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Tendonitis Workup

  • Author: Mark Steele, MD; Chief Editor: Herbert S Diamond, MD  more...
 
Updated: Oct 01, 2014
 

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.[8]

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.
 
 
Contributor Information and Disclosures
Author

Mark Steele, MD Professor, Department of Emergency Medicine, Chief Medical Officer, Truman Medical Center, University of Missouri-Kansas City School of Medicine

Mark Steele, MD is a member of the following medical societies: American Academy of Emergency Medicine, 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 Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

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.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Richard S Krause, MD Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Hawkins test. The examiner forward flexes the arms to 90° and then forcibly internally rotates the shoulder. This movement pushes the supraspinatus tendon against the anterior surface of the coracoacromial ligament and coracoid process. Pain indicates a positive test result for supraspinatus tendonitis.
Speed test.
Yergason test.
The proximal patellar tendon is most commonly affected in jumper's knee.
Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
The Ober test.
 
 
 
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