Case-based scenarios on the soft tissue affections (Carpal Tunnel Syndrome, De Quervain tenosynovitis, Ganglion cyst, Trigger finger, Dupuytren contracture, Tennis elbow, Frozen shoulder, Meralgia paraesthetica, Bursitis, Plantar fasciitis)

1. SOFT TISSUE
Affections

2. What is life
without
Quality of life!

3. Case 1
• Middle aged female, computer work all day
• History of morning stiffness in the hand (Rheumatoid arthritis,
a risk factor)
• Complains of numbness & tingling sensation in both
hands, sparing little fingers & central base of palm
(supplied by palmar cutaneous branch of median nerve which exits outside the
tunnel, so spared)
• Multiple awakenings at night due to hand pain &
numbness
Clinical tests for diagnosis?

4. Carpal tunnel syndrome

5. Phalen’s test & Tinel sign

6. Case 2
• Mother of a newborn, repeatedly lifts newborn
• Complains of pain & swelling over radial styloid
process
Clinical test to aid your diagnosis?

7. de Quervain’s tenosynovitis

8. Finkelstein’s test

9. Case 3
• Localized, tense, painless swelling
• Dorsum of wrist
Probable diagnosis?

10. Ganglion cyst
(Mucoid degeneration of tendon sheath/joint capsule causes cystic swelling)

11. Compound palmar ganglion

12. Case 4
• Tender swelling at the base of finger
• Especially on trying to passively extend the finger
• ‘Locking of finger’ on flexed position
Probable diagnosis?

13. Trigger finger
(Fibrous digital sheath constriction restricts free gliding of contained flexor tendons)

14. Case 5
• Nodules & cords at base of ring finger
• Ring finger contracture
• MCP & PIP joints are flexed
Probable diagnosis?

15. Dupytren’s contracture
(abnormal myofibroblast growth causes contracture of palmar aponeurosis)
Associated conditions
• Ledderhose disease
• Peyronie disease
• Drug (Phenytoin)
• Systemic condition
(Liver cirrhosis)

16. Case 6
• Elbow pain
• Pain localized around lateral epicondyle of
humerus
• History of over-weight lifting & playing badminton
excessively 3 days before pain onset
Probable Diagnosis?
-Tennis elbow
Clinical tests to aid your diagnosis?

17. Thomsen test & Chair test

18. Radial tunnel syndrome

19. Case 7
• Studious student (like you)
• Repeatedly keeps elbow over table for a long period
of time while studying & writing
• Presents with pain & swelling over olecranon tip
Probable Diagnosis?
Student’s elbow (Olecranon bursitis)

20. Case 8
• Painful & stiff shoulder
• History of preceding trauma
• Stiffness limited to internal rotation & abduction
Probable diagnosis?
Frozen shoulder

21. Case 9
• Tingling, burning & numbness in anterolateral
aspect of thigh (supplied by lateral cutaneous nerve of thigh)
• History of anterior iliac crest bone grafting
Probable Diagnosis?
Meralgia Paraesthetica

22. Case 10
• Fluctuating, non tender swelling lying centrally in
popliteal fossa, around the joint line
• Disappear on flexion, tense on extension of knee
Probable diagnosis?
Baker’s cyst

23. Case 11
• Active athlete
• Complains of heel pain, worst in early morning
(foot plantar flexed during sleep-shortening of plantar structures, but waking
from night’s sleep- foot dorsiflexed-stretching of plantar structures-pain)
• O/E: marked tenderness over medial aspect of
calcaneal tuberosity
Probable diagnosis?
- Plantar fascitis
D/D of heel pain?

24. Causes of heel pain

25. Summary
• Carpal tunnel syndrome- Median nerve compression
• Ganglion- Cystic swelling d/t mucoid degeneration of tendon
sheath/joint capsule
• De Quervain tenosynovitis- thickening of tendinous sheath of 1st dorsal
compartment
• Trigger finger- Fibrous digital sheath constriction
• Dupytren’s contracture- Palmar aponeurosis contracture
• Frozen shoulder- Glenohumeral capsule contracture
• Tennis elbow- Lateral epicondylitis
• Meralgia paraesthetica- Lateral cutaneous nerve of thigh compression
• Plantar fascitis- Plantar fascia inflammation

26. Happiness is a mirror
You become happy when you make
others happy - Dr. B. M. Hegde
THANK YOU!