Costochondritis

Description

• Inflammation of costochondral or costosternal junctions.

Epidemiology

• More common in younger female patients.

Presentation

• Sharp, positional chest pain that may worsen with deep inspiration.
• Focal tenderness to chest palpation (characteristic sign of costochondritis 🆚 differential diagnosis).

Differential Diagnosis

• Myocardial infarction
• Pulmonary embolism

De Quervain Tenosynovitis

Description

• Noninflammatory thickening of the abductor pollicis longus and extensor pollicis brevis tendons.

Presentation

• Pain or tenderness at the radial styloid.
• Positive Finkelstein test→ pain at radial styloid with active or passive stretch of thumb tendons.

Risk Factors

• New mothers (lifting baby)
• Golfers
• Racquet sport players
• “Thumb” texters.

• Other pictures

De Quervian tendonopathy.mp4

Dupuytren Contracture

Description

• Fibroblastic proliferation and thickening of the superficial palmar fascia.

Common Location

• Typically involves nodules at fascia of the base of the ring and little fingers that may evolve into fibrotic chords.

Etiology

• Unknown.
  • Thought to be due to overstimulation of WNT signaling pathway.

Epidemiology

• Most frequently seen in males > 50 years old of Northern European descent.

Flexion contracture of the small fingers

Ganglion Cyst

Description

• Fluid-filled swelling overlying joint or tendon sheath.

Common Location

• Dorsal side of wrist.

Pathophysiology

• Mucoid degeneration of periarticular tissue
• Mucinous fluid collects via a 1-way valve mechanism due to repetitive movement

Presentation

• Usually painless but can cause mild aching or compressive symptoms
• Smooth, rubbery, round structure that overlies a joint or tendon & Transilluminates (🆚tumors, lipoma; lack Transillumination)

Prognosis

• Usually resolves spontaneously.

• Other pictures

Lipoma

Definition

• Very common, benign tumors that arise from the subcutaneous fat.

Presentation

• Single or multiple round, soft, rubbery mobile, discrete nodules or masses
• Typically on the trunk, neck, and/or extremities
• Slow-growing
• Typically nontender and asymptomatic

Histopathology

• Normal mature adipocytes of mesenchymal origin
• Fibrous capsule

Iliotibial Band Syndrome

Description

• Overuse injury of the lateral knee.

Epidemiology

• Common in runners (repetitive flexion and extension of the knee )

Cause

• Pain in the lateral knee occurs due to friction of iliotibial band against the lateral femoral epicondyle.

• Overlay

Limb Compartment Syndrome

Pathophysiology

• Increased pressure within the fascial compartment of a limb→ Venous outflow obstruction and arteriolar collapse→ anoxia, necrosis, rhabdomyolysis→ acute tubular necrosis.

Causes

• Significant long bone fractures (e.g., tibia)
• Reperfusion injury
• Animal venoms.

Diagnosis

• Lab values
  • ↑ serum creatine kinase
• Presentation
  • Severe pain and tense, swollen compartments
  • Passive stretch of muscles in the affected compartment.
  • Motor deficits→ late signs of irreversible muscle and nerve damage.

<aside> 💡

5 P’s of acute limb ischemia: Pain, pallor, paresthesia, pulselessness, paralysis.

</aside>

Management

• surgical decompression (fasciotomy)

                  **Compartment syndrome of the lower leg**

Important to memorize components of each compartment

Medial Tibial Stress Syndrome (Shin splints)

Definition

• Exercise-induced pain along the posteromedial border of the tibia

Epidemiology

• Common in runners and military recruits.

Pathophysiology