Pain in tendonitis or bursitis, commonly involving the shoulder, elbow,
wrist, hip, knee and ankle, may be quite severe, often of sudden onset
and usually made worse by movement. This inflammation of the soft tissue
tendons and bursae located near joints will often be mistaken for arthritis.
However, while it can be recurrent or chronic in some conditions, it is
usually a temporary condition, particularly if treated early.
Fast Facts
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Tendonitis and bursitis are inflammations of the soft
tissue around muscles and bones, usually in the shoulder,
elbow, wrist, hip, knee and ankle.
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The pain of bursitis or tendonitis can be severe and
should be treated quickly.
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Failure to rest the inflamed limb or the joint, at
least temporarily, will usually result in longer-term problems
What tendonitis is
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| The green portion of the image illustrates the bursa, which
becomes inflamed in bursitis. |
|
Tendonitis is inflammation of the cord-like structure located where a
muscle narrows down to join a bone. This structure, the tendon, is more
fibrous and dense than the elastic and fleshy muscle. It transmits the
pull of the muscle to the bone to cause movement. Inflammation to the
tendon (increased blood flow through the area with warmth, swelling, pain
and loss of function) can be spelled tendonitis or tendinitis.
What Bursitis Is
Bursitis is inflammation of a bursa, a small sac that acts as a cushion
or pad between moving structures (bones, muscles, tendons or skin). If a
muscle or tendon is pulling around a corner, or over a bone, then a bursa
serves to protect it from fraying and stress. Irritation or inflammation
of this small sac is called bursitis (
itis means inflammation).
Who gets tendonitis and bursitis
Tendonitis can be caused by sudden intense injury, but is most often
the result of a repetitive, minor injury of the affected area. For example,
a middle-aged sedentary man who spends four hours painting a ceiling
may develop a tendonitis or bursitis in the shoulder. A typist who spends
long hours at a keyboard with poorly positioned hands and wrists may
develop tendonitis. The early season game of tennis can result in a
backhand which strains the tendon on the outside of the elbow. Bursitis
may occur at the knee from kneeling on a hard surface or kneeling longer
than is usual. In other instances, infection can occur in a bursa or
tendon sheath.
Tendonitis or bursitis may occur in individuals with diseases such
as rheumatoid arthritis, gout, psoriatic
arthritis, thyroid disease
and diabetes.
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| This illustration of a biceps shows the white tendons that
attach muscle to bone. In tendonitis, it is these structures
which become inflamed. |
|
How they are diagnosed
Diagnosis of tendonitis and bursitis requires a medical history and careful
physical examination. On physical examination, there will often be tenderness
along the involved tendon or its sheath (outer covering) or at one particular
point within the tendon and pain when the muscle to which the tendon is
attached is worked against resistance. X-rays do not show bursae or tendons,
but may be useful in excluding other bone or joint problems. Blood tests,
as well as MRI and diagnostic ultrasound which may be useful in the detection
of these conditions, are generally not required.
Not infrequently, shoulder x-rays show the presence of a calcium deposit
within a tendon sheath or around the shoulder joint. Tendonitis in the
shoulder can most often be resolved without any specific attention to
the calcium deposit. Many people have calcium deposits in the shoulder
that do not produce any symptoms.
How they are treated
Treatment of these two conditions is based on the underlying cause. In
overuse or injury, reduction of the causing force or stress is mandatory.
A typist may need to review the ergonomic position that is used on a daily
basis. Resting a painful hip from strengthening exercises may be required
to allow the problem to settle prior to resumption of the strengthening
program.
Failure to rest invariably will result in continuing symptoms. Splints
or braces for the affected part are a means of achieving rest and reduction
of stress on the part, especially in the hand and wrist area. Off the
shelf supports may be sufficient, or custom fashioned braces may be required.
Treatments, particularly ice, may help to reduce inflammation and pain.
Ultrasound is often of benefit. The ultrasound referred to here is “treatment
ultrasound” as distinct from diagnostic ultrasound and is most commonly
administered by a physical therapist.
In the lower limb, stressful weight bearing activities may need to be
reduced on a temporary basis to allow the inflammation to lessen. The
use of a cane in the opposite hand can assist a painful hip. Orthotics
may be required to reduce the stress at the ankle or within the foot.
An orthotic is an adaptive device that is placed inside the shoe between
the foot and the shoe, which serves to change the support and the angle
of the foot, to improve foot mechanics and relieve pain or pressure. They
can be custom made or off the shelf.
If an infection is present, there is usually an intense inflammation
present with redness, warmth and swelling (a blood test will contribute
to this diagnosis). Treatment with an appropriate antibiotic is necessary
and serial aspiration (withdrawal of fluid with a needle) or surgical
debridement of the tendon or bursa may be required. A potentially serious
complication of tendonitis is rupture of a tendon with the most common
being a tear of the Achilles tendon in the lower calf, which usually requires
surgical intervention to repair.
A limited number of tendon problems do not settle with the usual conservative
measures above and may require surgical intervention.
Prevention
Warming up and stretching prior to strenuous exercise will help to prevent
these problems from occurring. Therefore, activities should be begun slowly
prior to expending maximum effort. For example, golfers should warm up
at the driving range before driving the ball on the first tee.
Typists who spend long hours at the keyboard should ensure that the keyboard
is at an appropriate height. Wrists rests should not be used; instead
typing should be done with wrists extended in a neutral or slightly flexed
position. Typists should also take breaks.
Stretching and strengthening are very helpful to address any areas of
muscle imbalance. At work or when exercising, proper posture and body
mechanics are important. Proper conditioning of involved muscles is another
component of treatment.
Broader Health Impacts
It is important to complete a daily range of motion exercise program to preserve mobility, particularly in the shoulder joint, as a tendonitis or burisits in the shoulder not infrequently becomes a greater problem if the shoulder becomes stiff. A "frozen shoulder" is preventable if the tendonitis or bursitis, which is its usual precursor, is addressed early on. Lying down, on your back, clasp the fingers together and use the non painful arm to assist the painful arm above the head to the fullest extent. Full shoulder movement will be bringing the upper arm up alongside the ear. Lower and repeat 5 times. In standing you can walk the fingers of the involved arm up the wall, in front of you, to the highest tolerated position and then stretch the shoulder to the fullest extent by holding it in this stretched position for 20 seconds and then lowering. Repeat 5 times.
Living with Tendonitis/Bursitis
Seeking attention early will result in a faster resolution of the problem,
and prevent joint stiffness and chronic problems that may follow. The
pain of bursitis or tendonitis can be severe and, just because it is not
arthritis, does not mean it is less important. Failure to rest the limb
or the joint at least temporarily will usually result in the problem's
taking a longer course.
Points to Remember
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Rest the painful tendon from heavy activity and things that hurt.
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Ice the area for 10 – 15 minutes once or twice a day.
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Seek medical assistance if the problem does not improve in 8-12 weeks.
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Avoid repetitive motion and overuse of an extremity.
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Warm up by exercising at a relaxed pace prior to more strenuous activity.
To find a rheumatologist
For more information about rheumatologists, click here.
For a listing of rheumatologists in your area, click here.
For more information
For a listing of rheumatologists in your area, check the American College
of Rheumatology's Find a Rheumatologist feature. If you want more information
on this or any other form of arthritis, contact the Arthritis Foundation
at (800)283-7800 or visit the Arthritis Foundation Web site at www.arthritis.org.
Updated May 2005
Written by Bruce M. Clark, RPT, and reviewed by the American College of
Rheumatology
