Tendinitis And Bursitis

Tendinitis is a painful inflammation of tendons and of tendon-muscle attachments to bone, usually in the shoulders, hips, Achilles tendons, or hamstrings. Bursitis is a painful inflammation of one or more of the fluid-filled sacs that cover and cushion the ends of bones. Bursitis usually occurs under the shoulder muscles, at the elbows, the hip sockets, heel bones, or kneecaps. What Causes them?

Tendinitis commonly results from injury (such as strain during sports activity), another musculoskeletal disorder (rheumatic diseases, congenital defects), poor posture, abnormal body development, or loose tendons.

Bursitis usually occurs in middle age from repeated injury to a joint or from an inflammatory joint disease (rheumatoid arthritis, gout). Chronic bursitis follows attacks of acute bursitis or repeated injury and infection. Infectious bursitis may result from wound infection or from bacterial invasion of skin over the bursa.

What are their Symptoms?

With tendinitis of the shoulder, rotation of the arm is difficult and painful. The pain is usually worse at night, interfering with sleep. Pain typically extends from the top of the shoulder to a point under the large shoulder muscle in the back. Fluid accumulation causes swelling; in some cases, calcium deposits in the tendon cause weakness. These deposits may spread into nearby joints and bursae, aggravating the condition.

In bursitis, fluid accumulation in the bursae causes irritation, inflammation, and sudden or gradual pain, and limits movement. Other symptoms vary according to the affected site. Shoulder bursitis interferes with arm movement. Kneecap bursitis (housemaid's knee) produces pain when the person climbs stairs. Hip bursitis makes it painful to cross the legs. How are they Diagnosed?

In tendinitis, X-rays may be normal at first but later show bony fragments, changes in the bone, or calcium deposits. Diagnosis of tendinitis must rule out other causes of shoulder pain, such as blocked arteries and tendon injury. Characteristically, heat treatment aggravates the shoulder pain of tendinitis, in contrast to other painful joint disorders, in which heat is palliative.

Localized pain and inflammation and a history of unusual strain or injury 2 to 3 days before pain begins indicate bursitis. During its early stages X-rays may appear normal except in calcific bursitis, in which X-rays may show calcium deposits. How are they Treated?

Treatment to relieve pain includes resting the joint (by immobilizing it with a sling, splint, or cast), pain medication, applying cold or heat, ultrasound therapy, or local injection of an anesthetic and corticosteroids to reduce inflammation. A mixture of a corticosteroid and an anesthetic, such as Xylocaine, generally provides immediate pain relief. Extended-release injections of corticosteroids offer longer pain relief.

Treatment also includes oral anti-inflammatory agents, such as Clinoril and Indocin, and other pain relievers, until the person is free of pain and able to perform range-of-motion exercises easily. Other Treatments

Other treatments include fluid aspiration (removal through a needle), physical therapy to preserve motion and prevent frozen joints (usually effective in 1 to 4 weeks), and heat therapy; and ice packs for calcific tendinitis. Rarely, calcific tendinitis requires surgical removal of the calcium deposits. Long-term control of chronic bursitis and tendinitis may require changes in the person's activities to prevent more joint irritation.