Laboratory Studies

Laboratory tests are rarely contributory to the evaluation of overuse injury, and no laboratory results contribute to the diagnosis of overuse injury. However, several tests are generally ordered during the initial workup to rule out other etiologies of pain, depending on the patient's presentation, including, but not limited to, the following:

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 (CMP)

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 more 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.^[31]

Ultrasonography

In the hands of a skilled clinician, US can be a quick and effective method in the clinic to assess for fluid collections, impingements, and/or soft tissue tears associated with many overuse injuries. However, US typically is not utilized as much in the surgical planning process as the aforementioned imaging modalities.

Other Tests

Electrodiagnostic testing (eg, EMG, nerve conduction studies) can be very useful when employed in the appropriate scenarios. 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.

Treatment & Management

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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)

Johnathon R Blake, MD, MHSA Resident Physician, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine

Johnathon R Blake, MD, MHSA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

William J Sullivan, MD Associate Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine

William J Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, North American Spine Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: North American Spine Society (NASS) Executive Committee<br/>Received income in an amount equal to or greater than $250 from: NASS Editor SpineLine Journal; NASS Board of Directors Executive Committee.

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 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

Disclosure: Nothing to disclose.

Chief Editor

Ryan O Stephenson, DO Associate Professor of Clinical Practice, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Medical Director of Polytrauma and Brain Injury (Polytrauma Network Site), Department of Physical Medicine and Rehabilitation, Eastern Colorado Veterans Affairs Medical Center

Ryan O Stephenson, DO 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

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.

Scott R Strum, MD Physiatrist and Pain Medicine Specialist, Loma Linda University Outpatient Rehabilitation Center, Loma Linda University Health

Scott R 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.