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CRACKCast & Physicians as Humans on CanadiEM


CanadiEM aims to improve emergency care in Canada by building an online community of practice for healthcare practitioners and providing them with high quality, freely available educational resources. The CanadiEM Podcast brings you cutting edge clinical topics on the National Rounds Series and delves into the struggles that doctors face on the Physicians as Humans Series.

Oct 12, 2017

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