Bursitis and Tendinitis

What is Bursitis?

   Wherever your bones, tendons, and ligaments move against each other,
particularly near joints, the points of contact are cushioned by small fluid-filled sacs
called bursae. By reducing friction, each of the more than 150 bursae in your body
helps the joints operate smoothly through the full range of natural movement. But
when a bursa becomes irritated and swollen, it's called bursitis—or inflammation
of the bursa.

What Causes Bursitis?

   When a joint is overused or injured suddenly, or when it remains under pressure for
a long time, a nearby bursa can become inflamed. The sac fills with excess fluid,
causing pressure on surrounding tissue. The immediate signal is pain, often
accompanied by inflammation, swelling, and tenderness in the area. This is different
from tendinitis, which is inflammation or irritation in the cord attaching muscle to bone, called a tendon.
   Age plays a role in bursitis, and one of the most common places it strikes is in the shoulder, which has the greatest range of motion of all the body's major joints. The
pain is generally felt along the outside top of the shoulder. The discomfort of bursitis
tends to be most severe after a night's sleep and will typically subside somewhat with normal activity. Other places that are prone to bursitis are the elbows, hips, knees,
and the base of the thumb.
   Bursitis is associated with strenuous activity, particularly among the following types
of people:
         • Manual workers—Heavy lifting, repetitive motion or working for extended
           periods can strain the joints and bring on a bursitis attack.
         • Athletes—They may get bursitis after running, throwing, or jumping, or from            making aggressive arm swings in tennis, baseball, and even bowling.
         • Otherwise-sedentary people—If they push their bodies past reasonable limits,            they risk bursitis.

What are the Symptoms of Bursitis?

         • Pain, inflammation, and swelling in the shoulders, elbows, hips, knees,
           or joints of the hands or feet, particularly during stretching or extension when            exercising, lifting, or otherwise pushing the joint beyond its normal limits;          
         • Restricted range of motion in a joint, with or without immediate pain;
         • Muscle weakness;
         • Loss of motion, especially affecting the shoulder.

How is Bursitis Treated?

   Although bursitis generally disappears in a few days or weeks, you must take
measures to avoid further strain or injury. A physical therapy program that includes stretching and focused strengthening exercises could be helpful.
   Though you may be tempted to tough-out the pain, it's not a good idea. Left
untreated, chronic bursitis can lead to the formation of calcium deposits in normally
soft tissues, sometimes causing permanent reduction of motion in the affected joint.
   Initial treatment typically consists of aspirin or other over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). These pain relievers also tend to reduce
inflammation. These pain relievers also tend to reduce inflammation. An injection of a local anesthetic mixed with one or more cortisone preparations into the bursa may be recommended to decrease inflammation and reduce pain.  Heat and ultrasound can help relax the joint and promote tissue repair.
   Diathermy (deep-heat therapy), under the direction of a sports physician, licensed physical therapist, or trainer, not only can relieve the discomfort and inflammation of bursitis but also can soothe tense muscles, nerves, and tendons. It may help to apply
ice to the affected area for 20 to 30 minutes twice daily for two to three days.
   Bursitis may recur, particularly if you engage regularly in strenuous exercise or
physical labor. In such cases, your doctor may prescribe corticosteroid treatment, in
the form of either oral medication, topical creams, or injections to the affected joints.
In severe cases, it may be necessary to draw fluid from inflamed and swollen bursae
with a needle to relieve the pressure. In persistent conditions, bursae can be
surgically removed.

Tendinitis

What Is Tendinitis?

   Tendinitis is an inflammation in or around a tendon, a band of fibrous tissue that connects a muscle to a bone and transmits the force the muscle exerts. Tendons
are designed to withstand bending, stretching, and twisting, but they can become
inflamed because of overuse, disease, or injuries that leave them with torn fibers or
other damage. The pain can be significant and worsens if damage progresses because
of continued use of the joint. Most tendinitis heals in about two weeks, but chronic tendinitis can take more than six weeks, often because the sufferer doesn't give the tendon time to heal. Diseases such as diabetes, arthritis, and gout can slow healing.

What Causes It?

   Tendons can become inflamed when overstressed from any activity. Weekend
athletes, who exercise sporadically rather than regularly, are often laid low by sore tendons. But by far the most common cause is repetitive stress—using the same
joints for the same stressful movements again and again. This happens not only in
sports but also in many types of office work and other situations.

What are the Symptoms?

         • Pain or tenderness at or near a joint, especially around a shoulder, wrist, or
           heel (where it is known as Achilles tendinitis), or on the outside of an elbow
           (where it is called tennis elbow).
         • In some cases, numbness or tingling.
         • Stiffness that, along with the pain, restricts the movement of the joint
           involved.          
         • Occasionally, mild swelling at the joint.
         • Persistence of the soreness, which may last or recur long after the tendon
           has had time to recover from the original injury.

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