musculoskeletal and connective tissue disorders
Tendinitis and Tenosynovitis
Diagnosis of Tendinitis and Tenosynovitis
Clinical evaluation Sometimes imaging Usually, the diagnosis can be based on symptoms and physical examination, including palpation or specific maneuvers to assess pain. MRI or ultrasonography may be done to confirm the diagnosis, rule out other disorders, and detect tendon tears and inflammation. Rotator cuff tendinitis is the most common cause of shoulder pain. The rotator cuff is composed of four tendons, the supraspinatus, infraspinatus, subscapularis, and teres minor. The supraspinatus tendon is most frequently involved and the subscapularis is second. Active abduction in an arc of 40 to 120° and internal rotation cause pain ( see Rotator Cuff Injury/Subacromial Bursitis ). Passive abduction causes less pain, but abduction against resistance can increase pain. Calcium deposits in the tendon just below the acromion are sometimes visible on x-ray. Ultrasonography or MRI may help with further evaluation (eg, if the diagnosis is otherwise unclear) and with treatment decisions (eg, presence of significant tears that might require surgical interventions). Pain in the biceps tendon is aggravated by shoulder flexion or resisted supination of the forearm. Examiners can elicit tenderness proximally over the bicipital groove of the humerus by rolling (flipping) the bicipital tendon under their thumb. Volar flexor tenosynovitis ( Digital Flexor Tendinitis and Tenosynovitis (Trigger Finger) ) is a common musculoskeletal disorder that is often overlooked. Pain occurs in the palm on the volar aspect of the thumb or other digits and may radiate distally. Palpation of the tendon and sheath elicits tenderness; swelling and sometimes a nodule are present. The affected digit may rest in a flexed position, and passive extension elicits pain. In later stages, the digit may lock when it is flexed, and forceful extension may cause a sudden release with a snap (trigger finger). Patients with trochanteric bursitis almost always have gluteus medius tendinitis. In patients with trochanteric bursitis, palpation over the lateral prominence of the greater trochanter elicits tenderness. Patients often have a history of chronic pressure on the joint, trauma, a change in gait (eg, due to Osteoarthritis (OA) , 