Chapter 55: Soft Tissue Disorders

Soft Tissue Disorders disorders typically manifest as localized pain rather than systemic disease and are frequently encountered in primary care settings. The foundational management approach emphasizes ruling out systemic causes, identifying and removing aggravating factors, providing acute pain relief through medication and protective measures, and implementing patient education strategies. Initial acute care follows the PRICE protocol, while nonsteroidal anti-inflammatory drugs serve as first-line pharmacotherapy for symptom management and inflammation reduction. Corticosteroid injections offer effective relief for chronic overuse conditions and recurrent bursitis, though direct tendon injection must be avoided due to rupture risk. Orthopedic referral becomes appropriate when conservative management fails to produce improvement within four to six weeks. The chapter systematically covers bursitis as synovial sac inflammation triggered by repetitive motion, trauma, or infection, and addresses tendinitis and tenosynovitis as overuse injuries characterized by repetitive microtrauma and altered degeneration-regeneration cycles. Healing progresses through inflammation, proliferation, and remodeling phases, each requiring distinct management approaches. Specific regional disorders are examined, including carpal tunnel syndrome as the most common peripheral nerve compression, de Quervain's tenosynovitis affecting thumb extensors, trigger finger as stenosing tenosynovitis, and Dupuytren's contracture as progressive palmar fibromatosis. Shoulder pathology encompasses adhesive capsulitis with its characteristic three-phase progression, impingement syndrome involving subacromial compression, and rotator cuff tears requiring urgent surgical intervention within two to six weeks when full-thickness. Hip conditions include greater trochanteric pain syndrome combining tendinopathy and bursitis, meralgia paresthetica from lateral femoral cutaneous nerve compression, and avascular necrosis from compromised blood supply. Knee injuries focus on anterior cruciate ligament tears presenting with acute swelling and instability, and meniscus tears causing locking and clicking sensations. Foot and ankle disorders include plantar fasciitis characterized by morning heel pain and interdigital neuroma from metatarsal nerve compression. The chapter concludes by distinguishing benign bone tumors from malignant variants based on imaging characteristics and clinical presentation, emphasizing red flag symptoms requiring urgent evaluation.