Tendonitis
Background
- Tendonitis (aka "tendinitis" or "tendinopathy") is an inflammation or irritation of a tendon
- Commonly occurs in athletes or middle-aged (or older) patients
- Associated with excessive strain, repetitive trauma, or unaccustomed exercise
- Fluoroquinolone antibiotics and statins may increase risk for tendinopathy[1]
Tendinopathy Types
- Patellar tendonitis
- Lateral epicondylitis (tennis elbow)
- Medial epicondylitis (golf elbow)
- Pes anserine bursitis
Clinical Features
- Pain w/ movement, particularly at the insertion site.
- Mild swelling
Differential Diagnosis
- Muscle contusion
- Ligamentous Injury
- Nerve compression
- Tumor
- Bursitis
- Osteomyelitis
- Compartment syndrome
- Rhabdomyolysis
- Fracture
- Arthritis
- Myositis
- Fluoroquinolone use
Evaluation
Physical Exam
Exam techniques vary based on specific tendinopathy
- Lateral epicondylitis
- Medial epicondylitis
- Patellar tendonitis
- De Quervain tenosynovitis
- Rotator cuff tendinitis
- Bicipital tendinopathy
- Popliteus tendinopathy
- Iliotibial band syndrome
- Medial tibial stress syndrome ("shin splints")
Labs
- Consider labs if concern for infection:
- CBC
- CRP/ESR
Imaging
- Ultrasound
- May aid the diagnosis
- Findings include tendon disruption, increased blood flow, hypoechoic areas, or tendon thickening
- X-Ray
- Consider if concern for fracture, foreign body, or avulsion injury
- MRI
- Not frequently used in ED; may be used by specialist or in outpatient setting
Management
- Treatment specific to type of tendinopathy
- General management for acute, movement-based tendinopathies:
- Consider:
- Physical therapy referral
- Oral steroids
Disposition
- Most patients with tendinopathy can be discharged safely from the ED
- Admit patients who may benefit from hospitalization or surgery (infection, associated fracture, tendon rupture)
See Also
External Links
References
- ↑ Marie I, Delafenêtre H, Massy N, Thuillez C, Noblet C; Network of the French Pharmacovigilance Centers. Tendinous disorders attributed to statins: a study on ninety-six spontaneous reports in the period 1990-2005 and review of the literature. Arthritis Rheum. 2008;59(3):367-372. doi:10.1002/art.23309
- ↑ Ferry ST, Dahners LE, Afshari HM, Weinhold PS. The effects of common anti-inflammatory drugs on the healing rat patellar tendon. Am J Sports Med. 2007;35(8):1326-1333. doi:10.1177/0363546507301584