Tendon palpation

Tendinitis is an inflammatory painful tendon disorder which can be caused by quinolones. Typical cases are characterized by acute onset, palpation and sharp pain mostly of one or both Achilles tendons, but other tendons may also be affected. Magnetic resonance imaging (MRI) is used to support the diagnosis. Estimates for the incidence of quinolone-induced tendinitis range from approximately 1 100 to 1 10,000. The etiology remains unknown, concomitant... 

Ishizuki etal., 1989) 59 f Japan Kombu 4 years 28 mg/day Diffuse enlargement on palpation Fine finger tremor, fatigue, chest pain, muscle atrophy, enhanced deep tendon reflexes, pretibial edema... 

Maestro etal. (2013) [36] Partial ACL tear a healthy bundle with a diameter equivalent to at least one third of the original ACL was found, which was functional after palpation with a hook probe showing retention of its femoral and tibial insertions Autologous hamstring tendons... 

Progressive diminution and finally absence of deep tendon reflexes is an obligatory sign reflexes do not disappear simultaneously and some may still be present while others are lost. Subsequently, abdominal reflexes may be found decreased or absent, although the loss of other superficial reflexes is rare. In some cases superficial nerves appear thickened on palpation, in agreement with findings at biopsy or autopsy. 

Palpate the Achilles tendon at the heel and the biceps tendon at the elbow. 

On examination, the left buttocks was lender to palpation and there were tender points at the mid-pole of the sacrum on the lateral border and one deep to the gluteus maximus, where a lense piriformis could be palpated. There was a unilateral sacral flexion (sacral shear) present on the left. No lumbar somatic dysfunctions were present. There was mild tenderness at the sciatic notch of the ischium. Deep tendon reflexes were normal and muscle strength of the ihigh was normal. There was some pain on internal rotation and adduction of the left hip. 

The wrist and hand joints should be palpated for swelling, asymmetries, and tenderness. The skin of the wrist and hand shonld be evalnated for temperature and moisture changes. Tendons or joints may be tender. The anatomic snuffbox should be palpated. In case of trauma, any tenderness in this area should be noted, because the navicular is the most commonly fractured of the carpal bones. 

The tnnnels across the dorsum of the wrist should be palpated for swelling or tenderness. The volar tunnels should be similarly evaluated. Ganglia may occur in the tendon sheaths. These are firm, sometimes tender, nodules that are generally benign and of no significance but may be of concern to the patient. 

Examination of the shoulder revealed no bruising, swelling, or inflammation. Motion of the right shoulder was restricted in comparison to the left in flexion, abduction, extension, and external rotation, both passively and actively. He was unable to perform the Apley scratch test fully. Muscle strength was relatively normal, although it was difficult to test because of pain. The neck, elbow, and wrist were normal on examination. There was marked tenderness to palpation ofthe biceps tendon and some tenderness of the supinator tendon. There was no tenderness or swelling of the bursa of the shoulder. 

A major bony landmark is the greater trochanter, easily palpated on the lateral superior aspect of the shaft. The lesser trochanter is on the medial aspect of the inferior end of the femoral neck. This trochanter, although not palpable, is very important, because it is the site of attachment of the iliopsoas tendon. At its distal end, the femoral condyles and epicondyles are easily palpable at the knee joint. 

When a tendon lesion is suspected, specific resisted movements must be checked. Due to its superficial position, the distal biceps tendon can easily be palpated during resisted flexion while keeping the elbow 90 flexed and supinated. The rupture of this tendon is typically associated with retraction of the muscle into the arm, where it can be appreciated as a lump (see Sect. 8.5.1.1). Nevertheless, the retracted muscle belly can be difficult to detect in obese patients or when local swelling and pain... 

The less common tendinitis and partial tears of the distal biceps tendon present with localized pain and tenderness over the antecubital fossa. These conditions usually follow repetitive microtrauma or forceful biceps activation. Pain can be exacerbated during resisted elbow flexion or supination of the hand and is worsened by direct palpation of the tendon. At US, partial tears appear as hypoechoic thickening or thinning of the tendon and as contour... 

The carpal tunnel is almost invariably injected blindly after palpation of the flexor carpi radialis tendon, which is a good landmark to assess the position of the median nerve. Transverse and longitudinal planes may be helpful to confirm the adequate location of the needle tip relative to the flexor tendon. Because the median nerve is usually displaced from its location after release of the transverse carpal ligament, local injections to treat postsurgical recurrences are difficult without imaging guidance. In these cases, US may help to determine the position of the nerve and to mark the skin in order to ensure a safe local injection. 

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