| History: Obtaining a thorough history is important and should include the exact location of the pain; onset; associated activities at the time of onset; aggravating and alleviating factors; other medical conditions; current medications; and occupational and recreational history. The individual may complain of pain at a specific point in the area of a muscle origin or insertion. Pain may have begun gradually or be sudden in onset and reproduced with activity of the muscle or muscle group. The individual may also report repetitive use of that particular muscle group; it is very important to identify what activity (or activities) is causing the tendinitis. An athlete may report use of different footwear or equipment, or a change in training or training surfaces. Physical exam: A detailed physical examination is the key to diagnosis. Usually there is pain with palpation (gentle touch) of the muscle unit; the pain may be localized to the insertion or origin of the muscle. Swelling, warmth, stiffness, and redness may also be present. Creaking or popping (crepitus) may be palpated. Pain may limit the normal range of motion of the affected muscle or muscle group. A neurovascular exam will help to rule out compartment syndrome and nerve injury. If the tendinopathy is chronic, thickening of the tendon on the affected side may be noted when compared with the normal side. Extreme pain in a lower extremity may indicate acute compartment syndrome. Excessive swelling may be a sign of tendon rupture. Tests: Testing is seldom needed to make the diagnosis of tendinitis. If arthritis is suspected, specialized blood tests such as a rheumatoid factor assay may be helpful in determining the type of arthritis. If there is a history of trauma, an x-ray may reveal skeletal abnormalities at the site of tendon origin/insertion or calcium deposits in the tendons of the rotator cuff. Ultrasound can measure tendon width and integrity of the collagen as well as calcifications. Ultrasound is quick, non-invasive, and less expensive than MRI. |
Source: Medical Disability Advisor