Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

1024 Musculoskeletal Problems

Treatment Options

■Mechanical back pain: limited bed rest (2–4 days) w/ gradual

resumption of activities

➣Cyclobenzaprine for rest in acute phase

➣Physical therapy, exercises during recovery

■Shoulder (rotator cuff ) pain: ROM exercises, rotator cuff strengthen-

ing

➣Steroid injection

➣Surgery for recurrent or refractory symptoms

■Chest wall pain: local heat, analgesics, chest wall stretching exercises

■Elbow pain

➣Lateral epicondylitis: local heat, elastic support, steroid injec-

tions

➣Olecranon bursitis: aspiration of fluid

➣Antibiotics for infected bursa

➣Steroid injection for noninfected bursa

■Hand & wrist pain

➣Flexor tenosynovitis: steroid injection

➣Carpal tunnel syndrome: night splint, steroid injections, surgical

release for persistent symptoms, motor weakness

➣DeQuervain’s tenosynovitis: thumb splint, steroid injections

■Hip girdle pain

➣Trochanteric bursitis: steroid injection

➣Meralgia paresthetica: looser garments, time

■Knee & lower leg pain

➣Anserine bursitis: steroid injection

➣Popliteal cyst: knee joint aspiration, steroid injection

■Ankle & foot pain

➣Plantar fasciitis: local heat, heel cord & plantar stretching

➣Steroid injection for most, rarely surgery

➣Achilles’ tendinitis: heel lift, heat, stretching, donotinject

steroids

➣Morton’s neuroma: wider shoes, steroid injection, occasional

surgery

➣Tarsal tunnel syndrome: ankle support, steroid injection

Side Effects & Contraindications

■NSAIDs

➣Renal impairment, salt & fluid retention

Caution: hypertension, heart failure, edematous states

➣GI hemorrhage