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There is pain along an involved tendon, often poorly localized, that worsens with motion, resisted contraction, or passive stretching. A vibratory crepitus may be felt on palpation over the tendon during tendon movement. Common sites include the posterior heel, the inferior aspect of the patella, the greater tuberosity of the shoulder, the thumb side of the wrist (de Quervain disease, see Chapter 105 ), and the lateral elbow (tennis elbow, see Chapter 114 ). There may be a history of repetitive overuse of the tendon or of a single sudden pull. Older patients participating in occasional sports are particularly prone to tendon injuries.
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