eMedicine Specialties > Physical Medicine and Rehabilitation > Muscle Pain Syndromes

Overuse Injury: Differential Diagnoses & Workup

Author: Scott R Laker, MD, Staff Physician, Department of Rehabilitation, University of Colorado Health Sciences Center
Coauthor(s): William J Sullivan, MD, Assistant Professor, Pain Medicine Fellowship Director, Director of Medical Student Education, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center; Scott Strum, MD, Director of Traumatic Brain Injury Service, Assistant Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center
Contributor Information and Disclosures

Updated: Mar 12, 2008

Differential Diagnoses

Cubital Tunnel Syndrome
Gamekeeper's Thumb
Supraspinatus Tendonitis
Tarsal Tunnel Syndrome

Other Problems to Be Considered

Acromioclavicular degeneration (eg, Acromioclavicular Joint Injury)
Ankle degeneration
Anterior cruciate laxity (eg, Anterior Cruciate Ligament Injury)
Elbow degeneration (eg, Elbow and Forearm Overuse Injuries)
Knee degeneration
Neck pain
Pronator teres syndrome
Shin splints
Suprascapular nerve compression
Tibialis anterior tendinopathy
Tibialis posterior tendinopathy
Achilles tendinopathy

See also the following related Medscape topic:
Tendinopathy -- From Basic Science to Treatment

Workup

Laboratory Studies

  • Laboratory tests are rarely contributory to the evaluation of overuse injury. No laboratory results contribute to the diagnosis of overuse injury, although several tests are generally ordered during the initial workup to rule out other etiologies of pain, depending on the patient's presentation.
    • Erythrocyte sedimentation rate
    • Rapid plasma reagent testing
    • Antinuclear antibody testing
    • C-reactive protein
    • Complete blood count (CBC), B12, thyroid-stimulating hormone (TSH), comprehensive metabolic panel, and liver function tests are also used for initial evaluation.

Imaging Studies

  • The diagnosis of most overuse injuries does not require imaging studies. However, if surgical intervention is considered, imaging studies are vital for the decision-making process.
  • Radiography
    • Bony avulsions are relatively common among people who participate in dance, athletic activity, and heavy physical labor. Radiography is useful for defining these bony avulsions.
    • Stress fractures; calcification of tendons, which occurs in persons with chronic tendonitis; joint mice; myositis ossificans; heterotopic ossification; and atrophy of cartilage generally are revealed with radiography.
  • Bone scanning - This may reveal stress fractures that are not evident on radiographs.
  • Magnetic resonance imaging (MRI)
    • Typically, MRI is most effective for acute injuries; findings are generally more subtle with chronic injuries.
    • MRI is increasingly effective for revealing the site of nerve compression when large nerves are involved (eg, ulnar, median, sciatic), but it is not yet definitive for smaller nerves. Its true sensitivity is still being determined for these uses.
    • MRI has been quite successful in revealing tendon, ligament, and muscle injuries.  It is easily available, does not involve radiation, and can help to assess chronicity of soft-tissue injuries.
    • The presence of bone marrow edema on MRI scans may precede visualization of stress fractures of the cortical bone and indicates trauma to the trabecular portions of the bone.
    • Banks and colleagues published a review of MRI findings in athletes' overuse injuries.14

Other Tests

  • Electrodiagnostic testing (eg, EMG, nerve conduction studies) can be very useful when used appropriately. In cases of peripheral nerve compression or injury, such testing can provide evidence of the location and severity of the injury. EMG and nerve conduction studies are not tests with high specificity, although they can provide much-needed information when vague symptoms are the chief complaint. They are also very useful for documenting work-related injuries.

Procedures

  • Steroid injections are the most commonly used procedure in the treatment of overuse injuries, although controversy surrounding this treatment is still readily apparent. Tendons and ligaments can become structurally weakened by the use of steroids, predisposing them to rupture. The use of local anesthetics and steroids should be reserved for patients with significant pain who have the ability to change the underlying cause behind their injury. Repeatedly injecting patients who will inevitably return to the same routine that initially caused the injury is not advisable.
  • Many steroid injections can be performed under ultrasonographic guidance to increase accuracy and decrease the possibility of intratendon or intraligament injection.

More on Overuse Injury

Overview: Overuse Injury
Differential Diagnoses & Workup: Overuse Injury
Treatment & Medication: Overuse Injury
Follow-up: Overuse Injury
References
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Further Reading

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Keywords

repetitive stress disorder, repetition strain injury, cumulative trauma disorder, secondary gain, malingering, worker's compensation fraud, workers compensation fraud, worker's compensation abuse, workers compensation abuse, worker's compensation, workman's comp, overuse injuries, cumulative trauma disorder, repetitive demand injuries, occupational injury

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Contributor Information and Disclosures

Author

Scott R Laker, MD, Staff Physician, Department of Rehabilitation, University of Colorado Health Sciences Center
Scott R Laker, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

William J Sullivan, MD, Assistant Professor, Pain Medicine Fellowship Director, Director of Medical Student Education, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center
William J Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, International Spine Intervention Society, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Scott Strum, MD, Director of Traumatic Brain Injury Service, Assistant Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center
Scott Strum, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Medical Editor

Teresa L Massagli, MD, Residency Director, Professor, Department of Rehabilitation Medicine and Pediatrics, University of Washington School of Medicine
Teresa L Massagli, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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