CRACKCast E117 - Tendinopathy and Bursitis - a podcast by The CanadiEM.org Team

from 2017-10-12T13:10:29

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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:

Wisecracks:

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