Tendinitis And Bursitis
A painful inflammation of tendons and of tendon-muscle attachments to bone, tendinitis usually occurs in the shoulder rotator cuff, hip, Achilles tendon, or hamstring.
Bursitis is a painful inflammation of one or more of the bursae-closed sacs that are lubricated with small amounts of synovial fluid that facilitate the motion of muscles and tendons over bony prominences. Bursitis usually occurs in the subdeltoid, olecranon, trochanteric, calcaneal, or prepatellar bursae.
Tendinitis commonly results from trauma (such as strain during sports activity), another musculoskeletal disorder (rheumatic diseases, congenital defects), postural misalignment, abnormal body development, or hypermobility.
Bursitis usually occurs in middle age from recurring trauma that stresses or pressures a joint or from an inflammatory joint disease (rheumatoid arthritis, gout). Chronic bursitis follows attacks of acute bursitis or repeated trauma and infection. Septic bursitis may result from wound infection or from bacterial invasion of skin over the bursa.
Signs and symptoms
Signs of these conditions include the slow onset of discomfort and pain in the upper shoulder or upper third of the arm and/or difficulty sleeping on the shoulder. Tendinitis and bursitis also cause pain when the arm is lifted away from the body or overhead. If tendinitis involves the biceps tendon (the tendon located in front of the shoulder that helps bend the elbow and turn the forearm), pain will occur in the front or side of the shoulder and may travel down to the elbow and forearm. Pain may also occur when the arm is forcefully pushed upward overhead.
Diagnosis of tendinitis and bursitis requires a careful medical history and physical examination. X-rays may be helpful to exclude bony abnormalities or arthritis. Tendons and bursae are generally not visible on x-rays. Aspiration of a swollen bursa may be performed to exclude infection or gout. Blood tests may be ordered to confirm underlying conditions such as rheumatoid arthritis or diabetes, but are generally not necessary to diagnose tendinitis or bursitis.
Therapy to relieve pain includes resting the joint (by immobilization with a sling, splint, or cast), systemic analgesics, application of cold or heat, ultrasound, or local injection of an anesthetic and corticosteroids to reduce inflammation.
A mixture of a corticosteroid and an anesthetic, such as lidocaine, generally provides immediate pain relief. Extended-release injections of a corticosteroid, such as triamcinolone or prednisolone, offer longer pain relief. Until the patient is free of pain and able to perform range-of-motion exercises easily, treatment also includes oral anti-inflammatory agents, such as sulindac and indomethacin. Short-term analgesics include codeine, propoxyphene, acetaminophen with codeine and, occasionally, oxycodone.
Other treatment measures include fluid removal by aspiration, physical therapy to preserve motion and prevent frozen joints (improvement usually follows in 1 to 4 weeks), and heat therapy; for calcific tendinitis, ice packs. Rarely, calcific tendinitis requires surgical removal of calcium deposits.Long-term control of chronic bursitis and tendinitis may require changes in lifestyle to prevent recurring joint irritation.
THE R.I.C.E. RECOMMENDATIONS:
Vitamin E and selenium work together to limit inflammation and speed healing.
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