The requirements of a clinically useful disease classification system are that it should be simple, reliable, and clinically relevant. A classification system for soft tissue disorders can be developed based on the site, primary symptoms, clinical findings, and, increasingly, imaging findings (principally ultrasound and magnetic resonance imaging (MRI)).
Since pain is the cardinal symptom of musculoskeletal disease, it has been proposed that soft tissue disorders be classified by the regional site of painhence a diagnosis of shoulder pain, back pain, knee pain, etc. Whilst useful for epidemiological surveys, this approach lacks specificity and is not clinically helpful. Just as a cardiologist would not find the diagnosis of chest pain satisfactory, nor should the rheumatologist be content with this approach. Every pain has its distinct and pregnant signification if we will but carefully search for it.
Nevertheless, the symptom of pain is a useful starting point in a clinical classification system and its site, the specific tissue(s) affected, the degree of pain, and associated symptoms (e.g. instability) represent the initial stages of classification.
The duration of the complaint at presentation is included, where acute can be considered as less than 3 days, subacute 4 days to 6 weeks, and chronic more than 6 weeks.
Next, where possible, the pathology and aetiology should then be described. Most soft tissue tendon injuries are traumatic in origin. A macrotraumatic injury involves a single episode of acute tissue destruction, whereas a microtraumatic injury involves either chronic overload or an acute on chronic episode. They may be due to intrinsic and /or extrinsic factors that may result in inflammation, degeneration, tear, or rupture. Most of those factors that predispose to injury have the potential to impair the response to the event(s) and are prime considerations in planning management.
Rupture of a normal or healthy tendon is rare but occurs in tendons that are already abnormal, for example, due to injury or when there is degeneration within the central tendon substance (which may be subclinical up to the point of rupture). Degenerate tendon rupture can be painless and is often attritional (e.g. long head of biceps or rotator cuff).
Mild
Since pain is the cardinal symptom of musculoskeletal disease, it has been proposed that soft tissue disorders be classified by the regional site of painhence a diagnosis of shoulder pain, back pain, knee pain, etc. Whilst useful for epidemiological surveys, this approach lacks specificity and is not clinically helpful. Just as a cardiologist would not find the diagnosis of chest pain satisfactory, nor should the rheumatologist be content with this approach. Every pain has its distinct and pregnant signification if we will but carefully search for it.
Nevertheless, the symptom of pain is a useful starting point in a clinical classification system and its site, the specific tissue(s) affected, the degree of pain, and associated symptoms (e.g. instability) represent the initial stages of classification.
The duration of the complaint at presentation is included, where acute can be considered as less than 3 days, subacute 4 days to 6 weeks, and chronic more than 6 weeks.
Next, where possible, the pathology and aetiology should then be described. Most soft tissue tendon injuries are traumatic in origin. A macrotraumatic injury involves a single episode of acute tissue destruction, whereas a microtraumatic injury involves either chronic overload or an acute on chronic episode. They may be due to intrinsic and /or extrinsic factors that may result in inflammation, degeneration, tear, or rupture. Most of those factors that predispose to injury have the potential to impair the response to the event(s) and are prime considerations in planning management.
Rupture of a normal or healthy tendon is rare but occurs in tendons that are already abnormal, for example, due to injury or when there is degeneration within the central tendon substance (which may be subclinical up to the point of rupture). Degenerate tendon rupture can be painless and is often attritional (e.g. long head of biceps or rotator cuff).
Mild
- No pain : does not affect performance.
- With extreme exertion only; not intense; disappears on cessation of activity : does not affect performance.
- Starts with activity; lasts 1-2 hours after cessation of activity : performance may be affected.
- Starts and progresses with activity; lasts 4รข€“6 h after activity : performance significantly affected.
- Starts immediately upon any activity; major increase in pain on continuing activity; lasts 12-24 hours afterwards : performance may be prevented.