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Soft Tissue Rheumatism

Many people suffer from aches and pains that are not due to arthritis but come from the soft tissues around the joints (tendons, muscles, bursae and ligaments). These can be separated into conditions where there is evidence of inflammation of the soft tissues and those where there is no inflammation but the muscles seem to become sensitized and go into spasm (myofascial syndromes).

A common example of tendonitis is shoulder and upper arm pain caused by inflammation of the supraspinatus tendon and swollen sub-acromion bursa (see diagram).  The tendon can get pinched under the acromion on lifting movements and swells making the symptoms worse. Pain is typical on raising the arm from the side of the body and lying on the shoulder at night can be painful (painful arc syndrome). Often the swelling will go down by itself or with a few days of treatment with pain killers and ice packs. Physiotherapy and gentle exercises can help. If the problem persists injections of corticosteroid into the swollen bursa and around the tendon can reduce the swelling. Ultrasound examination is useful if the symptoms do not settle and can localise the inflammation and look for tears in the tendon which sometimes occur. Occasionally surgical decompression is needed.

Other common soft tissue conditions include tennis and golfers elbow, trigger fingers, carpal tunnel syndrome, Achilles tendonitis, trochanteric bursitis and adductor tendonitis.

Myofascial pain comes from muscles and soft tissues but does not represent tissue damage or inflammation. It is well recognised but not well understood. Pain is usually felt in a region such as around the shoulder girdle, neck, rib cage, lower back and hip. It is probably one of the commonest causes of back and neck pain. Pains are often worse after activity and may be made worse by stress.  Gentle exercises, low dose amitriptyline tablets and, occasionally, local corticosteroid injections into ‘trigger’ points can be helpful. Myofascial syndromes are associated with fatigue, sleep disturbance and are linked to the more widespread condition of fibromyalgia.

The Mayo Clinic in the USA has more information about myofascial syndrome.