WHAT IS TENDONITIS?

Tendonitis is inflammation or irritation of a tendon. Tendons are the thick fibrous cords that attach muscles to bone. They transmit the power generated by a muscle contraction to move a bone.

WHAT IS BURSITIS?

Bursitis is inflammation or irritation of a bursa. Bursae (the pleural of bursa) are small sacs located between moving structures such as bones, muscles, skin and tendons. The bursa acts as a cushion to allow smooth gliding between these structures.

Since both tendons and bursae are located near joints, inflammation in these soft tissues will often be perceived by patients as joint pain and mistaken for arthritis. Symptoms of bursitis and tendonitis are similar: pain and stiffness aggravated by movement. Pain may be prominent at night or after use. Almost any tendon or bursa in the body can be affected, but those located around a joint are affected most often. Tendonitis and bursitis are usually temporary conditions, but may become recurrent or chronic problems. Unlike arthritis, they do not cause deformity, but can cause significant pain and restrain motion.

CAUSE

The most common cause of tendonitis and bursitis is injury or overuse during work or play. Occasionally an infection within the bursa or tendon sheath will be responsible for the inflammation. Certain antibiotics, such as the quinolones (ciprofloxacin, others) may produce tendonitis. Tendonitis or bursitis may be associated with diseases such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disease and diabetes.

HEALTH IMPACT

DIAGNOSIS

Diagnosis of tendonitis 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. MRI and ultrasound may be useful in the detection of bursitis and tendonitis. Aspiration of a swollen bursa may be performed to exclude infection or gout. Blood tests may be ordered to confirm underlying conditions but are generally not necessary to diagnose tendonitis or bursitis.

TREATMENT

Treatment of these two conditions is based on the underlying cause. In overuse or injury, reduction or avoidance of a particular activity is useful. The use of modalities, especially ice, may help to reduce inflammation and pain. An adequate warm-up before and correct posture during exercise is useful.

The use of braces or splints for the affected area are helpful to decrease the stress on the area and support good alignment while symptoms are acute especially in the hand and wrist area. Orthotics and the temporary use of a cane can help unload the lower extremity to decrease pain and inflammation. Sometimes anti-inflammatory medications are needed to reduce inflammation and pain. Corticosteroid injections into the affected area are frequently helpful if symptoms persist.

Once the acute attack of tendonitis or bursitis subsides, preventing recurrences is crucial to avoid becoming a chronic problem. Education in joint protection and positioning to reduce repetitive activities is necessary. Appropriate splints or pads to protect susceptible areas can help to prevent recurrences. You may have learned to compensate for your symptoms so make sure you address adjacent structures in your treatment. Stretching and strengthening are very helpful to address any muscle imbalances to prevent a reoccurrence of symptoms. Occupational and physical therapists can help teach you what to do to meet your specific needs. Proper posture and body mechanics during activities is also a big component of treatment. You need to make sure you have ergonomically correct workstations and proper alignment when using exercise equipment or during the specific activities that aggravate your symptoms. Proper conditioning of involved muscles is another component of treatment.

If an infection is present, there is usually warmth, redness pain and swelling in the affected area. Treatment with an appropriate antibiotic is necessary and serial aspiration or surgical debridement of the tendon or bursa may be required. A potentially serious complication of tendonitis is rupture of a tendon with the most common being a tear of the Achilles tendon, which usually requires surgical intervention to repair it. Otherwise, surgical intervention for other forms of tendonitis or bursitis is uncommon.

THE RHEUMATOLOGIST’S ROLE IN TREATING TENDONITIS AND BURSITIS

Most cases of tendonitis and bursitis are self-limited and do not require a physician’s help. Persistent pain should be evaluated and treated by a physician. The rheumatologist, as a musculoskeletal disease expert, is well suited to manage treatment of tendonitis and bursitis because of experience and knowledge about patient education, rehabilitation and drug therapy. The physician can refer you to an occupational or physical therapist to provide a thorough evaluation and treatment plan to address your specific needs.