozen shoulder, housemaids knee and plantar fasciitis. Inflammation and pain can occur in soft tissues as a consequence of altered biomechanical factors or over activity. In an office setting, forearm and tendon tension can arise from poor or excessive use of a computer keyboard leading to tennis elbow, forearm tendinitis or carpal tunnel syndrome. Flat feet may cause problems in the lower limbs- resulting in pain around the heel, ankle or inner knee. An uneven gait pattern may result in pain over the outside of a hip, called trochanteric pain syndrome or bursitis.
There may be an underlying hypermobility syndrome, when a patient's joints can be put through a greater range of movement than normal, predisposing to soft tissue rheumatism.
The treatment of these conditions depends on addressing any biomechanical factors and using exercise based physiotherapy to regain normal muscle and tendon health. Cortisone injections often help ease the severe pain that accompanies these conditions.
Some commonly encountered forms of soft tissue rheumatism include:
The Upper Limb
De Quervains tenosynovitis
Painful tendons at the thumb-base and wrist, often seen in new mothers holding their babies.
Carpal tunnel syndrome
Pain and tingling in the thumb and first 3 fingers, often waking the patient at night and provoked by arm elevation, such as when using the phone, reading the paper or driving.
Pain over the outside of the elbow due to inflammation of the tendons of the forearm extensor muscles, often after over activity.
Similar pain, over the inner elbow relating to the tendons of the forearm flexor muscles.
Various tendons of the important rotator cuff may be involved, resulting in pain on arm elevation and with other movements, such as putting on a coat.
Inflammation of the shoulder capsule, causing restriction of all movements and severe pain that is often worse at night. The pain responds well to a steroid injection, the movement recovers over several months with the help of exercise programmes.
The Lower Limb
Trochanteric pain syndrome or bursitis
Painful inflammation in the bursae and tendons on the bony prominence on the outside of the upper thigh/hip. Often seen in patients with back problems and those with an uneven gait pattern.
Pes anserine bursitis
Pain on the inside of the knee. There may be underlying knee osteoarthritis or flat feet and many patients are overweight.
Heel pad pain which can occur with new or ill-fitting shoes, in patients with collapsed arches and those who spend a lot of time on their feet.