Tendonitis Clinical Presentation

Updated: Dec 23, 2016
  • Author: Mark Steele, MD; Chief Editor: Herbert S Diamond, MD  more...
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Presentation

History

The history in patients with tendonitis varies with the specific disorder, as follows:

  • Lateral epicondylitis - Pain at the lateral aspect of elbow is present and becomes worse with grasping and twisting [1] ; a history of playing racquet sports or manual labor is common.
  • Medial epicondylitis - Medial epicondylitis is common in Little League pitchers, golfers, bowlers, and carpenters [1] ; pain is located at the medial aspect of the elbow
  • Rotator cuff tendinopathy - This is associated with a history of participating in overhead activities such as painting, swimming, and throwing sports; deep ache in shoulder and painful range of motion are typical symptoms
  • Bicipital tendinopathy - Pain is in the anterior shoulder in the bicipital grove; pain worsens when flexing the shoulder or supinating the forearm
  • Patellar tendinopathy - Patellar tendinopathy, also referred to as jumper's knee, is associated with insidious onset of well-localized anterior knee pain; it is common in participants in jumping sports (eg, basketball, volleyball, high jumping) and running [2] ; anatomy of the patellar tendon is shown in the illustration below; pain worsens when changing position from sitting to standing or when walking or running uphill
    • The proximal patellar tendon is most commonly affe The proximal patellar tendon is most commonly affected in jumper's knee.
  • Popliteus tendinopathy - This type of tendinopathy is associated with lateral knee pain; running downhill is a risk factor
  • Iliotibial band syndrome - This is the most common overuse syndrome of the knee and manifests as lateral knee pain [3] ; the iliotibial band is depicted in the illustration below; this syndrome may be observed in cyclists, dancers, long-distance runners, football players, and military recruits; typically pain begins after completion of a run or several minutes into a run; pain is aggravated by running down hills, lengthening stride, or sitting for long periods of time with the knee flexed
  • Iliotibial band at the lateral femoral condyle, wi Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
  • Shin splints - Pain is located at the anteromedial aspect of the lower leg. Shin splints have been associated with overpronation and with running on hard surfaces without proper footwear
  • Achilles tendinopathy - Heel pain is evidence of Achilles tendinopathy; runners and other athletes have an increased incidence of Achilles tendinopathy; increased running distance, change in running surface, and poor footwear are associated factors
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Physical

Findings on physical examination vary with the specific disorder, as follows:

Lateral epicondylitis

  • Pain on palpation over the lateral epicondyle of the elbow
  • Pain at the elbow with resisted dorsiflexion of the wrist

Medial epicondylitis

  • Pain on palpation of the medial epicondyle of the elbow
  • Pain at the elbow with resisted flexion of the wrist

Supraspinatus tendinopathy (rotator cuff tendinopathy)

  • Pain on palpation over the greater tuberosity where the supraspinatus tendon inserts
  • Jobe test for supraspinatus function: With both arms abducted to 90°, held slightly in front of the body, and arms fully pronated comparative resistance is placed on both arms to compare strength and presence of pain. Inability to hold the arm up or presence of pain is suggestive of rotator cuff disease.
  • Hawkins test: Supraspinatus tendon impingement is suggested if pain occurs with forcible internal rotation with the patient's arm passively flexed and forward at 90°. The Hawkins test is shown in the image below.
    Hawkins test. The examiner forward flexes the arms 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.

Bicipital tendinopathy

  • Pain to palpation over the anterior shoulder
  • Focal tenderness over groove on humerus between the greater and lesser tuberosities
  • Pain with biceps resistance test (ie, shoulder flexion against resistance with elbow extended and forearm supinated)
  • Positive Yergason or Speed test (ie, pain with resisted supination of the wrist or with the elbow flexed at 90° and the arm adducted against the body); these tests are shown in the images below.
    Yergason test. Yergason test.
    Speed test. Speed test.

Patellar tendinopathy 

  • Tenderness at patellar tendon insertion into lower pole of the patella

Popliteus tendinopathy

  • Tenderness at the posterior-lateral joint line
  • Tendon palpated most easily when lateral ankle of the affected leg rests on the opposite knee
  • Lateral collateral ligament most prominent in this position; the popliteus is palpated just anterior to it and above the joint line
  • With patient supine, the knee flexed to 90°, and the leg rotated internally, resisted external rotation elicits pain (diagnostic maneuver described by Webb)

Iliotibial band syndrome

  • Pain localized to lateral femoral condyle - With patient supine and knee flexed to 90°, have patient extend knee while exerting pressure over the lateral femoral condyle; pain at 30° of knee flexion with compression of the iliotibial band
  • Positive Renne test finding (ie, flexing knee while standing with weight on affected knee resulting in pain at approximately 30° of flexion)
  • Positive Ober test result: The patient lies down with the unaffected side down and unaffected hip and knee at a 90° angle. If iliotibial band is tight, the patient will have difficulty adducting the leg beyond midline and may experience pain at the lateral aspect of the knee. The Ober test is shown below.
  • The Ober test. The Ober test.

Shin splints

  • Pain referred to anteromedial aspect of lower leg

Achilles tendinopathy

  • Localized tenderness approximately 6 cm proximal to the Achilles insertion on the heel
  • Pain with resisted plantar flexion of the ankle and passive dorsiflexion of the ankle
  • Crepitus may be palpable with severe cases
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