NON-ARTICULAR RHEUMATISMMusculoskeletal and Soft-tissue Emergencies 3292 Request X-ray which may show calcification in the supraspinatus tendon.
3 Give an anti-inflammatory analgesic, and consider referral to the ortho-
paedic or rheumatology clinic for aspiration and local steroid injection.
Subacromial bursitis
DIAGNOSIS AND MANAGEMENT
1 This may follow rupture of calcific material into the subacromial bursa,
again causing a ‘painful arc’, or a constant severe pain.
2 Treat as for supraspinatus tendonitis above.
Tennis and golfer’s elbow
DIAGNOSIS AND MANAGEMENT
1 Tennis elbow causes pain over the lateral epicondyle of the humerus from a
partial tear of the extensor origin of the forearm muscles used in repetitive
movements (e.g. using a screwdriver or playing tennis).
2 Advise the patient to avoid the activity causing the pain, and to rest the arm.
Give an anti-inflammatory analgesic.
3 Refer for local steroid injection if the pain is persistent.
4 Golfer’s elbow is a similar condition affecting the medial epicondyle and the
f lexor origin.
Olecranon bursitis
DIAGNOSIS AND MANAGEMENT
1 Painful swelling of this bursa is due to trauma, gout or infection, usually
with Staphylococcus aureus.
2 Aspirate under sterile conditions and send f luid for culture and polarizing
light microscopy if the latter two conditions are likely.
(i) Refer the patient for formal drainage of the bursa under
anaesthesia if infection is confirmed.
3 Otherwise, give a non-steroidal anti-inf lammatory analgesic and refer back
to the GP.
De Quervain’s stenosing tenosynovitis
DIAGNOSIS AND MANAGEMENT
1 This causes tenderness over the radial styloid, a palpable nodule from thick-
ening of the fibrous sheaths of the abductor pollicis longus and extensor
pollicis brev is tendons, and pain on mov ing t he t humb.
2 Treat by resting the thumb in a splint and by using an anti-inf lammatory
analgesic.