Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Diagnosis is usually made based on the way the affected tendon and movement of the associated muscle feels. The doctor may have you do the
following movements to check for pain and tenderness.
Medial epicondylitis: The forearm is placed in supine position (with the palm facing upward), and the fist is flexed against resistance while the forearm is held down. Tenderness is felt on the inner side of the elbow where the bony medial epicondyle is located.
Lateral epicondylitis: The forearm is placed in prone position (with the palm facing downward) on the table, while the forearm is held in place. You try to extend your wrist against resistance. Tenderness is felt along the top of the outer elbow near the bony lateral epicondyle.
Rotator cuff tendinitis
Supraspinatus: Bend the arm to 90° and place it forward 30° with the thumb pointed down. Pain or weakness against resistance can be felt if there is involvement of this tendon.
Infraspinatus and teres minor: With your arm against your body with elbow bent at 90°, the doctor will stabilize the elbow against your waist and have you externally rotate
(move your arm outward) against resistance, which will bring on pain if these tendons are involved.
Subscapularis: With your arm against your body and the elbow bent at 90°, while stabilizing the elbow, the doctor will have you internally rotate your arm inward around the front of your body against resistance, which will cause pain if this tendon is involved.
Patellar tendinitis: Tenderness can be felt over the patellar tendon at the lower part of the kneecap.
Popliteus tendinitis: Sit with the side of your
injured heel resting on the knee of the opposite leg. Tenderness can be felt on the side of the knee.
Achilles tendinitis: Tenderness is felt when the Achilles tendon is squeezed between the fingers.
Peroneal tendonitis: Tenderness is felt when the peroneal tendon (located on the side of the ankle) is palpated.
De Quervain's tenosynovitis: Pain occurs with the Finkelstein test. The thumb is placed inside the fist. The fist is then bent at the wrist toward the little finger by the examiner. The test is considered positive, or abnormal, if the maneuver is painful.
X-rays do not show tendons but may be ordered to exclude other problems with the bones or joints. Ultrasound evaluation of the tendon with real-time machines can give an accurate diagnosis. A CT scan may be ordered. An MRI can detect tears, partial tears, inflammation, or a tumor.