CRACKCast E117 - Tendinopathy and Bursitis

CRACKCast & Physicians as Humans on CanadiEM

This episode covers Chapter 107 of Rosen’s Emergency Medicine (9th Ed.), Tendinopathy and Bursitis.

Episode Overview:

• Mechanical overload and repetitive micro-trauma are the key underlying mechanisms of tendinopathy
• Most patients present with progressively worsening pain after work or sports-related activities that are repetitive in nature
• Tendinopathy can also be associated with non-mechanical causes such as:
  • Systemic manifestations of disease
  • Use of fluoroquinolones
  • Infectious etiologies
• Most patients with tendinopathies can be treated with conservative measures, such as:
  • Protection
  • Relative rest
  • Application of ice
  • Elevation
  • Medications
• Overuse syndromes take at least 6-12 weeks to heal
  • Patients need optimal loading and referral for physiotherapy or sports medicine therapy
• Urgent imaging of tendinopathy in the ED is rarely useful
  • Clinicians may elect to use bedside ultrasound to evaluate for other diagnoses
• Operative treatment of tendinopathy is required in select cases
• Consider infectious bursitis in all cases of acute bursitis
• Aspirate bursa and evaluate the fluid
  • Infectious bursitis is typically caused by Staph aureus
• Non-septic bursitis differential diagnosis:
  • Traumatic
  • Rheumatologic
  • Idiopathic
• Management of septic bursitis:
  • Antibiotics
  • NSAID's
  • Rest
  • Application of ice
  • Elevation
  • Prompt referral for follow-up +/- admission

Core questions:

1. What is the differential diagnosis for tendinopathy?
2. What are common sites for tendinitis?
3. List 6 differential diagnoses for atraumatic non-septic bursitis
4. List common causes for infected bursitis

Wisecracks:

1. Differentiate septic and inflammatory bursitis based on clinical exam and fluid aspirate results
2. List 4 physical exam findings of impingement syndrome