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Keywords

Diagnostic testing, upper extremity, tendinopathy, clinical reasoning

Abstract

Tendon pathology has been studied across healthcare professions but remains poorly understood. Imaging and clinical findings have been used to diagnose tendon pathology, but these findings are discrepant. It is vital that clinicians use sound clinical judgment to determine the most accurate clinical diagnosis and treatment options given documented clinical findings. The purposes of this study were to assess athletic trainers’: 1) documented clinical findings for patients presenting with tendon pain, 2) use of documented findings to inform clinical diagnosis of tendon pathology, and 3) change in tendon pathology classification when presented with a novel diagnostic term. A total of 430 patients (20.70 ± 7.35y) from a multisite research database were included in the study. Pain at the site of injury was documented in 95.8% of cases (n = 412). Pain during exercise that changed activity (n = 274, 63.7%), and an identified tender point (n = 259, 60.2%) were also present in almost two-thirds of cases. Of the patients diagnosed with tendinitis, 35.0% had pain as the only documented inflammatory sign. Of the initial set of clinical diagnosis options, tendinopathy was the most commonly (n = 290, 67.4%) selected. There was a 46.0% and 15.0% decrease in the number of tendinopathy and tendinitis diagnoses, respectively, when ‘tendinalgia’ was an option as a diagnostic classification term. There does not appear to be adequate clinical evidence to label tendon pathology as either inflammatory or degenerative. Furthermore, clinicians either appear to be: 1) relying on few symptoms to identify a diagnosis or 2) not at first fully considering all clinical findings when diagnosing a patient. According to these findings, tendinalgia seems to be the most appropriate term to describe tendon pain, to help clinicians understand tendon pathology as a pain condition rather than as inflammatory or degenerative.

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