Tendonitis

Background

Achilles tendon.

• 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

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:
  • Rest/load reduction
  • Ice/heat
  • NSAIDS (Ibuprofen favored)
• 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)