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