Dr. Tehila Zuckerman, MD, Chief of the Division of Rheumatology at NewYork-Presbyterian Hospital Queens, shared a comprehensive lecture on soft tissue pain in arthritis at Congregation Etz Chaim on Tuesday evening, January 14, on behalf of the Navigating the Medical System Lecture Series.
Dr. Zuckerman spoke about common causes of soft tissue pain and treatments. Regional skeletal pain that is not from a systemic disease is more of a local problem, she explained. This is also separate from pain from fractures.
She began with discussing shoulder pain. A common cause of shoulder pain is rotator cuff injury. She explained that the rotator cuff is made up of tendons of four muscles that control the shoulder movement. Any repetitive movement such as lifting outstretched arms or participating in sports will aggravate the problem. With tendonitis, you have to rest and stop doing the activity that is causing pain. It is treated with anti-inflammatory medicines like ibuprofen, ice, and physical therapy. Rotator cuff tear is a long-term result from chronically inflamed tendons. It can be hard to distinguish between a tendinopathy and a tear. When a person has a tear, he will not be able to elevate his arm. An MRI can help in the diagnosis of this. Sometimes a tear will require surgical repair. A person can first try conservative management with ice, physical therapy, and steroid injections.
The next type of shoulder issue she discussed was frozen shoulder. “Any injury to the shoulder might lead to this. The shoulder doesn’t move in this situation because it is really stiff. There is scarring and a person loses range of motion in his shoulder. Those more at risk for this include people with diabetes, a history of stroke, Parkinson’s disease, or thyroid disease. A frozen shoulder starts with pain and progresses to stiffness. She noted that “it is an injury that tends to heal. It takes a long time.” The majority of patients regain motion.
She then discussed elbow pain. Tennis elbow and golfer’s elbow are common problems. A person can develop a golf ball size swelling. It is not common to develop arthritis in the elbow. “Repetitive stress on the wrist can pull at bony insertions and can cause tendinitis.” Pain at bony insertions can interfere with activities of daily living. This is treated with a brace that fits over the belly of muscles and offloads tension on the tendons. This provides extra support. Ice, anti-inflammatory drugs, and physical therapy to strengthen muscles are the standard treatments. Most people heal within six to twelve weeks.
Wrist and hand pain include carpal tunnel syndrome. Osteoarthritis is common in the hand. Anything that causes compression can cause shooting pain into the palm area. Overt pain or numbness or tingling is worse at night. It is a common misconception that typing causes this. It aggravates it but it doesn’t cause it. Carpal tunnel is more common in women, in those overweight, and in those with diabetes or pregnancy. A test for carpal tunnel involves nerve conductor studies. This tests how nerves are conducting electricity. It is treated with a splint that keeps the wrist immobile, particularly at night. This relieves compression. It is also treated with steroid shots. If the muscles in the hand are weakened, then it may be necessary to have surgery to repair this.
She then explained that two muscles along the thumb control motion of the thumb. A brace will offload the tendon, and anti-inflammatories and steroid injections can help. Surgery is needed only in severe cases. Generally, this issue is self-limited. Dr. Zuckerman then spoke about trigger finger, which is a common soft tissue injury. It is a problem with the tendon and it presents with pain in the hands and the finger locks. A person with this issue cannot extend his finger naturally. Treatment for this includes a brace, avoiding repetitive movements, steroid injections, and in severe cases, surgery.
She taught that problems with the palm are caused by soft tissue, which surrounds the palm, thickening and forming nodules. It’s disabling. This type of issue has a genetic component. Other risk factors include age, diabetes, cigarette smoking, and alcohol consumption. Treatment includes steroid injection or surgery.
The session concluded with a question-and-answer session. Everyone left well-informed from this detailed lecture on soft tissue pain.