Bursitis and Tendonitis

What is Tendonitis?

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

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What is Bursitis?

Bursitis is inflammation or irritation of a bursa. Bursa are small sacs located between bone and other moving structures such as muscles, skin or tendons. The bursa allows smooth gliding between these structures.

Since both tendons and bursa 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. 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 restrain motion.

Causes

The most common cause of tendonitis 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. Tendonitis or bursitis may be associated with diseases such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disease and diabetes.

Health Impact

  • Tendonitis and bursitis are common musculoskeletal problems in both the young and old populations.
  • Overuse and sports injuries are common in physically active populations.
  • These diseases often result in loss of work and income.

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 bursa are generally not visible on x-rays. Aspiration of a swollen bursa may be performed to exclude infection or gout. Blood tests may be ordered to confirm underlying conditions such as rheumatoid arthritis or diabetes, 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. Proper positioning during offending activities is important to prevent recurrent injury. An adequate warm-up before and correct posture during exercise is useful. Splinting the affected area, applying moist heat, or sometimes ice, and using other form of physical therapy are helpful. Anti-inflammatory medications reduce inflammation and pain. Corticosteroids injections into the affected area are frequently helpful.

If an infection is present, an appropriate antibiotic is necessary and serial aspiration or surgical debridement of the tendon or bursa may be required. Surgical intervention for other forms of tendonitis or bursitis is uncommon.

Once the acute attack of tendonitis or bursitis subsides, preventing recurrences is crucial. Proper conditioning, ergonomically correct work stations and joint positioning, and appropriate splints or pads to protect susceptible areas help to prevent recurrences.

The Hematologist’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 hematologist, as a non-surgical 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.

Medications, herbs, and supplements to consider

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When using supplements, check label instructions for dosage for the specific formulation you are using, as well as for other specific instructions.

  • Tylenol may be used for pain.
  • Aspirin and other anti-inflammatory medications (NSAID), have a long history of effectiveness but have side effects which include gastric irritation. Long term, NSAIDs is not healthy for joint tissue.
  • Curcuma, an herbal preparation made from concentrated tumeric (described above), with anti-inflammatory properties. Standardized extracts are preferred but may be difficult to find; dose will vary with formulation.
  • Antioxidants; to assist tissue health and healing by scavenging oxidative products of tissue damage. Many herbs have antioxidant properties, including Grape Seed Extract, dose in acute injury is 150-300 mg/day). Quercetin is a chemical precursor to many other bioflavanoids, dosage 200-400 three times per day. Well known, inexpensive antioxidant supplements include Vitamin E, 400-800 IU as natural mixed tocopherols, and Selenium, 200 mcg/day. The power of inexpensive, readily available Vitamin E should not be underestimated, and it also has a history of use for scar, which may contribute to chronic pain.
  • Ginkgo Biloba: this well studied herb with many beneficial properties has antioxidant activity, has been shown to benefit nerve tissue, and benefits extremity blood flow. This may facilitate delivery of healing substances to injured tissues. Dose of standardized extract is 40 mg, 3 times per day.
  • Glucosamine Sulfate, 500 mg, 3 times per day, may help preserve and rebuild connective tissue. (Research on Chondroitin, N-Acetyl Glucosamine, and Glucosamine Hydrochloride is more hazy; for the money, purchase a quality Glucosamine Sulfate product at the full dose).
  • Bromelain may help absorption of Curcuma.
  • Manganese 25-100 mg twice daily for 2 weeks, then 15-30 mg/day. This is felt to increase the amount of natural antioxidant produced by the body.
  • Omega 3 Fatty Acids, present in Flax Seed Oil and Fish Oil, help the body to decrease inflammatory processes. One to 2 tablespoons of Flax Seed Oil can be used as salad dressing each day.
  • Gotu Kola may be useful for tissue support when scarring is felt to contribute to pain, as may be the case in chronic conditions. It also has a reputation for enhanced would healing, and interestingly, in the reduction of cellulite. Standardized extracts are hard to find; dose will vary with formulation.