Tendonitis
Tendonitis: Excerpt from The 5-Minute Pediatric Consult
David D. Sherry, MD
Tendonitis - BASICS
Tendonitis - description
Inflammation of a tendon or along the tendon sheath
Tendonitis - epidemiology
- Increases with age and at time of puberty.
- May be slightly more common in girls.
Tendonitis - risk factors
Tendonitis - genetics
Hypermobile individuals may be prone to tendonitis.
Tendonitis - pathophysiology
Inflammation and microtearing may be present.
Tendonitis - etiology
Frequently associated with repetitive motion/overuse activities
Tendonitis - DIAGNOSIS
Tendonitis - signs & symptoms
Tendonitis - history
Trauma or overuse:
- Verify acute nature of injury.
Tendonitis - physical exam
- Evidence of hematoma:
- Palpate around and about affected areas, detecting point tenderness especially at tendon insertions as well as over bony prominences.
- Evidence of bursitis or arthritis:
- Systemic conditions such as spondyloarthropathy can lead to inflammation of tendons, bursa, and joints, and bursitis can mimic the pain of tendonitis.
- Pop or snap felt at the time of the event:
- Sometimes this is felt when tendons and ligaments are torn or avulsed.
- Caution: False-positives:
- Patients may have torn ligaments, fractures, or arthritis, not just tendonitis on examination.
- Pitfalls:
- Overdiagnosis in young children, in whom overuse is rare and other diagnoses should be considered
- Underdiagnosis in older children in whom repetitive activities are likely to occur.
Tendonitis - tests
Tendonitis - lab
ESR:
Occasionally helpful to rule out inflammatory conditions if history and/or physical examination are suggestive
Tendonitis - imaging
Plain radiograph:
Affected area may be indicated to rule out a fracture, avulsion, or identify a bone spur.
Tendonitis - differencial diagnosis
- Infection:
- Especially gonococcal disease, septic arthritis, or osteomyelitis
- Environmental:
- Metabolic:
- Congenital:
- Generalized hypermobility
- Marfan syndrome
- Ehlers-Danlos
- Immunologic:
- Ankylosing spondylitis and the reactive spondyloarthropathies (inflammatory bowel disease, reactive arthritis)
- Inflammatory arthritides
- Psychologic:
- Amplified musculoskeletal pain
Tendonitis - TREATMENT
Tendonitis - general measures
- Rest/Reduced use of the affected tendon/muscle group is essential, occasionally requiring splinting.
- Duration of therapy:
Tendonitis - special therapy
Tendonitis - phys therapy
Physical or occupational therapy:
Either self-directed or formal help with resumption of desired activity, through gentle range of motion exercises against low resistance and advanced as tolerated
Tendonitis - medication
- NSAIDs
- Rarely do soft-tissue steroid injections have a role in children.
Tendonitis - FOLLOW UP
Improvement often takes 2–6 weeks.
Tendonitis - prognosis
Usually good for children; however, many will suffer recurrences if proper exercises before desired activity are not continued.
Tendonitis - complications
Ongoing pain and predisposition for recurrence
Tendonitis - patient monitoring
If the provocative activity is resumed too soon, the irritation will recur.
Tendonitis - bibliography
- Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: An analysis of the literature. Med Sci Sports Exerc. 1998;30:1183–1190.
- Athreya BH, Cheh ML, Kingsland LC 3rd. Computer assisted diagnosis of pediatric rheumatic disease. Pediatrics. 1998;102:E48.
- Marsh JS, Daigneault JP. Ankle injuries in the pediatric population. Curr Opin Pediatr. 2000;12:52–60.
- Micheli LJ, Fehlandt AF. Overuse injuries to tendons and apophyses in children and adolescents. Clin Sports Med. 1992;11:713–726.
Tendonitis - CODES
Tendonitis - icd9
726.90 Tendonitis
Tendonitis - FAQ
- Q: Which activities can result in overuse syndromes and tendonitis?
- A: Virtually any repetitive activity in which children engage can cause tendonitis. For example, pain in the tendons of the thumb has occurred in children overusing video games.
Book Source Details
- Book Title: The 5-Minute Pediatric Consult
- Author(s): M. William Schwartz MD; et al.
- Year of Publication: 2008
- Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.
More About Tendinitis
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: The 5-Minute Pediatric Consult
Authors: M. William Schwartz MD; et al.
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7577-9
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