Soft Tissue Rheumatism

There’s a wide range of commonly encountered conditions that fall into this category, including tennis elbow, frozen shoulder, housemaids knee and plantar fasciitis.

Inflammation and pain can occur in soft tissues as a consequence of altered biomechanical factors or over activity. In an office setting, forearm and tendon tension can arise from poor or excessive use of a computer keyboard leading to tennis elbow, forearm tendinitis or carpal tunnel syndrome. Flat feet may cause problems in the lower limbs- resulting in pain around the heel, ankle or inner knee. An uneven gait pattern may result in pain over the outside of a hip, called trochanteric pain syndrome or bursitis.

There may be an underlying hypermobility syndrome, when a patient’s joints can be put through a greater range of movement than normal, predisposing to soft tissue rheumatism.

The treatment of these conditions depends on addressing any biomechanical factors and using exercise based physiotherapy to regain normal muscle and tendon health.

Cortisone injections often help ease the severe pain that accompanies these conditions.

Some commonly encountered forms of soft tissue rheumatism include:
The Upper Limb
De Quervains Tenosynovitis
A very painful swelling of the tendons at the base of the thumb and overlying the wrist. Often due to overuse and sometimes seen in new mums from holding their babies. Treated with splinting and very responsive to a cortisone injection.
Carpal Tunnel Syndrome
Pain and tingling in the fingers and thumb, often waking the patient at night and also provoked by arm elevation when using a phone, driving or reading the paper. There are several causes but it is often due to inflammation of the wrist tendons due to overuse or inflammation of the wrist itself due to arthritis. Having identified the cause, a splint or an injection may be required. Occasionally, a patient is referred for surgery.
Tennis Elbow
Pain over the outside of the elbow (called the lateral epicondyle), due to inflammation of the tendons of the forearm extensor muscles. This is often due to overuse. It can be treated with physiotherapy or a cortisone injection.
Golfers Elbow
A similar pain felt on the other side of the elbow (the medial epicondyle) and treated in the same way.
Shoulder Tendinitis
The rotator cuff is a complex group of muscles and tendons which allows the shoulder to move in more ways than any other joint. The tendons can become inflamed for a number of different reasons. Pain occurs with arm elevation, putting on a jacket and when lying on the affected shoulder at night. Some patients develop calcification within the tendons causing very severe pain. Ultrasound scans are useful in diagnosis and for performing guided cortisone injections. Physiotherapy also plays an important role.
Frozen Shoulder (capsulitis)
The shoulder capsule becomes inflamed causing marked restriction of movement of the shoulder and severe pain, especially at night. Whilst the pain can respond well to an injection, the range of movement recovers slowly over 9-18 months.
The Lower Limb
Trochanteric Pain Syndrome Or Bursitis
Painful inflammation in the bursae and tendons on the bony prominence on the outside of the upper thigh/hip. Often seen in patients with back problems and those with an uneven gait pattern.
Pes Anserine Bursitis
Pain on the inside of the knee. There may be underlying knee osteoarthritis or flat feet and many patients are overweight.
Plantar Fasciitis
Heel pad pain which can occur with new or ill-fitting shoes, in patients with collapsed arches and those who spend a lot of time on their feet.