Dr David Collins  MD FRCP

  Consultant Rheumatologist


Tel / Fax: 01285 885146


This is a wide group of conditions predominantly characterised by pain, discomfort and restriction of movement as a result of inflammation or degeneration of the soft tissues around the joints, irritability and hypersensitivity of the muscles or trapping of the nerves supplying the limbs.


Common examples include:

Upper limb:

   Shoulder tendonitis with pain on raising the arm.

   Frozen Shoulder with restriction of all shoulder movements.

   Tennis and Golfers elbows.

   Tendonitis if the wrist and fingers, including trigger fingers.

   Trapping of the nerves in the neck, or at the elbow or wrist (Carpal Tunnel Syndrome).


Lower Limb:

   Bursitis around the hip or behind the knee.

   Inflammation of the tendons around the hip (eg adductor tendonitis),

         or below the knee (eg Achilles tendonitis).

   Plantar Fasciitis (Policeman's Heel).

   Morton's Neuroma in the foot.



More complex is Myofascial pain which comes from muscles and soft tissues but does not represent tissue damage or inflammation. Pain is usually felt in a region such as around the shoulder girdle, neck, damage or inflammation but probably represents a ‘reprogramming of the pain pathways in the nervous system. 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 the more widespread condition of fibromyalgia.

The treatment of these conditions depends on addressing any biomechanical factors and using exercise based physiotherapy to regain normal muscle and tendon health. Analgesic drugs are helpful to enable rehabilitation. Corticosteroid injections are useful in certain cases and occasionally surgery is required to free up trapped nerves or tissue.