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Overuse Injury Workup

  • Author: Scott R Laker, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Aug 20, 2015
 

Laboratory Studies

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  • 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.
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Imaging Studies

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  • 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.[21]
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Other Tests

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  • 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.
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Procedures

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  • 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.[22]
  • Many steroid injections can be performed under ultrasonographic guidance to increase accuracy and decrease the possibility of intratendon or intraligament injection.
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Contributor Information and Disclosures
Author

Scott R Laker, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Medical Director, Lone Tree Health Center

Scott R Laker, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Scott Strum, MD 

Scott Strum, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

William J Sullivan, MD Associate Professor, Pain Medicine Fellowship Site 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, North American Spine Society, International Spine Intervention Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Teresa L Massagli, MD Professor of Rehabilitation Medicine, Adjunct Professor of Pediatrics, University of Washington School of Medicine

Teresa L Massagli, MD is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

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