Tendonitis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Achilles-tendon.jpg|thumb|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<ref>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</ref> | |||
{{Tendinopathy types}} | |||
==Clinical Features== | ==Clinical Features== | ||
*Pain w/ movement, particularly at the insertion site. | |||
*Mild swelling | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* Muscle contusion | * Muscle contusion | ||
* Ligamentous Injury | * Ligamentous Injury | ||
* | * Nerve compression | ||
* Tumor | * Tumor | ||
* Compartment syndrome | * [[Bursitis]] | ||
* Rhabdomyolysis | * [[Osteomyelitis]] | ||
* | * [[Compartment syndrome]] | ||
* [[Rhabdomyolysis]] | |||
* Arthritis | * [[Fracture]] | ||
* Myositis | * [[Arthritis]] | ||
* [[Myositis]] | |||
*[[Fluoroquinolones|Fluoroquinolone]] use | |||
==Evaluation== | ==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== | ==Management== | ||
* Treatment specific to type of tendinopathy | |||
* General management for acute, movement-based tendinopathies: | |||
**Rest/load reduction | |||
**Ice/heat | |||
**NSAIDS ([[Ibuprofen]] favored)<ref>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</ref> | |||
*Consider: | |||
** Physical therapy referral | |||
** Oral steroids | |||
==Disposition== | ==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== | ==See Also== | ||
| Line 37: | Line 75: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | |||
[[Category:Sports Medicine]] | |||
Latest revision as of 19:44, 31 August 2022
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