Basics
Description
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 overuse
- Verify acute nature of injury.
- Signs and symptoms
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 and 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
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
- Infection
- Especially gonococcal disease, septic arthritis, or osteomyelitis; rarely, tuberculosis
- Environmental
- Metabolic
- Congenital
- Generalized hypermobility
- Marfan syndrome
- Ehlers-Danlos
- Immunologic
- Ankylosing spondylitis and the reactive spondyloarthropathies (inflammatory bowel disease, reactive arthritis)
- Juvenile idiopathic arthritis
- Psychological or neuropathic
- Amplified 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.