Tendinitis and Bursitis | American College of Rheumatology | ACR

Tendinitis and Bursitis | American College of Rheumatology | ACR

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Tendinitis or bursitisoften involves the shoulder, elbow, wrist, hip, knee and ankle. The pain itcauses may be quite severe and often occurs suddenly. As in arthritis, the painis worse during movement. Unlike arthritis, the pain is often in parts of thebody far from a joint.

Tendinitis often results fromrepetitive use (overuse). Though the problem can recur or be chronic (longterm) in some people, it is most often short term, mainly if treated early.

Fast FactsTendinitis 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.
What is tendinitis?
Tendonsare cord-like structures located where a muscle narrows down to attach to abone. The tendon is more fibrous and dense than the elastic, fleshy muscle. Atendon transmits the pull of the muscle to the bone to cause movement.Tendinitis is often very tender to the touch.

What is bursitis?
Bursitisis 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 acorner of a bone, or over a bone, a healthy bursa protects it from fraying andstress. When a bursa is inflamed, it becomes very painful, even during rest.

What causes tendinitis and bursitis?
Tendinitiscan occur from a sudden intense injury. Most often, though, it results from arepeated, minor injury of that tendon. Doctors call this repetitive stress oroveruse. For example:
Painting a ceiling for four hours or more, typing long hours, improper body position while using akeyboard, chopping, cutting or sawing may result in tendinitis or bursitishours 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.
To prevent these overuse injuries, follow the tips in the Joint Protection Table.

Persons with gout, pseudogout,or blood or kidney diseases often develop bursitis as part of that disease.Older persons are more prone to get tendinitis and bursitis.

Rarely, some drugs cancause tendinitis and tendon rupture (spontaneous tear). These include fluoroquinoloneantibiotics and statins (drugs that lower cholesterol).
Green part of image illustrates the anserine bursa of the knee, which becomes inflamed in bursitis. Tendons (white) connect the muscles (red) to insert onto bone, above the bursa.

How are tendinitis and bursitis diagnosed?
To determine the cause ofthese problems, a health care provider asks about your medical history and doesa careful physical exam. Tenderness along the tendon or its sheath (outercovering), or at one specific point in the tendon, suggests tendinitis. Pain occurswhen the muscle to which the tendon is attached is worked against resistance aspart of the exam.

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

How are tendinitis and bursitis treated?
Treatment depends on thecause. In overuse or injury, you must reduce the causing force or stress. If tendinitisis job related, the doctor or physical therapist should review proper ergonomics,so you can work safely. Some patients may need joint protection advice andsupport of the involved region. There is little proof that therapeuticultrasound helps these problems, and most doctors do not recommend it.

Treatment can consist ofany of the following.

Rest. Youshould rest the injured limb or joint, at least for a short time. Failure torest it will most likely continue your symptoms. If the problem is in a hip,leg or foot, you may need to stop stressful weightbearing activities for ashort time. This lets the inflammation lessen.

Ice. Ice mayhelp reduce inflammation and pain. Ice the area for 10-15 minutes once or twice a day.

Medicine. Ifyour pain persists, you may need nonsteroidal anti-inflammatory drugs--oftenreferred to as NSAIDs--such as aspirin, ibuprofen or naproxen. Topical (appliedto the skin) forms of NSAIDs are now available and may reduce pain andinflammation without stomach upset. Acetaminophen (Tylenol) also can helprelieve pain.

Coricosteroid injectionsmay provide short-term benefit in certain forms of tendinitis, and may beconsidered if you are unable to take NSAIDs.

If an infection ispresent, you most often will need a proper antibiotic. (Daily drainage of fluidwith a needle also may be needed.)

If crystals of gout are foundin joint fluid, there is medicine that controls the disease.

Supports. Useof 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-shelfsupports may be enough. If not, you may need custom-made braces and referral toan occupational therapist.

For ankle tendinitis, youmay need orthotics to reduce the stress at the ankle or in the foot. Anorthotic is a device that goes inside the shoe, which changes the support andthe angle of the foot. This improves foot mechanics and relieves pain orpressure. They can be custom made or off the shelf.

Physical therapy. Some tendon problems do not go away despite standard treatment. Iftendinitis lasts beyond a few weeks, you may need a referral to a physicaltherapist or a rheumatologist. The doctor or therapist can give youexercises to do that will maintain strength and function. If the tendinitis or bursitis has begun to limitjoint movement, or already restricts movement, seeing a physical therapist iswise. For instance, if pain in a shoulder has gone away, but you can no longerraise your arm as high as your healthy arm, a "frozen shoulder" orother rotator cuff problems are developing. You can prevent this problem withearly treatment.

Surgery. If, after a few months of treatment, tendinitis stilllimits an essential activity, you may want to consider surgery. Ask your doctorto refer you to an experienced orthopaedic surgeon.

Some patients with aninfection or adhesions of the tendon or bursa may need a cortisone injection oran operation.

Apossibly serious complication of tendinitis is rupture of a tendon. The mostcommon rupture is a tear of the Achilles tendon in the lower calf. It mostoften needs surgery.

There are ways you can prevent these problems from occurring. These tips apply to all joints:
Before strenuousexercise, warm up and stretch.Properly trainfor a new activity. Slowly increase the intensity of your workout.Engage in exercise and sports daily ornear daily rather than just on weekends.Learn and maintainproper posture and body mechanics.Make sure sports equipment is theright size and fit for you, and designed for the sport you are doing.Avoid staying inone position for too long. Take rest breaks or change positions every 20-40minutes.Stop any activitythat causes pain.Avoid compulsive behavior, like "I'mgoing to finish this job even if it kills me!"
The Table shows how toprotect certain joints.

Table: Joint Protection
ShoulderFace an object you are reaching for, rather than reaching sideways or backward.Rise from a chair by pushing off with your thigh muscles, not your shoulders or hands.Do pushups from the wall, not the floor.When reaching for a heavy object overhead, keep the load centered in front of you and use both hands. Elbow and wristRecognize and avoid hand clenching or gripping tools or other objects too hard. Use power tools. In the kitchen, use aids such as jar openers. Pad your car steering wheel.Use your stomach muscles to help roll over when getting out of bed.Avoid carrying heavy items in one hand or at the side of your body. Knee and ankleAvoid sitting with a leg folded under.Wear shoes that give support and comfort, with room for the toes to extend fully during weightbearing.Check shoes often for signs of wear, and replace them when worn.If you walk or stand on concrete, cushion the inside bottom of your shoes with pads or wear walking or running shoes with cushioned soles.Keep leg muscles strong. Do leg lifts with ankle weights (5-20 pounds) while seated.
Tendinitis or bursitis inthe shoulder can become a greater problem if the shoulder becomes stiff. It isimportant to do range of motion exercises, such as stretching, each day. Thispreserves movement in the shoulder joint.

Tendinitis or bursitis canbe painful. Seek medical attention early to prevent joint stiffness and chronicproblems that may follow. It also is important to rest the limb or the joint,at least until movement is free of pain. Failure to rest it most often delaysfull healing.

Points to rememberRest the painful tendon. Avoid heavy activity or any activity that causes pain.Ice the area for 10-15 minutes once or twice a day.Seek medical help at once if pain worsens, if redness and swelling appear or if the problem does not improve in 3-6 weeks.Avoid overuse of any part of the body, such as doing the same motion over and over.Warm up by exercising at a relaxed pace before doing more strenuous activity.
To find a rheumatologist
For a list of rheumatologists in your area, click here.

Learn more about rheumatologists and rheumatology health professionals.

For more information
The American College of Rheumatology has compiled this list to give you a starting point for your own additional research. The ACR does not endorse or maintain these web sites, and is not responsible for any information or claims provided on them. It is always best to talk with your rheumatologist for more information and before making any decisions about your care.

The Arthritis Foundation

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse

Updated February 2013
Written by RobertP. Sheon, MD, FACP, and reviewed by the AmericanCollege of Rheumatology Communications and Marketing Committee.

This patient fact sheet is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

(C)2013 American College of Rheumatology

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