Tendinitis and bursitis
Tendinitis and bursitis: Excerpt from Handbook of Diseases
A painful inflammation of tendons and of tendon-muscle attachments to bone, tendinitis usually occurs in the shoulder rotator cuff, hip, Achilles tendon, or hamstring.
Bursitis is a painful inflammation of one or more of the bursae — closed sacs that are lubricated with small amounts of synovial fluid that facilitate the motion of muscles and tendons over bony prominences. Bursitis usually occurs in the subdeltoid, olecranon, trochanteric, calcaneal, or prepatellar bursae.
Causes
Tendinitis commonly results from trauma (such as strain during sports activity), another musculoskeletal disorder (rheumatic diseases, congenital defects), postural misalignment, abnormal body development, or hypermobility.
Bursitis usually occurs in middle age from recurring trauma that stresses or pressures a joint or from an inflammatory joint disease (rheumatoid arthritis, gout). Chronic bursitis follows attacks of acute bursitis or repeated trauma and infection. Septic bursitis may result from wound infection or from bacterial invasion of skin over the bursa.
Signs and symptoms
Tendinitis and bursitis have characteristic signs and symptoms.
Tendinitis
The patient with tendinitis of the shoulder complains of restricted shoulder movement, especially abduction, and localized pain, which is most severe at night and often interferes with sleep. The pain extends from the acromion (the shoulder’s highest point) to the deltoid muscle insertion, predominately in the so-called painful arc — that is, when the patient abducts his arm between 50 and 130 degrees. Fluid accumulation causes swelling.
In calcific tendinitis, calcium deposits in the tendon cause proximal weakness and, if calcium erodes into adjacent bursae, acute calcific bursitis.
Bursitis
In bursitis, fluid accumulation in the bursae causes irritation, inflammation, sudden or gradual pain, and limited movement. Other symptoms vary according to the affected site. Subdeltoid bursitis impairs arm abduction; prepatellar bursitis (housemaid’s knee) produces pain when the patient climbs stairs; hip bursitis makes crossing the legs painful.
Diagnosis
In tendinitis, X-rays may be normal at first but later show bony fragments, osteophyte sclerosis, or calcium deposits. Arthrography is usually normal, with occasional small irregularities on the undersurface of the tendon.
Diagnosis of tendinitis must rule out other causes of shoulder pain, such as myocardial infarction, cervical spondylosis, and tendon tear or rupture.
Significantly, in tendinitis, heat aggravates shoulder pain; in other painful joint disorders, heat usually provides relief.
Localized pain and inflammation and a history of unusual strain or injury 2 to 3 days before onset of pain are the bases for diagnosing bursitis. During early stages, X-rays are usually normal, except in calcific bursitis, in which X-rays may show calcium deposits.
Treatment
Therapy to relieve pain includes resting the joint (by immobilization with a sling, splint, or cast), systemic analgesics, application of cold or heat, ultrasound, or local injection of an anesthetic and a corticosteroid to reduce inflammation.
A mixture of a corticosteroid and an anesthetic such as lidocaine generally provides immediate pain relief. Extended-release injections of a corticosteroid, such as triamcinolone or prednisolone, offer longer pain relief. Treatment also includes oral anti-inflammatory agents.
Supplementary treatment
Other treatment measures include fluid removal by aspiration, physical therapy to preserve motion and prevent frozen joints (improvement usually follows in 1 to 4 weeks), and heat therapy; for calcific tendinitis, ice packs. Rarely, calcific tendinitis requires surgical removal of calcium deposits.
Long-term control of chronic bursitis and tendinitis may require changes in lifestyle to prevent recurring joint irritation.
Special considerations
❑ Assess the severity of pain and the range of motion to determine the treatment’s effectiveness.
❑ Before injecting corticosteroids or local anesthetics, ask the patient about drug allergies.
❑ Before intra-articular injection, scrub the patient’s skin thoroughly with povidone-iodine or a comparable solution, and shave the injection site if necessary. After the injection, massage the area to ensure penetration through the tissue and joint space. Apply ice intermittently for about 4 hours to minimize pain. Avoid applying heat to the area for 2 days.
Patient teaching is essential. (See Tendinitis and bursitis tips.)
Pictures
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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