Regional Rheumatic Disorders

Regional Rheumatic Disorders

• Present with localized pain related to tendons, ligaments, fascia, and bursae, in addition to arthritis, bone disease, and neurological problems.

Bursitis

• Inflammation of a closed sac lined with synovial cells and containing synovial fluid.
• Located in areas of friction, facilitating movement of tendons and muscles and protecting bony prominences from repetitive trauma.
• Important bursae include:
• Subacromial/Subdeltoid bursa: between the acromion and rotator cuff, common cause of shoulder pain.
• Olecranon bursa: over the olecrannon process, also known as "student's elbow".
• Trochanteric bursa: between the hip capsule and iliopsoas muscle and tendon, common cause of lateral hip pain.
• Prepatellar bursa: between the skin and patella, also known as "housemaid knee".
• Achilles bursa: between the calcaneus and Achilles tendon.

Popliteal Cyst

• Posterior extension of synovial membranes into the popliteal area due to persistent fluid production in the knee, commonly seen with osteoarthritis and rheumatoid arthritis.

Etiology of Bursitis

• Trauma: acute or chronic
• Overuse: leading to microtrauma
• Systemic disease: inflammatory processes affecting tendon sheaths and bursae
• Septic: direct involvement from local injury or as part of a septic process

Diagnosis

• Localized pain
• Swelling: only in certain sites (e.g., olecranon)
• Erythema: gouty or septic
• Tenderness to palpation
• Pain on specific maneuvers for shoulder ROM
• Impingement sign: pain on abduction of the arm above 90 degrees suggests an inflamed subacromial bursa
• Drop arm test: suggests a complete tear of the rotator cuff

Imaging Studies

• X-rays: may reveal calcific deposits from previous inflammatory episodes
• US and MRI: helpful in detecting inflammation

Treatment

• Rest: discontinue aggravating activities, immobilization for 7-10 days
• Cold compresses: for acutely inflamed areas
• Analgesic medication: acetaminophen
• Anti-inflammatory medication: NSAIDs, corticosteroids
• Aspiration and corticosteroid injection of inflamed bursa
• Surgery: failure of conservative management

Tendinitis

• Intra-tendinous lesions: associated with microtrauma, commonly in supraspinatus and gluteus medius/minor tendons
• Peritendinous inflammation or tenosynovitis: susceptible to inflammation and pain
• Examples: De Quervain disease (inflammation of tendon sheaths over the distal radial head) and "trigger finger" (inflammatory thickening of the fibrous sheath of flexor tendons)

Diagnosis of Tendinitis

• Pain on motion
• De Quervain's tenosynovitis: stretching of tendons is particularly sensitive

Learn about regional rheumatic disorders, including bursitis, tendinitis, and other conditions affecting tendons, ligaments, fascia, and bursae. Understand the causes and symptoms of these disorders.