eMedicine Specialties > Emergency Medicine > Rheumatology

Tendonitis: Differential Diagnoses & Workup

Author: Mark Steele, MD, Associate Dean for Truman Medical Center Programs, Professor, Department of Emergency Medicine, University of Missouri-Kansas City
Coauthor(s): Jeffrey G Norvell, MD, Clinical Assistant Professor of Emergency Medicine, University of Kansas School of Medicine
Contributor Information and Disclosures

Updated: Mar 31, 2008

Differential Diagnoses

Abdominal Pain in Elderly Persons
Gout and Pseudogout
Ankle Injury, Soft Tissue
Hand Infections
Arthritis, Rheumatoid
Knee Injury, Soft Tissue
Bursitis
Plantar Fasciitis
Carpal Tunnel Syndrome
Psoriasis
Compartment Syndrome, Extremity
Reactive Arthritis
Deep Venous Thrombosis and Thrombophlebitis
Rotator Cuff Injuries
Gonorrhea
Tenosynovitis

Other Problems to Be Considered

Osteoarthritis

Workup

Imaging Studies

  • Radiographs may be indicated if a history of trauma is present, but findings usually are negative with tendinopathy.
    • Occasionally a fleck of bone may be visualized, suggesting an avulsion fracture at the site of tendinous insertion.
    • A roughened appearance of the bone at the site of tendinous insertion may suggest periostitis.
    • Calcium deposits along the tendon may be visualized with calcific tendinopathy.
  • Further imaging studies, such as ultrasonography and magnetic resonance imaging (MRI), are usually reserved for when the diagnosis is unclear or the patient's condition fails to improve with conservative management.
    • Ultrasonography is a rapid, noninvasive, and portable method to evaluate for tendinopathy.
      • On ultrasound images, tendon changes are noted by alterations in tendon morphology and echogenicity. Mucoid degeneration and tendon tearing diminish echogenicity. Calcification can also be appreciated.
      • Ultrasonography has been shown to be accurate in evaluating the rotator cuff and Achilles tendon.
      • One recent study found that ultrasonography had a greater accuracy than MRI in confirming the clinical diagnosis of patellar tendinopathy.1
    • MRI is also accurate in accessing tendon pathology.
      • In the United States, tendinopathy is imaged more often with MRI than with ultrasonography.
      • One of the strengths of MRI is that it can also assess cartilage injuries, bony abnormalities, and ligamentous injury, which greatly aids patient management.

More on Tendonitis

Overview: Tendonitis
Differential Diagnoses & Workup: Tendonitis
Treatment & Medication: Tendonitis
Follow-up: Tendonitis
References
[ CLOSE WINDOW ]

References

  1. [Best Evidence] Warden SJ, Kiss ZS, Malara FA, Ooi AB, Cook JL, Crossley KM. Comparative accuracy of magnetic resonance imaging and ultrasonography in confirming clinically diagnosed patellar tendinopathy. Am J Sports Med. Mar 2007;35(3):427-36. [Medline].

  2. Warden SJ, Metcalf BR, Kiss ZS, Cook JL, Purdam CR, Bennell KL, et al. Low-intensity pulsed ultrasound for chronic patellar tendinopathy: a randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford). Apr 2008;47(4):467-71. [Medline].

  3. Adler RS, Finzel KC. The complementary roles of MR imaging and ultrasound of tendons. Radiol Clin North Am. Jul 2005;43(4):771-807, ix. [Medline].

  4. Biundo JJ Jr, Mipro RC Jr, Fahey P. Sports-related and other soft-tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. Mar 1997;9(2):151-4. [Medline].

  5. Biundo JJ, Irwin RW, Umpierre E. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. Mar 2001;13(2):146-9. [Medline].

  6. Crawford JO, Laiou E. Conservative treatment of work-related upper limb disorders: a review. Occup Med (Lond). Jan 2007;57(1):4-17. [Medline].

  7. Garrick JG, Webb DR. Sports Injuries: Diagnosis and Management. Philadelphia, Pa: WB Saunders; 1990.

  8. Gold L, Igra H. Levofloxacin-induced tendon rupture: a case report and review of the literature. J Am Board Fam Pract. Sep-Oct 2003;16(5):458-60. [Medline].

  9. Hales TR, Bernard BP. Epidemiology of work-related musculoskeletal disorders. Orthop Clin North Am. Oct 1996;27(4):679-709. [Medline].

  10. Harrell RM. Fluoroquinolone-induced tendinopathy: what do we know?. South Med J. Jun 1999;92(6):622-5. [Medline].

  11. Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician. Apr 15 2005;71(8):1545-50. [Medline].

  12. McLoughlin RF, Raber EL, Vellet AD, et al. Patellar tendinitis: MR imaging features, with suggested pathogenesis and proposed classification. Radiology. Dec 1995;197(3):843-8. [Medline].

  13. Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005;87-A:187-202. [Medline].

  14. Sorosky B, Press J, Plastaras C, Rittenberg J. The practical management of Achilles tendinopathy. Clin J Sport Med. Jan 2004;14(1):40-4. [Medline].

  15. Tytherleigh-Strong G, Hirahara A, Miniaci A. Rotator cuff disease. Curr Opin Rheumatol. Mar 2001;13(2):135-45. [Medline].

  16. van Tulder M, Malmivaara A, Koes B. Repetitive strain injury. Lancet. May 26 2007;369(9575):1815-22. [Medline].

  17. Wang JH, Iosifidis MI, Fu FH. Biomechanical basis for tendinopathy. Clin Orthop Relat Res. Feb 2006;443:320-32. [Medline].

  18. Wilson JJ, Best TM. Common overuse tendon problems: A review and recommendations for treatment. Am Fam Physician. Sep 1 2005;72(5):811-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

tendonitis, pain at tendinous insertions, lateral epicondylitis, tennis elbow, medial epicondylitis, calcific tendinitis, rotator cuff tendonitis, patellar tendonitis, popliteus tendonitis, iliotibial band syndrome, shinsplints, Achilles tendonitis, supraspinatus tendonitis, bicipital tendonitis, Yergason test, Speed test, Renne test, tendonopathy, tendinopathy, tendinitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Mark Steele, MD, Associate Dean for Truman Medical Center Programs, Professor, Department of Emergency Medicine, University of Missouri-Kansas City
Mark Steele, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey G Norvell, MD, Clinical Assistant Professor of Emergency Medicine, University of Kansas School of Medicine
Jeffrey G Norvell, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Richard S Krause, MD, Clinical Assistant Professor, Residency Program Director, Department of Emergency Medicine, State University of New York at Buffalo School of Medicine
Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Gino A Farina, MD, Program Director, Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine
Gino A Farina, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.