Bursitis occurs when the bursa become inflamed, resulting in painful movement of the joint. Bursitis often affects the shoulders, elbows, hips, knee, heel and the base of the big toe. Bursitis pain usually dissipates within a few weeks with proper treatment, but recurrent flare-ups are common.
Tendonitis is inflammation of the actual tendons; tough, flexible bands of fibrous tissue that connect your muscles to the bones.
Because both tendons and bursae are located near joints, inflamed soft tissues will often be felt by patients as joint pain and may be mistaken for arthritis. Symptoms of bursitis and tendonitis are very similar, and include pain and stiffness that is worse when moving. Pain may be felt more at night. Almost any tendon or bursa in the body can be affected, although those located around a joint are affected most often. Tendonitis and bursitis are usually temporary. However, these conditions may be recurrent or become ongoing. They do not cause deformity but they can limit motion.
The most common cause of tendonitis and bursitis is injury or overuse of a joint during work or play. This is particularly true if the patient is unfit, has bad posture or uses the affected limb in an awkward way. People such as carpenters, gardeners, musicians, and athletes who perform activities that require repetitive motions or place stress on joints are at higher risk for tendinitis and bursitis. They may also be linked to other conditions including rheumatoid arthritis, gout, psoriatic arthritis, thyroid disease and diabetes.
Diagnosis of tendinitis and/or bursitis begins with a medical history and physical examination. The location and onset of pain, whether it varies in severity throughout the day, and the factors that relieve or aggravate the pain are all important diagnostic clues. Manual selective tissue tension tests are used to determine which tendon is involved. X-rays do not show tendons or bursae, but may be helpful in ruling out problems in the bone or arthritis: in the case of a torn tendon, x rays may help show which tendon is affected. The doctor may also use magnetic resonance imaging (MRI) to confirm a partial or total tear. MRIs detect both bone and soft tissues like muscles, tendons and their coverings (sheaths), and bursae. An anesthetic-injection test is another way to confirm a diagnosis of tendinitis. A small amount of anesthetic (lidocaine hydrochloride) is injected into the affected area. If the pain is temporarily relieved, the diagnosis is confirmed. To rule out infection, the doctor may remove and test fluid from the inflamed area.
There are some steps that high risk patients can use to help prevent inflammation from bursitis or tendonitis:
• Warm up or stretch before physical activity. Strengthen muscles around the joint.
• Take breaks from repetitive tasks often.
• Cushion the affected joint. Use foam for kneeling or elbow pads.
• Increase the gripping surface of tools with gloves or padding. Apply grip tape or an oversized grip to golf clubs. Use two hands to hold heavy tools; use a two-handed backhand in tennis.
• Don't sit still for long periods. Practice good posture and position the body properly when going about daily activities.
• Begin new activities or exercise regimens slowly. Gradually increase physical demands following several well-tolerated exercise sessions. If a history of tendonitis is present, consider seeking guidance from your doctor or therapist before engaging in new exercises and activities.
Treatment focuses on healing the injured bursa or tendon. The first step in treating both of these conditions is to reduce pain and inflammation with rest, compression, elevation, and anti-inflammatory medicines. Activity involving the affected joint is also restricted to encourage healing and prevent further injury. If there is no improvement, the doctor may inject a corticosteroid medicine into the area surrounding the inflamed bursa or tendon, although this procedure must be used with caution because it may lead to weakening or rupture of the tendon. If there is still no improvement after 6-12 months, the doctor may perform either arthroscopic or open surgery to repair damage and relieve pressure on the tendons and bursae. If the bursitis is caused by an infection, the doctor will prescribe antibiotics. If a tendon is completely torn, surgery may be needed to repair the damage.
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