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What Soft Tissue Problems Are There?

Tennis Elbow (Lateral epicondylitis)

With pain over the outside part of the elbow and Golfers Elbow (medial epicondylitis), pain over the inside part of the elbow (bony prominences). Many people with these conditions have never held a tennis racquet or golf club! The problem is caused by repeated use of specific tendons, which move the wrist, and the points of pain are where the tendons are actually attached to the bone. Repeated movements such as backhand tennis, lifting heavy weights, repeated gripping and twisting make the pain worse. The treatment involves stopping the repeated movements, which aggravate the pain, physiotherapy and wearing a tennis elbow clasp. These may be very helpful early measures. If the pain persists, a corticosteroid injection administered by the Consultant Rheumatologist may be really helpful in resolving the problem.

Shoulder Pain

The shoulder is a complex joint and pain may come from a variety of places, Tears of the rotator cuff (the muscles and tendons around the head of the humerus) PICTURE occur more frequently with increasing age and if there has been some trauma to the shoulder. Sometimes the tendons may be inflamed and cause pain, and restrict movement, as the shoulder is elevated or at night. ‘Wear and tear’ in the joints (osteoarthritis), may also contribute to the pain. It is important to diagnose the problem and MRI scanning is a very helpful tool in making the diagnosis and excluding a rotator cuff tear. Ultrasound scans are also very useful if MRI is not available. If the MRI or ultrasound scan shows inflammation around the tendons or bursitis, a corticosteroid injection may be used to treat the problem. Physiotherapy may be helpful and early referral to an orthopaedic shoulder specialist may be warranted.


Trigger Finger

In this case the finger or thumb catches during the flexion of the digit. This is due to a small nodule in the palm, getting caught in the delicate pulley system. Initially, a tiny corticosteroid injection may be very effective in freeing the tendon. If the problem persists, decompression, by a hand surgeon, is recommended.

Carpal Tunnel Syndrome

This problem causes tingling, pain and numbness of the thumb, index finger, middle finger and sometimes part of the ring finger. The symptoms are worse at night and may wake you up. The problem is due to squashing (compression) of the median nerve at the wrist. The condition is seen more frequently in pregnancy, people with thyroid conditions, diabetes and in people who have gained weight. The diagnosis is made by taking a history, examining the patient and confirmed by nerve conduction tests (carried out by a neurophysiologist). In mild cases, a corticosteroid injection, from the Consultant Rheumatologist, may greatly reduce the symptoms and wearing a wrist splint, at night, may be recommended. If the pressure on the nerve is severe, surgical decompression (by a hand surgeon) is advised.

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