TENDINITIS/BURSITIS

Fast Facts

Tendinitis and bursitis are inflammation or degeneration (breakdown) of the soft tissue around muscles and bones.
Immediate treatment includes RICE: Rest, Ice, Compression and Elevation.
Danger signs include rapid worsening of pain, redness and swelling, or sudden inability to move a joint.

Tendons are cord-like structures located where a muscle narrows down to attach to a bone. The tendon is more fibrous and dense than the elastic, fleshy muscle. A tendon transmits the pull of the muscle to the bone to cause movement. Tendinitis is often very tender to the touch.

Tendinitis or bursitis often involves the shoulder, elbow, wrist, hip, knee and ankle. The pain it causes may be quite severe and often occurs suddenly. As in arthritis, the pain is worse during movement. Unlike arthritis, the pain is often in parts of the body far from a joint. Tendinitis often results from repetitive use (overuse). Though the problem can recur or be chronic (long term) in some people, it is most often short term, mainly if treated early.

Bursitis is inflammation of a bursa. This small sac acts as a cushion between moving structures (bones, muscles, tendons or skin). If a muscle or tendon is pulling around a corner of a bone, or over a bone, a healthy bursa protects it from fraying and stress. When a bursa is inflamed, it becomes very painful, even during rest.

What causes tendinitis and bursitis?

Tendinitis can occur from a sudden intense injury. Most often, though, it results from a repeated, minor injury of that tendon. Doctors call this repetitive stress or overuse. For example:

Painting a ceiling for four hours or more, typing long hours, improper body position while using a keyboard, chopping, cutting or sawing may result in tendinitis or bursitis hours or days later.
Tight clenching while using hand tools or while driving a long time.
Using a backhand, mainly single handed, in an early-season game of tennis (“tennis elbow”).
Wearing improper running shoes or not getting the proper training before sports.

How are tendinitis and bursitis diagnosed?

To determine the cause of these problems, a health care provider asks about your medical history and does a careful physical exam. Tenderness along the tendon or its sheath (outer covering), or at one specific point in the tendon, suggests tendinitis. Pain occurs when the muscle to which the tendon is attached is worked against resistance as part of the exam.

Most patients at first do not need imaging tests like X-rays, magnetic resonance imaging (often referred to as MRI) or ultrasound scans. Imaging and blood tests are done only if the problem recurs or does not go away. A blood test also can help detect an infection. Signs of an infection include redness, warmth and swelling. If bursitis is the result of infection, fluid must be drained from the bursa at once and promptly studied.

How are tendinitis and bursitis treated?

Treatment depends on the cause. In overuse or injury, you must reduce the causing force or stress. If tendinitis is job related, the doctor or physical therapist should review proper ergonomics, so you can work safely. Some patients may need joint protection advice and support from the involved region. There is little proof that therapeutic ultrasound helps these problems, and most doctors do not recommend it. Treatment can consist of any of the following:

Rest. You should rest the injured limb or joint, at least for a short time. Failure to rest it will most likely continue your symptoms. If the problem is in a hip, leg or foot, you may need to stop stressful weight bearing activities for a short time. This lets the inflammation lessen.
Ice. Ice may help reduce inflammation and pain. Ice the area for 10–15 minutes once or twice a day.
Medicine. If your pain persists, you may need nonsteroidal anti-inflammatory drugs—often referred to as NSAIDs – such as aspirin, ibuprofen or naproxen. Topical (applied to the skin) forms of NSAIDs are now available and may reduce pain and inflammation without stomach upset. Acetaminophen (Tylenol) also can help relieve pain.

Corticosteroid injections may provide short-term benefit in certain forms of tendinitis, and may be considered if you are unable to take NSAIDs. If an infection is present, you most often will need a proper antibiotic. (Daily drainage of fluid with a needle also may be needed.) If crystals of gout are found in joint fluid, there is medicine that controls the disease.

Support. Use of a cane in the opposite hand can help a painful hip. Splints or braces for the affected body part help rest and reduce stress on the body. Off-the-shelf support may be enough. If not, you may need custom-made braces and referral to an occupational therapist.

Physical therapy. Some tendon problems do not go away despite standard treatment. If tendinitis lasts beyond a few weeks, you may need a referral to a physical therapist or a rheumatologist. The doctor or therapist can give you exercises to do that will maintain strength and function.
Surgery. If, after a few months of treatment, tendinitis still limits an essential activity, you may want to consider surgery. Ask your doctor to refer you to an experienced orthopaedic surgeon. Some patients with an infection or adhesions of the tendon or bursa may need a cortisone injection or an operation.

Preventing tendinitis and bursitis

There are ways you can prevent these problems from occurring. These tips apply to all joints:

Before strenuous exercise, warm up and stretch.
Properly train for a new activity. Slowly increase the intensity of your workout.
Engage in exercise and sports daily or near daily rather than just on weekends.
Learn and maintain proper posture and body mechanics.
Make sure sports equipment is the right size and fit for you, and designed for the sport you are doing.
Avoid staying in one position for too long. Take rest breaks or change positions every 20–40 minutes.
Stop any activity that causes pain.
Avoid compulsive behavior, like “I’m going to finish this job even if it kills me!”