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]

Clinical Features

  • Pain w/ movement, particularly at the insertion site.
  • Mild swelling

Differential Diagnosis

Evaluation

Physical Exam

Exam techniques vary based on specific tendinopathy

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

  1. 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
  2. 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