Tackling Tendonitis

Tendonitis or bursitis is the inflammation of the soft tissue tendons and bursae located near joints and is often mistaken for arthritis. However, while it can be recurrent or chronic in some conditions, it is usually a temporary condition, particularly if treated early.

Pain in tendonitis or bursitis, commonly involving the shoulder, elbow, wrist, hip, knee and ankle, may be quite severe, often of sudden onset and usually made worse by movement.

Fast facts

Tendonitis and bursitis are inflammations of the soft tissue around muscles and bones, usually in the shoulder, elbow, wrist, hip, knee and ankle. The pain of bursitis or tendonitis can be severe and should be treated quickly.

Failure to rest the inflamed limb or the joint, at least temporarily, will usually result in longer-term problems.

What is tendonitis?

Tendonitis is inflammation (increased blood flow through the area with warmth, swelling, pain and loss of function) of the cord-like structure located where a muscle narrows down to join a bone. This structure, the tendon, is more fibrous and dense than the elastic and fleshy muscle. It transmits the pull of the muscle to the bone to cause movement.

What is bursitis?

Bursitis is inflammation of a bursa, a small sac that acts as a cushion or pad between moving structures (bones, muscles, tendons or skin). If a muscle or tendon is pulling around a corner, or over a bone, then a bursa serves to protect it from fraying and stress. Irritation or inflammation of this small sac is called bursitis (itis means inflammation).

Who gets tendonitis and bursitis?

The green portion of the image illustrates the bursa, which becomes inflamed in bursitis.

Tendonitis can be caused by sudden intense injury, but is most often the result of a repetitive, minor injury of the affected area. For example, a middle-aged sedentary man who spends four hours painting a ceiling may develop tendonitis or bursitis in the shoulder.

A typist who spends long hours at a keyboard with poorly positioned hands and wrists may develop tendonitis. The early season game of tennis can result in a backhand which strains the tendon on the outside of the elbow. Bursitis may occur at the knee from kneeling on a hard surface or kneeling longer than is usual. In other instances, infection can occur in a bursa or tendon sheath.

Tendonitis or bursitis may occur in individuals with diseases such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disease and diabetes.

How are tendonitis and bursitis diagnosed?

Diagnosis of tendonitis and bursitis requires a medical history and careful physical examination. On physical examination, there will often be tenderness along the involved tendon or its sheath (outer covering) or at one particular point within the tendon and pain when the muscle to which the tendon is attached is worked against resistance. X-rays do not show bursae or tendons, but may be useful in excluding other bone or joint problems. Blood tests, as well as MRI and diagnostic ultrasound which may be useful in the detection of these conditions, are generally not required.

How are tendonitis and bursitis treated?

Treatment of these two conditions is based on the underlying cause. In overuse or injury, reduction of the causing force or stress is mandatory. A typist may need to review the ergonomic position that is used on a daily basis. Resting a painful hip from strengthening exercises may be required to allow the problem to settle prior to resumption of the strengthening programme.

Failure to rest invariably will result in continuing symptoms. Splints or braces for the affected part are a means of achieving rest and reduction of stress on the part, especially in the hand and wrist area. Off the shelf supports may be sufficient, or custom-fashioned braces may be required. Treatments, particularly ice, may help to reduce inflammation and pain. Ultrasound is often of benefit. The ultrasound referred to here is “treatment ultrasound” as distinct from diagnostic ultrasound and is most commonly administered by a physiotherapist.

This illustration of a biceps shows the white tendons that attach muscle to bone. In tendonitis, it is these structures which become inflamed.

In the lower limb, stressful weight bearing activities may need to be reduced on a temporary basis to allow the inflammation to lessen. The use of a cane in the opposite hand can assist a painful hip.

Orthotics may be required to reduce the stress at the ankle or within the foot. An orthotic is an adaptive device that is placed inside the shoe between the foot and the shoe, which serves to change the support and the angle of the foot, to improve foot mechanics and relieve pain or pressure. They can be custom made or bought off the shelf.

If an infection is present, there is usually an intense inflammation present with redness, warmth and swelling (a blood test will contribute to this diagnosis). Treatment with an appropriate antibiotic is necessary and serial aspiration (withdrawal of fluid with a needle) 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 in the lower calf, which usually requires surgical intervention to repair.

A limited number of tendon problems do not settle with the usual conservative measures above and may require surgical intervention.

Prevention

Warming up and stretching prior to strenuous exercise will help to prevent these problems from occurring. Therefore, activities should be started slowly prior to expending maximum effort.

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.

Stretching and strengthening are very helpful to address any areas of muscle imbalance. At work or when exercising, proper posture and body mechanics are important. Proper conditioning of involved muscles is another component of treatment.

Living with tendonitis/ bursitis

Seeking attention early will result in a faster resolution of the problem, and prevent joint stiffness and chronic problems that may follow. The pain of bursitis or tendonitis can be severe and just because it is not arthritis, does not mean it is less important. Failure to rest the limb or the joint at least temporarily will usually result in the problem taking a longer course.

(The writer is a Consultant Rheumatologist)