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Tendinitis and Bursitis

In tendinitis, inflammation affects the tendons and tendon-muscle attachments to bone, usually in the shoulder rotator cuff, hip, Achilles tendon, hamstring, or elbow.

Tendinitis is more common in older people, but it can afflict anyone who performs an activity that overstresses a tendon or repeatedly stresses a joint. The disorder causes localized pain around the affected area and restricts joint movement. Initially, swelling results from fluid accumulation. As the disorder progresses, calcium deposits form in and around the tendon, causing further swelling and immobility.

Bursitis is a painful inflammation of one or more bursae. These closed sacs hold lubricating synovial fluid and facilitate the movement of muscles and tendons over bony prominences. Bursitis causes sudden or gradual pain and limits joint motion. Usually, the disorder occurs in the subdeltoid, subacromial, olecranon, trochanteric, calcaneal, or prepatellar bursae. It may be septic, calcific, acute, or chronic.

Causes

The most common cause of tendinitis and bursitis is injury or overuse during work or play, particularly if the patient is poorly conditioned, has bad posture, or uses the affected limb in an awkward position. Occasionally an infection within the bursa or tendon sheath will be responsible for the inflammation. Tendinitis or bursitis may be associated with diseases such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disease and diabetes.

Signs and Symptoms

Diagnostic tests

X-rays may appear normal at first in tendinitis but, later, bony fragments, osteophyte sclerosis, or calcium deposits may appear. In early bursitis, X-rays also usually appear normal, except in calcific bursitis, where films show calcium deposits in the joint.

Arthrography results are usually normal in tendinitis with minor irregularities on the tendon undersurface.

Arthrocentesis detects microorganisms and other causes of inflammation if joint infection is suspected.

Additionally, various blood tests and urinalysis may be performed to rule out other disorders.

Treatment

To relieve pain. treatment involves resting the joint (by immobilization); nonsteroidal anti-inflammatory drugs; cold, heat or ultrasound applications; possible injection of a local anesthetic (such as lidocaine) and corticosteroids for immediate relief; and extended­release corticosteroids. such as triamcinolone or prednisolone, for longer relief.

Until the patient can perform range-of-motion (ROM) exercises easily, treatment also includes oral anti-inflammatory agents and short-term analgesics. Supplementary measures involve fluid removal by aspiration, physical therapy to preserve motion and prevent frozen joints, and heat and cold therapies. Rarely, calcific tendinitis requires surgical removal of calcium deposits. Long-term control of chronic bursitis and tendinitis may require lifestyle changes.

Prevention

Warming up and stretching prior to strenuous exercise will help to prevent these problems from occurring. Therefore, activities should be begun slowly prior to expending maximum effort. For example, golfers should warm up at the driving range before driving the ball on the first tee.

Typists who spend long hours at the keyboard should ensure that the keyboard is at an appropriate height. Wrists rests should not be used; instead typing should be done with wrists extended in a neutral or slightly flexed position. Typists should also take breaks.



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