Atlas of pathophysiology, 2 Edition

Part II - Disorders

Musculoskeletal disorders

Tendinitis

Tendinitis is a painful inflammation of tendons and of tendon-muscle attachments to bone, especially in the shoulder rotator cuff, Achilles' tendon, or hamstring.

Causes

·   Overuse, such as strain during sports activity

·   Other musculoskeletal disorder, such as rheumatic diseases, congenital defects

·   Postural misalignment

·   Abnormal body development

·   Hypermobility

Pathophysiology

A tendon is a band of dense fibrous connective tissue that attaches muscle to bone. Tendons are extremely strong, flexible, and inelastic. Tendinitis is an inflammation of the tendon, usually resulting from a strain.

Age Alert

Common forms of tendinitis in adolescents (both males and females) are patellar tendinitis associated with inflammation of the tibial apophysis (Osgood-Schlatter disease) and Achilles' tendinitis at the calcaneal apophysis (Sever's disease).

Signs and symptoms

·   Restricted range of motion

·   Localized pain (most severe at night; commonly interferes with sleep)

·   Swelling

·   Crepitus

·   Calcific tendinitis

§  Proximal weakness (due to calcium deposits in the tendon)

§  Calcium erosion into adjacent bursae (acute calcific bursitis)

Diagnostic test results

·   X-rays may be normal at first but later show bony fragments, osteophyte sclerosis, or calcium deposits.

·   Arthrography shows irregularities on the undersurface of the tendon.

·   Computed tomography scan and magnetic resonance imaging identify tears, partial tears, and inflammation.

Treatment

·   Immobilization with a sling, splint, or cast

·   Systemic analgesics

·   Application of cold or heat

·   Injection of a corticosteroid and an anesthetic such as lidocaine into tendon sheath

·   Oral nonsteroidal anti-inflammatory drugs until patient is free of pain and able to perform range-of-motion exercises easily

·   Surgical debridement of degenerative tendon or excision of calcific deposits may be needed.

P.239

ELBOW TENDINITIS

image