This present power point presentation on soft tissue conditions, is an orthopedic topic useful for a quick glance of the conditions mostly of UL and LL. Physiotherapists and other health professionals will be benefited.

1. SOFT TISSUE
CONDITIONS
by
Dr M. Rajani Cartor MPT Ortho
Principal
VAPMS College of Physiotherapy
Visakhapatnam

8. • Tendinopathy - Tendons of the musculoskeletal system
becomes degenerated, most often as a result of
repetitive stresses and overloading during sports or
occupational activities.
• Tendinitis (acute) – Inflammation of a tendon due to
overuse or strain.
• Untreated tendinitis leads to tendinosis.
• Tendinosis (chronic)- No inflammation in the tendon but
rather actually tissue in the tendon is degrading.

9. • Rotator cuff tendinitis, or tendonitis,
affects the tendons and muscles that help move shoulder joint.
tendinitis, means that tendons are inflamed or irritated. Rotator cuff
tendinitis is also called impingement syndrome.
• This condition usually occurs over time. It can be the result of
keeping your shoulder in one position for a while, sleeping on your
shoulder every night, or participating in activities that require lifting
your arm over your head.
• Athletes playing sports that require lifting their arm over their head
commonly develop rotator cuff tendinitis. This is why the condition
may also be referred to as:
• swimmer’s shoulder
• pitcher’s shoulder
• tennis shoulder
• Sometimes rotator cuff tendinitis can occur without any known cause.
Most people with rotator cuff tendinitis are able to regain full function
of the shoulder without any pain.

10. symptoms of rotator cuff tendinitis:
• The symptoms of rotator cuff tendinitis tend to get worse over
time. Initial symptoms may be relieved with rest, but the
symptoms can later become constant. Symptoms that go
past the elbow usually indicate another problem.
• Symptoms include:
• pain and swelling in the front of your shoulder and side of
your arm
• pain triggered by raising or lowering your arm
• a clicking sound when raising your arm
• stiffness
• pain that causes you to wake from sleep
• pain when reaching behind your back
• a loss of mobility and strength in the affected arm

11. • Biceps tendinitis
is an inflammation or irritation
of the upper biceps tendon.
Also called the long head of
the biceps tendon, this
strong, cord-like structure
connects the biceps muscle
to the bones in the shoulder.
• Pain in the front of the
shoulder and weakness are
common symptoms of biceps
tendinitis.
• In severe cases, surgery may
be needed to repair the
tendon.

12. Subacromial bursitis is a common cause of shoulder pain that is
usually related to shoulder impingement of bursa between rotator
cuff tendons and bone (acromion). A bursa is essentially a self-
contained bag of lubricant that keeps reduces friction between two
moving structures in body.
symptoms:
• Gradual onset of symptoms over weeks or
months.
• Pain on the outside of shoulder.
• Pain may spread down arm towards the
elbow or wrist.
• Pain made worse when lying on affected
shoulder.
• Pain made worse when using arm above
head.
• Painful arc of movement – shoulder pain felt
between 60 - 90° of the arm moving up and
outwards.
• When arm is by side there is minimal pain and
above 90° relief of pain.
• Shoulder pain with activities such as washing
hair, reaching up to a high shelf in the
cupboard.

13. • Lateral
epicondylitis, also
known as "Tennis
Elbow", is the most
common overuse
syndrome in the elbow. It
is a tendinopathy injury
involving the extensor
muscles of the forearm.
These muscles originate
on the lateral epicondylar
region of the
distal humerus.

14. • In a lot of cases, the insertion of the extensor carpi
radialis brevis is involved.
• People with repetitive one-sides movements in their jobs
such as electricians, carpenters, gardeners also
commonly present with this condition.
It occurs often in repetitive upper extremity activities such
as computer use, heavy lifting, forceful forearm pronation
and supination, and repetitive vibration.
Mill’s Test: PT palpates the patient’s lateral epicondyle with
one hand, while pronating the patient’s forearm, fully flexing
the wrist, the elbow extended. A reproduction of pain in the
area of the insertion at the lateral epicondyle indicates a
positive test.
Cozen’s test = Resisted wrist extension with radial deviation
and full pronation

15. Medial epicondylitis (golfer’s
elbow) is a type of tendinitis that affects
the inside of the elbow. It develops
where tendons in the forearm muscle
connect to the bony part on the inside of
the elbow.
Tendons attach muscles to bones. Due
to injury or irritation, they can become
swollen and painful.
It can occur from any activity involving
use of the arms or wrists, including
tennis and baseball.
Other risk factors for this type of
tendinitis include playing baseball or
softball, rowing, and weightlifting.
Activities like playing an instrument
and typing on the computer can also
lead to medial epicondylitis
Golfer's Elbow Test. The patient
should be seated or standing and
should have his/her fingers flexed
in a fist position. The examiner
palpates the medial epicondyle
with one hand and grasps the
patient's wrist with his/her other
hand. The examiner then
passively supinates the forearm
and extends the elbow and wrist.

16. Olecranon bursitis is a condition
characterized by swelling, redness, and
pain at the tip of the elbow. If the
underlying cause is due to
an infection, fever may be present.The
condition is relatively common and is
one of the most frequent types
of bursitis.
It usually occurs as a result of trauma or
pressure to the elbow, infection, or certain
medical conditions such as rheumatoid
arthritis or gout.
Olecranon bursitis is associated with certain
types of work including plumbing, mining,
gardening, and mechanics. The underlying
mechanism is inflammation of the fluid filled
sac between the olecranon and skin.

17. at the carpal tunnel.
The main symptoms are
pain, numbness and
tingling in the thumb,
index finger, middle
finger and the thumb
side of the ring fingers.

18. • when the tunnel becomes narrowed or when tissues
surrounding the flexor tendons swell, putting pressure
on the median nerve. These tissues are called the
synovium.
• When the synovium swells, it takes up space in the
carpal tunnel and, over time, crowds the nerve. This
abnormal pressure on the nerve can result in pain,
numbness, tingling, and weakness in the hand.
TINEL’S
SIGN

19. RISK FACTORS:
• Heredity. This is likely an important factor. The carpal tunnel may be
smaller in some people or there may be anatomic differences that
change the amount of space for the nerve—and these traits can run
in families.
• Repetitive hand use. Repeating the same hand and wrist motions or
activities over a prolonged period of time may aggravate the tendons
in the wrist, causing swelling that puts pressure on the nerve.
• Hand and wrist position. Doing activities that involve extreme flexion
or extension of the hand and wrist for a prolonged period of time can
increase pressure on the nerve.
• Pregnancy. Hormonal changes during pregnancy can cause
swelling.
• Health conditions. Diabetes, rheumatoid arthritis, and thyroid gland
imbalance are conditions that are associated with carpal tunnel
syndrome.

20. Dupuytren's contracture (palmar fibromatosis)
Age. Dupuytren's contracture occurs most commonly after the age of 50.
Sex. Men are more likely to develop Dupuytren's and to have more severe
contractures than are women.
Ancestry. People of Northern European descent are at higher risk of the disease.
Family history. Dupuytren's contracture often runs in families.
Tobacco and alcohol use. Smoking is associated with an increased risk of
Dupuytren's contracture, perhaps because of microscopic changes within blood
vessels caused by smoking. Alcohol intake also is associated with Dupuytren's.
Diabetes. People with diabetes are reported to have an increased risk of
Dupuytren's contracture.
Dupuytren's contracture is a condition
in which one or more fingers become
permanently bent in a flexed position.
It usually begins as small hard
nodules just under the skin of the
palm, then worsens over time until the
fingers can no longer be straightened.

21. De Quervain’s Disease / Tenosynovitis
De Quervain syndrome is
inflammation of two
tendons that control
movement of the thumb
and their tendon sheath.
This results in pain at the
outside of the wrist. Pain is
typically increased with
gripping or rotating the
wrist. The thumb may also
be difficult to move
smoothly.
Abductor pollicis longus,
Extensor pollicis brevis.
Tenosynovitis: Inflkammation
of tendon sheath.(due to
infection, diseases,
inflammation, RA…)
Tenovaginitis: inflammation of
tendon sheath due to repeated
usage or micro and minor
injuries.

22. • Trigger finger is a condition that
causes pain, stiffness, and a
sensation of locking or catching
when tried to bend and
straighten the finger.
• The condition is also known as
“stenosing tenosynovitis.” The
ring finger and thumb are most
often affected by trigger finger.
• a popping or clicking sensation
and tenderness in the affected
finger. Triggering is usually
worse in the morning.

23. A mallet finger is a
deformity of
the finger caused when
the tendon that straightens
your finger (the extensor
tendon) is damaged.
When a ball or other object
strikes the tip of the finger or
thumb and forcibly bends it,
the force tears the tendon that
straightens the finger

24. Wry neck can have several causes. However, it is the thought that
the pain and reduction in range of motion results mainly from
two mechanisms. Either Facet Wry Neck caused by a locked facet
joint or Discogenic Wry Neck caused by a cervical disc injury.
Wry neck is a complaint
where you develop neck
pain and stiffness, which is
often accompanied by
spasm of the surrounding
neck muscles.
This causes neck pain and
an inability to turn your
neck through its full range
of motion.

25. TORTICOLLIS

26. Piriformis syndrome is
a condition which is
believed to result from
compression of the
sciatic nerve around
the piriformis muscle.
Symptoms may include
pain and numbness in
the buttocks and down
the leg. Often symptoms
are worsened with
sitting or running.
Symptoms: Buttock pain
that is worse with sitting
Causes: Trauma,
spasms, overuse injury
Other names: Deep
gluteal syndrome

27. • Gluteal trauma in the sacroiliac or gluteal areas
predisposing anatomic variants
• Myofascial trigger pointsHypertrophy and spasm of the
piriformis muscle
• Secondary to laminectomy Abcess, hematoma, myositis
• Bursitis of the piriformis muscleNeoplasms in the area of the
infrapiriform foramen
• Colorectal carcinoma Neurinoma of the sciatic nerve
• Episacroiliac lipoma Intragluteal injection
• Femoral nailing Myositis ossificans of the piriformis muscle

28. ILIOTIBIAL TRACT SYNDROME
• Iliotibial band syndrome (ITBS) is a common knee injury that usually
presents with pain and/or tenderness on palpation of the lateral
aspect of the knee, superior to the joint line and inferior to the lateral
femoral epicondyle.
• It is considered a non-traumatic overuse injury and is often
concomitant with underlying weakness of hip abductor muscles.
• Overuse is thought to be caused by repetitive knee flexion and
extension movements frequently seen in cyclists and runners .
• This repetitive motion causes excessive friction between the lateral
femoral epicondyle and the iliotibial tract. Studies have described an
‘impingement zone’ occurring at, or slightly below, 30° of knee flexion
during foot strike and the early stance phase of running. During this
impingement period in the running cycle, eccentric contraction of the
tensor fascia latae muscle and of the gluteus maximus causes the leg
to decelerate, generating tension in the iliotibial band.

31. Two wedge-shaped pieces of cartilage act as "shock absorbers"
between your thighbone and shinbone. These are called
meniscus. They are tough and rubbery to help cushion the
joint and keep it stable.
Any activity that causes you to forcefully twist or rotate
your knee, especially when putting your full weight on
it, can lead to a torn meniscus.

32. Bucket handle tear Flap tear
Radial tear Degenerative tear

33. A strain is an acute or chronic soft
tissue injury that occurs to a muscle, tendon, or
both (contractile components).
A strain can occur as a result of
improper body mechanics with any
activity (e.g., contact sports, lifting
heavy objects, overstretching) that
can induce mechanical trauma or
injury.
Generally, the muscle or tendon
overstretches and is placed under
more physical stress than it can
exert. Strains commonly result in a
partial or complete tear of a tendon
or muscle, or they can be severe in
the form of a complete tendon
rupture.

34. • The most common body location for strains to occur is in
the foot, leg, or back.
• Acute strains are more closely associated with recent
mechanical trauma or injury.
• Chronic strains typically result from repetitive movement of the
muscles and tendons over a long period of time.
• Degrees of Injury:
• First degree (mildest) – little tissue tearing; mild tenderness;
pain with full range of motion.
• Second degree – torn muscle or tendon tissues; painful, limited
motion; possibly some swelling or depression at the spot of the
injury.
• Third degree (most severe) – limited or no movement; severe
acute pain, though sometimes painless straight after the initial
injury

37. Mild hamstring strains may feel more like a tightness or low-grade
ache in your hamstring. Severe hamstring strains can be
extremely painful, making it impossible to walk or even stand. Other
possible symptoms of a hamstring strain are: Suddenand severe pain
during exercise, along with a snapping or popping feeling.

39. • Calf muscle strains usually occur either as a result of a
sudden, pushing off movement, or from excessive and
forced over-stretching of the muscles. This is more likely
to occur from a sudden explosive change of direction.

40. Runner’s knee is pain behind the kneecap. It may
also be called patellofemoral disorder, patellar
malalignment, patellofemoral pain syndrome, and
chondromalacia.
The most common symptom is
knee pain that worsens when
walking up or down stairs.
Kneeling, squatting or sitting
cross-legged may also hurt.
Without treatment, chondromalacia can lead to patella-
femoral arthritis. This occurs when the cartilage gets severely
worn away by damage.

41. poor alignment due to a
congenital condition
weak hamstrings
and quadriceps (the muscles
in the back and front of
thighs, respectively)
muscle imbalance between
the adductors and abductors
(the muscles on the outside
and inside of thighs)
repeated stress to knee joints,
such as from running, skiing,
or jumping
a direct blow or trauma to
kneecap

42. Pain may worsen after sitting for a prolonged period of
time or during activities that apply extreme pressure to
your knees, such as standing for an extended period or
exercising.
• Grading:
• Grade 1 severity indicates softening of the cartilage in
the knee area.
• Grade 2 indicates a softening of the cartilage along with
abnormal surface characteristics. This usually marks the
beginning of tissue erosion.
• Grade 3 shows thinning of cartilage with active
deterioration of the tissue.
• Grade 4, the most severe grade, indicates exposure of
the bone with a significant portion of cartilage
deteriorated. Bone exposure means bone-to-bone
rubbing is likely occurring in the knee.

43. Patellar Tendonitis (Jumper’s Knee)
Patellar tendinitis is an
injury to the tendon
connecting kneecap
(patella) to shinbone.
The patellar tendon works
with the muscles at the
front of the thigh to extend
knee so that one can kick,
run and jump.

44. • Patellar tendinitis is a common overuse injury, caused by
repeated stress on patellar tendon. The stress results in tiny
tears in the tendon, which the body attempts to repair.
• But as the tears in the tendon multiply, they cause pain from
inflammation and weakening of the tendon. When this tendon
damage persists for more than a few weeks, it's called
tendinopathy
• Initially, one may only feel pain in knee as one begin physical
activity or just after an intense workout.
• Over time, the pain worsens and starts to interfere with playing
sport. Eventually, the pain interferes with daily movements such
as climbing stairs or rising from a chair.

45. Prepatellar bursitis is an inflammation of the bursa in the
front of the kneecap (patella). It occurs when
thebursa becomes irritated and produces too much fluid,
which causes it to swell and put pressure on the adjacent
parts of the knee.

46. An ankle sprain is an injury to the tough bands of tissue
(ligaments) that surround and connect the bones of the leg to the
foot. The injury typically happens when one accidentally twist or
turn ankle in an awkward way. This can stretch or tear the
ligaments that hold ankle bones and joints together.

48. Achilles tendinitis is a common condition
that occurs when the large tendon that runs
down the back of the lower leg becomes
irritated and inflamed.
Although the Achilles tendon can withstand
great stresses from running and jumping, it
is also prone to tendinitis, a condition
associated with overuse and degeneration.
Types: Non-insertional , Insertional

52. An inflammation of a thick band of tissue that
connects the heel bone to the toes.
Plantar fasciitis occurs when the strong band of tissue
that supports the arch of your foot becomes irritated
and inflamed.
• The plantar fascia is designed to absorb the high stresses and
strains we place on our feet. But, sometimes, too much
pressure damages or tears the tissues. The body's natural
response to injury is inflammation, which results in the heel pain
and stiffness of plantar fasciitis.
• Although many people with plantar fasciitis have heel spurs,
spurs are not the cause of plantar fasciitis pain. One out of 10
people has heel spurs, but only 1 out of 20 people (5%) with
heel spurs has foot pain. Because the spur is not the cause of
plantar fasciitis, the pain can be treated without removing the
spur.

55. • Morton's Neuroma (MN) is a condition associated with the
common plantar digital nerves, caused by entrapment of the
nerve and repetitive traction underneath the deep transverse
metatarsal ligament leading to epineural and perineural fibrous
overgrowth
• Also known as Morton neuroma, Morton's metatarsalgia,
Intermetatarsal neuroma and Intermetatarsal space neuroma
the benign neuroma most commonly affects the intermetatarsal
plantar nerve of the second and third intermetatarsal spaces
(between 2nd−3rd and 3rd−4th metatarsal heads), which
results in the entrapment of the affected nerve.
• The main symptoms are pain and/or numbness, sometimes
relieved by removing footwear.

58. Enthesitis is inflammation of the entheses, the sites
where tendons or ligaments insert into the bone. It is an
enthesopathy, a pathologic condition of the entheses.
It is associated
with HLA
B27 arthropathies such
as ankylosing
spondylitis, psoriatic
arthritis, and reactive
arthritis
Manifest in inflammation or occasionally
in fibrosis and calcification, enthesitis can be caused by
recurring stress or by inflammatory autoimmune disease.
A common autoimmune enthesitis is at the heel, where
the Achilles tendon attaches to the calcaneus.

59. THANK YOU