Back Pain
330 Musculoskeletal and Soft-tissue Emergencies
3 This condition may require surgical release of the tendon sheaths if local
injection of steroid fails.Carpal tunnel syndrome
DIAGNOSIS AND MANAGEMENT
1 This is a compressive neuropathy of the median nerve at the wrist, most
commonly affecting middle-aged females.
2 Secondary causes include rheumatoid arthritis, post-trauma such as a Colles’
fracture, pregnancy, and rarely myxoedema, acromegaly and amyloidosis.
Most cases though are idiopathic or related to minor trauma.
3 Patients complain of pain and paraesthesiae in the distribution of the
median nerve in the hand, primarily the thumb, index, middle and lateral
aspect of the ring finger. It is typically worse at night or following repetitive
strain such as computer work.
4 Test for reduced sensation over the palmar aspect of the affected digits and
we a k ne s s of t hu mb abduc t ion. T h is is a s soc iated w it h t hena r mu scle wa st i ng
in more chronic cases.
5 Perform Phalen’s test, by reproducing paraesthesiae in the distribution of the
median nerve following 60-second wrist hyperf lexion. Or look for Tinel’s
sign eliciting median nerve paraesthesiae by tapping on the volar aspect of
the wrist over the median nerve.
6 Treat with an anti-inf lammatory analgesic, and immobilize the wrist in a
volar splint in the neutral position, particularly at night.
7 Refer resistant cases to the orthopaedic clinic for consideration of carpal
tunnel decompression.Housemaid’s knee
DIAGNOSIS AND MANAGEMENT
1 This is a pre-patellar bursitis due to friction or infection.
2 Treat by giving an anti-inf lammatory analgesic, avoiding further trauma
and, if necessary, by aspiration and steroid injection by the GP or outpatient
clinic (orthopaedic or rheumatology).
3 Refer the patient to the orthopaedic team if bacterial infection is suspected.BACK PAIN
This is a common problem that can be considered under four headings:
● Direct back trauma
● Indirect mechanical back trauma