4/11/2020 https://emedicine.medscape.

com/article/809692-print

emedicine.medscape.com

Tendonitis
Updated: Dec 21, 2019
Author: Mark Steele, MD; Chief Editor: Herbert S Diamond, MD

Overview

Practice Essentials
Tendonitis is an inflammatory condition characterized by pain at tendinous insertions into bone. The term tendinosis refers to the
histopathologic finding of tendon degeneration. The term tendinopathy is a generic term used to describe a common clinical
condition affecting the tendons, which causes pain, swelling, or impaired performance. Because of the fact that most pain from
tendon conditions is not actually inflammatory in nature, tendinopathy may be a better term than tendonitis.

Common sites of tendinopathy include the following:

Rotator cuff of the shoulder (ie, supraspinatus) and bicipital tendons

Insertion of the wrist extensors (ie, lateral epicondylitis, tennis elbow) and flexors (ie, medial epicondylitis) at the elbow
Patellar and popliteal tendons and iliotibial band at the knee
Insertion of the posterior tibial tendon in the leg (ie, shin splints)
Achilles tendon at the heel

Pathophysiology
Tendons transmit the forces of muscle to the skeleton. As such, they are subjected to repeated mechanical loads, which are felt
to be a major causative factor in the development of tendinopathy. Pathologic findings include tendon inflammation, mucoid
degeneration, and fibrinoid necrosis in tendons. Microtearing and proliferation of fibroblasts have also been reported. However,
the exact pathogenesis of tendinopathy is unclear.

Epidemiology
Middle-aged adults are most susceptible to the development of tendinopathy.

Prognosis
In general, the prognosis is very good with rest and conservative therapy. Chronic tendinopathy can lead to weakening of the
tendon and subsequent rupture. Complications of tendonitis may include chronic disability, tendon rupture, and adhesive
capsulitis (ie, frozen shoulder).

https://emedicine.medscape.com/article/809692-print 1/12
4/11/2020 https://emedicine.medscape.com/article/809692-print

Patient Education
Quadriceps strengthening exercises is helpful for patellar tendinopathy and change in training routine and/or equipment, if
indicated. Runners with Achilles tendinopathy should wear proper footwear, run on softer surfaces, and avoid hills. Patients with
tennis elbow should maintain proper backhand technique, use a less tightly strung racket, and play on slower surfaces. Range-
of-motion exercises are recommended for patients with rotator cuff tendinopathy to avoid complication of adhesive capsulitis.

For patient education information, see Tendinitis and Tennis Elbow.

Presentation

History
The history in patients with tendonitis varies with the specific disorder, as follows:

Lateral epicondylitis - Pain at the lateral aspect of elbow is present and becomes worse with grasping and twisting[1] ; a
history of playing racquet sports or manual labor is common.

Medial epicondylitis - Medial epicondylitis is common in Little League pitchers, golfers, bowlers, and carpenters[1] ; pain
is located at the medial aspect of the elbow

Rotator cuff tendinopathy - This is associated with a history of participating in overhead activities such as painting,
swimming, and throwing sports; deep ache in shoulder and painful range of motion are typical symptoms

Bicipital tendinopathy - Pain is in the anterior shoulder in the bicipital grove; pain worsens when flexing the shoulder or
supinating the forearm

Patellar tendinopathy - Patellar tendinopathy, also referred to as jumper's knee, is associated with insidious onset of well-
localized anterior knee pain; it is common in participants in jumping sports (eg, basketball, volleyball, high jumping) and
running[2] ; anatomy of the patellar tendon is shown in the illustration below; pain worsens when changing position from
sitting to standing or when walking or running uphill

https://emedicine.medscape.com/article/809692-print 2/12
4/11/2020 https://emedicine.medscape.com/article/809692-print

The proximal patellar tendon is most commonly affected in jumper's knee.

Popliteus tendinopathy - This type of tendinopathy is associated with lateral knee pain; running downhill is a risk factor

Iliotibial band syndrome - This is the most common overuse syndrome of the knee and manifests as lateral knee pain[3] ;
the iliotibial band is depicted in the illustration below; this syndrome may be observed in cyclists, dancers, long-distance
runners, football players, and military recruits; typically pain begins after completion of a run or several minutes into a
run; pain is aggravated by running down hills, lengthening stride, or sitting for long periods of time with the knee flexed

Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.

Shin splints - Pain is located at the anteromedial aspect of the lower leg. Shin splints have been associated with
overpronation and with running on hard surfaces without proper footwear

Achilles tendinopathy - Heel pain is evidence of Achilles tendinopathy; runners and other athletes have an increased
incidence of Achilles tendinopathy; increased running distance, change in running surface, and poor footwear are
associated factors

Physical Examination
Findings on physical examination vary with the specific disorder, as follows:

Lateral epicondylitis

Pain on palpation over the lateral epicondyle of the elbow

Pain at the elbow with resisted dorsiflexion of the wrist

Medial epicondylitis

Pain on palpation of the medial epicondyle of the elbow

Pain at the elbow with resisted flexion of the wrist

Supraspinatus tendinopathy (rotator cuff tendinopathy)

https://emedicine.medscape.com/article/809692-print 3/12
4/11/2020 https://emedicine.medscape.com/article/809692-print
Pain on palpation over the greater tuberosity where the supraspinatus tendon inserts

Jobe test for supraspinatus function: With both arms abducted to 90°, held slightly in front of the body, and arms fully
pronated comparative resistance is placed on both arms to compare strength and presence of pain. Inability to hold the
arm up or presence of pain is suggestive of rotator cuff disease.

Hawkins test: Supraspinatus tendon impingement is suggested if pain occurs with forcible internal rotation with the
patient's arm passively flexed and forward at 90°. The Hawkins test is shown in the image below.

Hawkins test. The examiner forward flexes the arms to 90° and then forcibly internally rotates the shoulder. This
movement pushes the supraspinatus tendon against the anterior surface of the coracoacromial ligament and coracoid
process. Pain indicates a positive test result for supraspinatus tendonitis.

Bicipital tendinopathy

Pain to palpation over the anterior shoulder

Focal tenderness over groove on humerus between the greater and lesser tuberosities

Pain with biceps resistance test (ie, shoulder flexion against resistance with elbow extended and forearm supinated)

Positive Yergason or Speed test (ie, pain with resisted supination of the wrist or with the elbow flexed at 90° and the arm
adducted against the body); these tests are shown in the images below.

https://emedicine.medscape.com/article/809692-print 4/12
4/11/2020 https://emedicine.medscape.com/article/809692-print

Yergason test.

Speed test.

Patellar tendinopathy

Tenderness at patellar tendon insertion into lower pole of the patella

Popliteus tendinopathy

Tenderness at the posterior-lateral joint line

Tendon palpated most easily when lateral ankle of the affected leg rests on the opposite knee

Lateral collateral ligament most prominent in this position; the popliteus is palpated just anterior to it and above the joint
line

With patient supine, the knee flexed to 90°, and the leg rotated internally, resisted external rotation elicits pain (diagnostic
maneuver described by Webb)

Iliotibial band syndrome

Pain localized to lateral femoral condyle - With patient supine and knee flexed to 90°, have patient extend knee while
exerting pressure over the lateral femoral condyle; pain at 30° of knee flexion with compression of the iliotibial band

https://emedicine.medscape.com/article/809692-print 5/12
4/11/2020 https://emedicine.medscape.com/article/809692-print
Positive Renne test finding (ie, flexing knee while standing with weight on affected knee resulting in pain at approximately
30° of flexion)

Positive Ober test result: The patient lies down with the unaffected side down and unaffected hip and knee at a 90°
angle. If iliotibial band is tight, the patient will have difficulty adducting the leg beyond midline and may experience pain at
the lateral aspect of the knee. The Ober test is shown below.

The Ober test.

Shin splints

Pain referred to anteromedial aspect of lower leg

Achilles tendinopathy

Localized tenderness approximately 6 cm proximal to the Achilles insertion on the heel

Pain with resisted plantar flexion of the ankle and passive dorsiflexion of the ankle

Crepitus may be palpable with severe cases

DDx

Differential Diagnoses
Acute Compartment Syndrome

Ankle Injury, Soft Tissue

Bursitis

Carpal Tunnel Syndrome in Emergency Medicine

Deep Venous Thrombosis and Thrombophlebitis

Diphyllobothriasis

Gout and Pseudogout

Hand Infections

Plantar Fasciitis

Reactive Arthritis

Rheumatoid Arthritis (RA)

Rotator Cuff Injuries

Soft Tissue Knee Injury

https://emedicine.medscape.com/article/809692-print 6/12
4/11/2020 https://emedicine.medscape.com/article/809692-print

Workup

Workup

Imaging Studies
Radiographs may be indicated if a history of trauma is present, but findings usually are negative with tendinopathy.

Occasionally a fleck of bone may be visualized, suggesting an avulsion fracture at the site of tendinous insertion.

A roughened appearance of the bone at the site of tendinous insertion may suggest periostitis.

Calcium deposits along the tendon may be visualized with calcific tendinopathy.

Further imaging studies, such as ultrasonography and magnetic resonance imaging (MRI), are usually reserved for when the
diagnosis is unclear or the patient's condition fails to improve with conservative management.

Ultrasonography is a rapid, noninvasive, and portable method to evaluate for tendinopathy.

On ultrasound images, tendon changes are noted by alterations in tendon morphology and echogenicity. Mucoid
degeneration and tendon tearing diminish echogenicity. Calcification can also be appreciated.

Ultrasonography has been shown to be accurate in evaluating the rotator cuff and Achilles tendon.

One recent study found that ultrasonography had a greater accuracy than MRI in confirming the clinical diagnosis of
patellar tendinopathy.[4]

MRI is also accurate in accessing tendon pathology.

In the United States, tendinopathy is imaged more often with MRI than with ultrasonography.

One of the strengths of MRI is that it can also assess cartilage injuries, bony abnormalities, and ligamentous injury, which
greatly aids patient management.

Treatment

Approach Considerations
The goal of treatment is to reduce pain and to return to activity. Nonpharmacologic treatments of tendinopathy are as follows:

Rest or decrease activity level. No clear recommendations are available for the duration of rest; however, patients should
restrict activities that cause pain.

Ice is recommended for the first 24-48 hours.

Splinting and/or immobilization; sling for rotator cuff tendonitis

Strengthening and stretching exercises can be performed once the pain has subsided. Eccentric strength training can be
effective in treating tendinopathies.

Low-intensity pulsed ultrasound was shown to be no more effective than placebo in the treatment of patellar tendinopathy.[5]
Transcutaneous electrical nerve stimulation (TENS) provided no benefit over primary care management in a randomized trial in
241 adults with tennis elbow.[6]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving tendinopathy pain, and may be administered topically or
orally. However, because the vast majority of tendinopathies are not inflammatory, whether NSAIDs are more effective than
other analgesics is unclear.

https://emedicine.medscape.com/article/809692-print 7/12
4/11/2020 https://emedicine.medscape.com/article/809692-print

Corticosteroid injection may be considered for patients with tendonitis in whom conservative therapy with rest, immobilization,
and anti-inflammatory agents has failed.The corticosteroid (eg, triamcinolone) is typically combined with a local anesthetic (eg,
lidocaine) to provide prompt analgesia; in addition, pain relief confirms the diagnosis and accurate placement of the
corticosteroid.

The efficacy of locally injected steroids is debated. A systematic review concluded that steroid injections provide short-term pain
relief but may not have long-term efficacy.[7] Response to injection therapy may vary with the anatomic site of tendinopathy.

A randomized, controlled trial in 165 patients with unilateral lateral epicondylalgia of longer than 6 weeks' duration found that
although results at 4 weeks favored corticosteroid injection, at 1 year the rate of much improvement or complete recovery was
lower with corticosteroid injection than with placebo injection (83% vs 96%, respectively; relative risk [RR], 0.86; P = 0.01)).
One-year recurrence was also higher with corticosteroid versus placebo (54% vs 12%; RR, 0.23; P< 0.001).[8]

Never use injections for Achilles tendonitis, because cases of Achilles tendon rupture have been reported following a single
injection of corticosteroid. Avoid repetitive corticosteroid injections in any site, as well as injection directly into a tendon, because
of the risk of tendon rupture. The use of ultrasound to direct these treatments improves accuracy and performance by facilitating
visualization of the target and relevant adjacent structures.[9]

In patients with calcific tendonitis of the shoulder, a systematic review concluded that ultrasound (US)-guided needling and
lavage has a high success rate and low complication rate.[10] In a randomized controlled study in 48 patients with calcific
tendonitis of the rotator cuff that compared the combination of barbotage and US-guided corticosteroid injection in the
subacromial bursa with subacromial bursa injection alone, both treatment groups demonstrated improvement at 1-year follow-
up, but clinical and radiographic results were significantly better in the barbotage group.[11] After US-guided treatment, recovery
may be enhanced by use of a rehabilitation protocol that focuses on mobility, strength, and function.[12]

A retrospective evaluation of double-needle US-guided percutaneous fragmentation and lavage (DNL) in 147 patients
with rotator cuff calcific tendinitis found DNL to be safe and effective, with prompt relief of pain and function restoration.[13]
However, a systematic review of the efficacy of US-guided needle lavage in treating calcific tendinitis found a lack of high-quality
evidence to determine the relative efficacy.[14]

Surgical therapy

Patients with symptoms resistant to conservative therapy may benefit from arthroscopic or open surgical treatment for tendon
decompression and tenodesis. A Japanese study in 23 patients with chronic lateral epicondylitis who underwent arthroscopic
surgery found that the procedure provided significant improvement in pain and functional recovery up to 3 months after surgery.
However, the visual analog scale (VAS) for pain and satisfaction criteria during activity did not fall below 10 points until 6 months
postoperatively.[15]

Isolated gastrocnemius recession has been shown to provide significant and sustained pain relief for chronic
Achilles tendinopathy. Good function can be expected for activities of daily living, however ankle plantarflexion power and
endurance deficits were noted.[16, 17]

Platelet-rich therapies

Platelet-rich therapies represent an experimental approach to treatment of tendinopathies and other musculoskeletal soft tissue
injuries. In this technique, a quantity of the patient's blood is centrifuged and the active, platelet-rich fraction is extracted and
applied to the injured tissue (eg, by injection). In theory, the growth factors produced by platelets should enhance tissue healing.

Although platelet-rich therapies are gaining wider use, however, few level one studies exist demonstrating a clear benefit.[18,
19] Systematic reviews of the literature have concluded that evidence of benefit for the use of protein-rich plasma (PRP) as a
treatment for tendinopathies varies by site. There is evidence to support PRP injections for the treatment of lateral elbow and
patellar tendinopathy, whereas there remains insufficient evidence to support PRP for Achilles tendon or rotator cuff pathology.
[20] [21]

Medication

Medication Summary
The goals of pharmacotherapy are to control pain and decrease inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs)
are effective in relieving tendinopathy pain, and may be administered topically or orally. Corticosteroids may be considered when
conservative therapy has failed.

https://emedicine.medscape.com/article/809692-print 8/12
4/11/2020 https://emedicine.medscape.com/article/809692-print

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary
These agents are used for the relief of mild to moderate pain. Although the effects of NSAIDs in the treatment of pain tend to be
patient specific, ibuprofen usually is the drug of choice (DOC) for initial therapy. Other options include naproxen and
indomethacin.

Ibuprofen (Motrin, Advil, Ibuprin, Nuprin)

Usually DOC for treatment of mild to moderate pain if no contraindications are present.

Inhibits inflammatory reactions and pain, probably by decreasing activity of the enzyme cyclooxygenase, which results in
inhibition of prostaglandin synthesis.

Naproxen (Naprosyn, Aleve)

For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase,
which results in decrease of prostaglandin synthesis.

Indomethacin (Indocin, Indochron E-R)

Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits
prostaglandin synthesis.

Corticosteroids

Class Summary
These agents have both anti-inflammatory (glucocorticoid) and salt-retaining (mineralocorticoid) properties. Glucocorticoids
have profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.

Dexamethasone acetate (Decadron, AK-Dex, Alba-Dex, Dexone)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. Dosage
varies with degree of inflammation and size of affected area.

Methylprednisolone acetate (Solu-Medrol, Depo-Medrol, Medrol)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary
permeability.

Use 0.5-1 mL (40 mg/mL) mixed with equal or double volume of 1% local anesthetic (ie, lidocaine). Dosage varies with degree
of inflammation and size of affected area.

Hydrocortisone acetate (Solu-Cortef, Cortef)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary
permeability.

https://emedicine.medscape.com/article/809692-print 9/12
4/11/2020 https://emedicine.medscape.com/article/809692-print

Use 0.5-1 mL (25 or 50 mg/mL) mixed with equal or double volume of 1% local anesthetic (ie, lidocaine). Dosage varies with
degree of inflammation and size of affected area.

Contributor Information and Disclosures

Author

Mark Steele, MD Professor, Department of Emergency Medicine, Chief Medical Officer, Truman Medical Center, University of
Missouri-Kansas City School of Medicine

Mark Steele, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for
Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey G Norvell, MD, MBA, RDMS Associate Professor, Program Director, Department of Emergency Medicine, University of
Kansas Medical Center

Jeffrey G Norvell, MD, MBA, RDMS is a member of the following medical societies: American Academy of Emergency Medicine,
American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy;
Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra
University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency
Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate
Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians,
American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Richard S Krause, MD Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of
Buffalo State University of New York School of Medicine and Biomedical Sciences

Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency
Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

1. Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012 Sep. 4(5):384-93. [Medline]. [Full
Text].
https://emedicine.medscape.com/article/809692-print 10/12
4/11/2020 https://emedicine.medscape.com/article/809692-print
2. Mann KJ, Edwards S, Drinkwater EJ, Bird SP. A lower limb assessment tool for athletes at risk of developing patellar tendinopathy.
Med Sci Sports Exerc. 2012 Oct 10. [Medline].

3. Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician. 2005 Apr 15. 71(8):1545-50.
[Medline].

4. Warden SJ, Kiss ZS, Malara FA, Ooi AB, Cook JL, Crossley KM. Comparative accuracy of magnetic resonance imaging and
ultrasonography in confirming clinically diagnosed patellar tendinopathy. Am J Sports Med. 2007 Mar. 35(3):427-36. [Medline].

5. Warden SJ, Metcalf BR, Kiss ZS, Cook JL, Purdam CR, Bennell KL, et al. Low-intensity pulsed ultrasound for chronic patellar
tendinopathy: a randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford). 2008 Apr. 47(4):467-71. [Medline].

6. Chesterton LS, Lewis AM, Sim J, Mallen CD, Mason EE, Hay EM, et al. Transcutaneous electrical nerve stimulation as adjunct to
primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial). BMJ. 2013 Sep 2. 347:f5160.
[Medline]. [Full Text].

7. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of
tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010 Nov 20. 376(9754):1751-67. [Medline].

8. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes
in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013 Feb 6. 309(5):461-9. [Medline]. [Full Text].

9. Burke CJ, Adler RS. Ultrasound-Guided Percutaneous Tendon Treatments. AJR Am J Roentgenol. 2016 Sep. 207 (3):495-506.
[Medline]. [Full Text].

10. Gatt DL, Charalambous CP. Ultrasound-Guided Barbotage for Calcific Tendonitis of the Shoulder: A Systematic Review including
908 Patients. Arthroscopy. 2014 Sep. 30(9):1166-1172. [Medline].

11. de Witte PB, Selten JW, Navas A, Nagels J, Visser CP, Nelissen RG, et al. Calcific tendinitis of the rotator cuff: a randomized
controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med. 2013 Jul.
41(7):1665-73. [Medline].

12. Abate M, Schiavone C, Salini V. Usefulness of Rehabilitation in Patients with Rotator Cuff Calcific Tendinopathy after Ultrasound-
Guided Percutaneous Treatment. Med Princ Pract. 2014 Sep 6. [Medline].

13. Bazzocchi A, Pelotti P, Serraino S, Battaglia M, Bettelli G, Fusaro I, et al. Ultrasound imaging-guided percutaneous treatment of
rotator cuff calcific tendinitis: success in short-term outcome. Br J Radiol. 2016. 89 (1057):20150407. [Medline].

14. Vignesh KN, McDowall A, Simunovic N, Bhandari M, Choudur HN. Efficacy of ultrasound-guided percutaneous needle treatment of
calcific tendinitis. AJR Am J Roentgenol. 2015 Jan. 204 (1):148-52. [Medline].

15. Oki G, Iba K, Sasaki K, Yamashita T, Wada T. Time to functional recovery after arthroscopic surgery for tennis elbow. J Shoulder
Elbow Surg. 2014 Oct. 23(10):1527-31. [Medline].

16. Nawoczenski DA, Barske H, Tome J, Dawson LK, Zlotnicki JP, DiGiovanni BF. Isolated gastrocnemius recession for achilles
tendinopathy: strength and functional outcomes. J Bone Joint Surg Am. 2015 Jan 21. 97 (2):99-105. [Medline].

17. Nawoczenski DA, DiLiberto FE, Cantor MS, Tome JM, DiGiovanni BF. Ankle Power and Endurance Outcomes Following Isolated
Gastrocnemius Recession for Achilles Tendinopathy. Foot Ankle Int. 2016 Jul. 37 (7):766-75. [Medline].

18. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane
Database Syst Rev. 2013 Dec 23. 12:CD010071. [Medline].

19. Setayesh K, Villarreal A, Gottschalk A, Tokish JM, Choate WS. Treatment of Muscle Injuries with Platelet-Rich Plasma: a Review of
the Literature. Curr Rev Musculoskelet Med. 2018 Dec. 11 (4):635-642. [Medline]. [Full Text].

20. Filardo G, Di Matteo B, Kon E, Merli G, Marcacci M. Platelet-rich plasma in tendon-related disorders: results and indications. Knee
Surg Sports Traumatol Arthrosc. 2018 Jul. 26 (7):1984-1999. [Medline].

21. Le ADK, Enweze L, DeBaun MR, Dragoo JL. Platelet-Rich Plasma. Clin Sports Med. 2019 Jan. 38 (1):17-44. [Medline].

22. Ackermann PW, Renström P. Tendinopathy in sport. Sports Health. 2012 May. 4(3):193-201. [Medline]. [Full Text].

23. Gold L, Igra H. Levofloxacin-induced tendon rupture: a case report and review of the literature. J Am Board Fam Pract. 2003 Sep-
Oct. 16(5):458-60. [Medline].

24. Wise BL, Peloquin C, Choi H, Lane NE, Zhang Y. Impact of Age, Sex, Obesity, and Steroid Use on Quinolone-associated Tendon
Disorders. Am J Med. 2012 Sep 28. [Medline].

25. Harrell RM. Fluoroquinolone-induced tendinopathy: what do we know?. South Med J. 1999 Jun. 92(6):622-5. [Medline].

26. Adler RS, Finzel KC. The complementary roles of MR imaging and ultrasound of tendons. Radiol Clin North Am. 2005 Jul.
43(4):771-807, ix. [Medline].
https://emedicine.medscape.com/article/809692-print 11/12
4/11/2020 https://emedicine.medscape.com/article/809692-print
27. Biundo JJ Jr, Mipro RC Jr, Fahey P. Sports-related and other soft-tissue injuries, tendinitis, bursitis, and occupation-related
syndromes. Curr Opin Rheumatol. 1997 Mar. 9(2):151-4. [Medline].

28. Biundo JJ, Irwin RW, Umpierre E. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr
Opin Rheumatol. 2001 Mar. 13(2):146-9. [Medline].

29. Crawford JO, Laiou E. Conservative treatment of work-related upper limb disorders: a review. Occup Med (Lond). 2007 Jan. 57(1):4-
17. [Medline].

30. Garrick JG, Webb DR. Sports Injuries: Diagnosis and Management. Philadelphia, Pa: WB Saunders; 1990.

31. Hales TR, Bernard BP. Epidemiology of work-related musculoskeletal disorders. Orthop Clin North Am. 1996 Oct. 27(4):679-709.
[Medline].

32. McLoughlin RF, Raber EL, Vellet AD, et al. Patellar tendinitis: MR imaging features, with suggested pathogenesis and proposed
classification. Radiology. 1995 Dec. 197(3):843-8. [Medline].

33. Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005. 87-A:187-202. [Medline].

34. Sorosky B, Press J, Plastaras C, Rittenberg J. The practical management of Achilles tendinopathy. Clin J Sport Med. 2004 Jan.
14(1):40-4. [Medline].

35. Tytherleigh-Strong G, Hirahara A, Miniaci A. Rotator cuff disease. Curr Opin Rheumatol. 2001 Mar. 13(2):135-45. [Medline].

36. van Tulder M, Malmivaara A, Koes B. Repetitive strain injury. Lancet. 2007 May 26. 369(9575):1815-22. [Medline].

37. Wang JH, Iosifidis MI, Fu FH. Biomechanical basis for tendinopathy. Clin Orthop Relat Res. 2006 Feb. 443:320-32. [Medline].

38. Wilson JJ, Best TM. Common overuse tendon problems: A review and recommendations for treatment. Am Fam Physician. 2005
Sep 1. 72(5):811-8. [Medline].

https://emedicine.medscape.com/article/809692-print 12/12