A ganglion is a cyst that develops under the skin near a joint and is filled with a jelly-like fluid. The ganglion is usually an outgrowth from the capsule surrounding a joint or from the sheath of tendon, the fibrous cord that attaches muscle to bone. The fluid inside the ganglion is derived from the synovial fluid that lubricates tendons and joints.

Ganglia are extremely common and are usually painless. They most commonly occur on the wrist or the back of the hand but occasionally they develop on the foot. They vary in size from that of a small pea to that of a plum.

A ganglion may be left as a lump under the skin and may be present for several years without causing a problem. However, some ganglia become very uncomfortable or even painful. A ganglion may disappear spontaneously, or it can be removed surgically under local anaesthesia. Ganglia sometimes recur.

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In Dupuytren’s contracture, the fibrous tissue in the palm of the hand becomes thickened and shortened. As a result, one or more fingers, often the fourth and fifth fingers, are pulled towards the palm into a bent position. Sometimes, painful lumps develop on the palm, and the overlying skin becomes puckered. In about half of all cases, both hands are involved. Rarely, the disorder affects the soles of the feel and the toes.

Dupuytren's contracture of the ring finger

The tissue changes in Dupuytren’s contracture develop slowly over months or years. The cause is unknown, but it occurs more commonly in men over the age of 50, in people with diabetes mellitus or epilepsy, and in people who abuse alcohol. About 1 in 10 people with Dupuytren’s contracture has a relative with the disorder.

What might be done?

In mild cases, no treatment may he needed. If your fingers are slightly bent, you may benefit from stretching exercises or short-term splinting. If you have painful lumps in your palm, a corticosteroid may be injected into the area. In severe cases, it may be necessary to surgically remove the thickened tissue in the palm to allow the fingers to straighten. The disorder can recur, especially in people who have a family history of Dupuytren’s contracture and who are effected in both hands.

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Tendinitis is inflammation of a tendon, the fibrous cord that attaches a muscle to a bone. Tenosynovitis is inflammation of the sheath of tissues that surrounds a tendon. These two conditions usually occur together. Tendons around the shoulder, elbow, wrist, fingers, thigh, knee or back of the hell are most commonly affected.

Both conditions may be caused by injury of a particular tendon or rarely, by an infection. Inflammation of the Achilles tendon between the heel and the calf may be the result of a sports injury or of wearing ill-fitting shoes. Tenosynovitis may be associated with rheumatoid arthritis. In some cases, the cause is unknown.

What are the symptoms?

You may notice the following symptoms in the affected area, particularly during movement:

- Pain and/or mild swelling.
- Stiffness and restricted movement in the affected area.
- Warm, red skin over the tendon.
- A tender lump over the tendon.

Occasionally, you may feel a crackling sensation (known as crepitus) when the affected tendon moves.

What may be done?

Diagnosis is based on the symptoms and a physical examination. Your doctor will treat any underlying disorder. To reduce the pain and inflammation, he or she may recommend nonsteroidal anti-inflammatory drugs. You may also require an injection of a corticosteroid drug into the tendon sheath. If the condition is due to an infection, a course of antibiotics will be prescribed. In some cases, a tendon will heal more quickly if it is splinted. Tendinitis and tenosynovitis improve with treatment.

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Tennis elbow and golfer’s elbow both occur when the tendon attachment of the muscle to the bone at the elbow becomes damaged. In tennis elbow, the tendon on the outer side of the elbow is injured; in golfer’s elbow, the tendon on the inner side of the elbow is affected.

Both conditions are caused by vigorous and repeated use of the forearm against resistance, which can occur when playing certain sports, such as tennis, or using a screwdriver. The tendon is repeatedly pulled at the point at which may cause small tears to develop. The resulting damage leads to tenderness and pain in the affected arm.

You should rest the affected painful arm as much as possible. Physiotherapy, ice packs, simple exercises to stretch and strengthen the muscles, and ultrasound treatment may help to relieve symptoms. You may also find that a nonsteroidal anti-inflammatory drug helps. If the condition does not improve within 2-6 weeks, your doctor may inject a corticosteroid drug into the affected area. Once the symptoms have subsided, you should seek advice on ways to change your technique before resuming the sport or activity that gave rise to the condition.

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Prolonged, repeated movements of one part of the body, particularly if the movements are rapid and forceful, can cause symptoms described as repetitive strain injury (RSI). Overuse injury and cumulative trauma disorder are other names for the same condition. RSI most commonly affects the muscles and tendons in the arms. The condition may be associated with stress in the workplace or the home.

People who often carry out repeated movements as part of their everyday work, such as those using a keyboard or working on a production line, are particularly at risk of RSI. Musicians and athletes are also susceptible. Other disorders that cause pain in the muscles and tendons, such as tendinitis and tenosynovitis or carpal tunnel syndrome, can cause symptoms similar to those of RSI.

What are the symptoms?

The symptoms of RSI develop gradually and at first may occur only while performing the repetitive activity. The symptoms may include:

- Pain, aching and tingling.
- Restricted movement in the affected part of the body.

In the early stages of RSI, the symptoms may disappear when the affected area is rested. Later, you may have symptoms at rest. If you develop RSI, you should consult your doctor without delay since the condition is more difficult to treat one it has become long-standing.

What might be done?

Your doctor will ask about your lifestyle and any repetitive physical activities. Diagnosis is usually made after a physical examination. However, you may also have X-ray and blood tests to rule out disorders such as rheumatoid arthritis. Your doctor may also recommend a painkiller or nonsteroidal anti-inflammatory drug to relieve discomfort.

What can I do?

If you believe the symptoms are related to your occupation, you should inform your employer and seek advice from an occupational doctor or nurse. He or she can give you advice about posture changes and special equipment, such as adjustable seating, that may help you to avoid unnecessary strain. You should also make sure you take regular breaks from repetitive tasks. Rarely, a change in work or leisure activities may be advisable.

What is the prognosis?

If RSI is recognized at an early stage and steps are taken to reduce stress at work, you should make a complete recovery. A physiotherapist will probably be able to give you advice on how to use your muscles and build up their strength.

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Fibromyalgia is a disorder that causes widespread muscle pain and tenderness. The condition has no particular cause, and no visible abnormality has ever been identified in the muscle tissue. However, fibromyalgia commonly develops during periods of stress.

What are the symptoms?

The symptoms of fibromyalgia develop slowly over weeks and occur in a distinct pattern around the body. They may include the following:

- Muscle pain in the upper back, head, thighs, abdomen, and hips.
- Particularly tender areas of muscle, typically at the base of the skull and near the shoulder blades.

Fibromyalgia is commonly associated with headaches, tiredness, depression, anxiety disorders, and disturbed sleep patterns. Some people have irregular bowel movement. All of these symptoms usually become worse when levels of stress increase.

What might be done?

The diagnosis of fibromyalgia is often based on the symptoms and a physical examination, but you doctor may arrange for blood tests to rule out other disorders, such as rheumatoidj arthritis. Although there is no specific treatment, the pain may be relieved by deep tissue massage and locally applied moist heat, ultrasound treatment, or an injection with a local anaesthetic. Your doctor may also prescribe a low dosage of amitriptyline to relieve pain. Regular exercise is also important. Many people make a full recovery or learn to manage their symptoms and maintain a normal lifestyle, but some may be disabled.

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In torticollis, the muscles on one side of the neck contract and cause the head to be pulled over to one side. The condition is typically accompanied by pain and stiffness in the neck.

Torticollis may develop in babies after a difficult birth involving neck muscle damage. In children, the disorder may be a result of swollen glands in the neck caused by an infection. Torticollis in adults is often caused by physical injury to muscles or by sleeping in an awkward position. The disorder can also be a side effect of certain drugs, such as some tranquilizers. An uncommon cause of the condition is cervical spondylosis, a form of arthritis that affects the bones of the neck.

Your doctor may make the diagnosis from a physical examination. Torticollis in babies will gradually get better with physiotherapy. In adults and older children, painkillers, local heat, massage, and use of a neck collar may help to relieve the muscle spasm. Recovery usually takes only a few days but if torticollis persists, a local injection of botulinum toxin may be given. If the disorder is caused by a particular drug, it will improve once the drug is stopped.

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Muscle cramps affect almost everyone from time to time. Painful spasms, often lasting only a few minutes, make the affected muscle become hard and tender. Muscle cramps may occur in any muscle in the body but they are most common in leg muscles. When abdominal muscles are affected, the condition is also known as a “stitch”.

Muscle cramps often develop during physical exercise, possibly as a result of reduction in the oxygen supply to the muscles or build-up of chemical waste produced by muscles during exercise. Another possible cause is the loss of salt and water that occurs due to heavy sweating during hot weather or strenuous exercise. Muscle cramps may also develop if you have been sitting or lying in an awkward position for a long time. Sometimes, there is no obvious cause.

Cramps are not the only cause of attacks of muscle pain. If you develop recurrent muscle pain in your calves when walking, you should consult your doctor; the cause may be lower limb ischaemia, a disorder in which the arteries that supply blood to the leg muscles become narrowed.

The immediate self-help treatment for muscle cramps is to stretch and rub the affected area and to apply a heat pad. You should drink plenty of fluids and eat something salty. If you regularly have cramps at night, your doctor may prescribe a low dose of quinine, an antimalarial drug that effectively relieves the symptoms.

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