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Tendonitis, Pediatric

Basics

Description

- Evidence of hematoma - Palpate around and about affected areas, detecting point tenderness especially at tendon insertions as well as over bony prominences.

- Pop or snap felt at the time of the event - Sometimes this is felt when tendons and ligaments are torn or avulsed.

- 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

- Immunologic - Ankylosing spondylitis and the reactive spondyloarthropathies (inflammatory bowel disease, reactive arthritis) - Juvenile idiopathic arthritis

- Psychological or neuropathic - Amplified musculoskeletal pain

Inflammation of a tendon or along the tendon sheath

Epidemiology

  • Increases with age and at time of puberty
  • May be slightly more common in girls

Risk Factors

Genetics

Hypermobile individuals may be prone to tendonitis.

Pathophysiology

Inflammation and microtearing may be present.

Etiology

Frequently associated with repetitive motion/overuse activities

Diagnosis

History

  • Trauma or overuseVerify acute nature of injury.
  • Signs and symptoms

Physical Exam

  • Evidence of hematomaPalpate around and about affected areas, detecting point tenderness especially at tendon insertions as well as over bony prominences.
  • Evidence of bursitis or arthritisSystemic 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 eventSometimes this is felt when tendons and ligaments are torn or avulsed.
  • Caution: false positivesPatients may have torn ligaments, fractures, or arthritis and not just tendonitis on examination.
  • PitfallsOverdiagnosis in young children, in whom overuse is rare and other diagnoses should be consideredUnderdiagnosis in older children in whom repetitive activities are likely to occur

Diagnostic Tests & Interpretation

Lab

Erythrocyte sedimentation rate (ESR): occasionally helpful to rule out inflammatory conditions if history and/or physical exam are suggestive

Imaging

Plain radiograph: Affected area may be indicated to rule out a fracture or avulsion or identify a bone spur.

Differential Diagnosis

  • InfectionEspecially gonococcal disease, septic arthritis, or osteomyelitis; rarely, tuberculosis
  • Environmental
  • Metabolic
  • CongenitalGeneralized hypermobilityMarfan syndromeEhlers-Danlos
  • ImmunologicAnkylosing spondylitis and the reactive spondyloarthropathies (inflammatory bowel disease, reactive arthritis)Juvenile idiopathic arthritis
  • Psychological or neuropathicAmplified musculoskeletal pain

Treatment

Medication

  • NSAIDs initially
  • Rarely, if ever, do soft tissue steroid injections have a role in children.

Additional Therapies

General Measures

  • Rest/reduced use of the affected tendon/muscle group is essential, occasionally requiring splinting.
  • Duration of therapy

Additional Therapies

  • Physical or occupational therapy for eccentric muscle strengthening
  • Either self-directed or formal help with resumption of desired activity to improve biomechanics

Ongoing Care

Follow-up Recommendations

Improvement often takes 2 " 6 weeks.

Patient Monitoring

If the provocative activity is resumed too soon, the irritation will recur.

Prognosis

Usually good for children; however, many will suffer recurrences if proper exercises before desired activity are not continued.

Complications

Ongoing pain and predisposition for recurrence

Additional Reading

  • Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc. 1998;30(8):1183 " 1190. [View Abstract]
  • Jonsson P, Alfredson H. Superior results with eccentric compared to concentric quadriceps training in patients with jumper 's knee: a prospective randomised study. Br J Sports Med. 2005;39(11):847 " 850. [View Abstract]
  • Marsh JS, Daigneault JP. Ankle injuries in the pediatric population. Curr Opin Pediatr. 2000;12(1):52 " 60. [View Abstract]
  • Pommering TL, Kluchurosky L. Overuse injuries in adolescents. Adolesc Med State Art Rev. 2007;18(1):95 " 120. [View Abstract]

Codes

ICD09

  • 726.90 Enthesopathy of unspecified site

ICD10

  • M77.9 Enthesopathy, unspecified

SNOMED

  • 34840004 Tendinitis (disorder)

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.