DRG Category 232 Mean LOS 32 days Description Surgical Arthroscopy

Tendinitis is a painful inflammation or tearing of tendons, tendon-muscle attachments, or tendon sheaths. Commonly affected joints include the shoulder (rotator cuff), hip, heel (Achilles' tendinitis), and hamstring. The disorder is characterized by restricted joint movement and pain in the joint area. Fluid accumulation causes swelling early in the course of the disorder, but calcium deposits can increase swelling and cause further joint immobility or acute calcific bursitis.

It can be difficult to differentiate tendinitis from bursitis in the initial stages of both conditions. Bursitis is an inflammation of one or more bursae, the padlike sacs that contain synovial fluid; these sacs reduce the friction between tendons, ligaments, and bones. Untreated tendinitis can result in bursitis, which can cause joint immobilization.

Tendinitis may result from a traumatic injury, strenuous exercise, or repetitive movement at a rapid pace. It can also be caused by postural misalignment, defective body development, or complications from another disease process such as any of the rheumatic diseases.

Tendinitis can occur in any age group in anyone who performs an activity that stresses or overloads a joint on a repetitive basis. Women are more prone to tendinitis in their middle and older years. Elderly men also develop the disorder as their joints and soft tissues undergo the changes that occur with aging. There are no racial or ethnic considerations.

HISTORY. Ask the patient to describe normal and unusual exercise and activity patterns. Determine if the patient has had localized joint swelling, pain, and restricted movement and which joints have been affected. Ask if the pain has affected sleeping patterns. Establish a history of repetitive joint stress or trauma. Determine if the patient has either a congenital musculoskeletal condition that might have caused the tendinitis or a history of rheumatic disease. Determine if the patient has allergies to specific corticosteroids or local anesthetics, which are sometimes prescribed for tendinitis.

PHYSICAL EXAMINATION. The affected joint may be red, warm, and tender to touch. Note to what degree mobility is restricted and the number and location of joints that are involved.

PSYCHOSOCIAL. Patients may be concerned about permanent long-term immobility or restricted movement and how it will affect their lives. Assess their coping abilities.

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