Soft tissue includes ligament, muscle and tendons around joints and spine. Often these structures are source of pain in many disease conditions like rheumatoid arthritis, spondyloarthritis, spondylosis. Even these structures get affected following trauma, injury or repeated wear and tear in old ages leading to pain. Very frequently, ligaments and tendons get damaged in sports injury leading to acute and in some cases persistent pain.
Some common examples of soft tissue pain
- Tennis Elbow– Here the outer elbow (lateral epicondyle- a bony prominence) from which the forearm extensor muscles origin, get affected leading to elbow pain which occurs during activity.
- De Quairvain’s Tenosynovitis– In this condition, patients experience pain over outer wrist and thumb movement or activities involving thumb are painful. The 1stextensor compartment tendons are affected leading to pain.
- Trigger Finger– Base of the finger on palmar aspect gets trapped within a small pulley leading to pain. In advanced disease, the fingers get locked and one has to straighten it using other finger.
- Plantar Fasciitis/Heel Pain– Very common cause of heel pain is the irritation and thickening of “plantar fascia”, a structure connecting bones of hand foot to fore foot. Another cause is Achilles tendon which attaches to heel bone on the back of the foot. These two are common causes of soft tissue pain in foot.
- Tendon Inflammation– Often times, tendon (end of part of muscle which attach to the bone) is the source of pain in many rheumatological conditions or following wear and tear.
- Muscle pain– Many muscles can develop “taut bands or trigger points” and can be source of pain.
Diagnosis
For diagnosis of soft tissue pain, bedside ultrasound and MRI are the imaging of choice. At Neuron Pain & Spine clinic, we utilize bedside ultrasound which helps diagnose many disease conditions or pain cause instantly and that helps in disease making and formulating a treatment plan. In other cases, blood tests are also necessary.
Treatment
- Treatment of cause– Some soft tissue pain resolve following treatment of cause like rheumatic disease and other inflammation. Often, ice, rest, limb elevation and rest/activity modification works very well.
- Peritendon/Soft tissue injection– Many conditions mentioned above usually benefit from “ultrasound-guided targeted injection” around the tendon sheath or inflamed tendons or ligaments. Typically, corticosteroid is given in rheumatological or inflammatory cause whereas platelet-rich plasma (PRP) is given in conditions like tennis elbow, ligament sprain/injury, plantar fasciitis etc.
- Physical Therapy/Rehabilitation– This forms important part of treatment following injection therapy.
