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Virginia Institute
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What Is ?
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Cause
Tendonitis and bursitis are common causes of musculoskeletal pain in people between the ages of 30 and 60. They also occur in people who are both older and younger than that. These problems may occur in various parts of the body including the shoulder, elbow, wrist, hand, hip, knee, ankle and foot. The exact cause is not well understood. As you grow older, the different parts of your body do not tolerate stress as well as they used to. Rather than developing sore muscles which go away in a few days, your body appears to develop an inflammatory or irritated response that can last for a long time and be quite painful. These problems often follow an episode of unaccustomed activity such as raking leaves or they may follow a specific incident of excessive stress or injury to your body.
Bursitis
Anywhere in your body that two surfaces need to glide over each other, there is a bursa. A bursa consists of two surfaces of slick tissue which face each other and glide over each other. The edges are sealed and they form essentially a collapsed sac. When inflamed, this sac fills with fluid, swells and becomes sore and tender. There is a bursa where the skin at the point of your elbow glides over the underlying bone. Another bursa lies under the skin which glides over your knee cap. There are bursae in the heel where the skin glides a little over the bone. There are also bursa deeper within your shoulders and your hips. Inflammation of these structures is called bursitis.
Tendonitis
Detailed studies of the blood supply to the tendons that surround the shoulder indicate that the amount of blood supply decreases significantly as we age through the 30's, 40's and 50's. It is likely that a similar steady decrease in blood supply occurs in other tendons and muscle-tendon junctions of the body. This may explain why our tendons are less able to withstand stress and are more likely to become inflamed. Inflammation of the tendons, their attachments to bone and the muscle-tendon junctions is called tendonitis. An acute injury or multiple small injuries from chronic stress can lead to small tears in the tendons, at their attachments to bone, or at the muscle-tendon junction. These small tears can result in an area of chronic inflammation. This process is called tendonitis.
Deposits of calcium are sometimes laid down in areas of the tendons which develop decreased blood supply. The calcium crystals are very irritating to the tissues and cause pain and inflammation. This is called calcific tendonitis and often is the cause of the acute tendonitis that appears suddenly without cause. The pain may be severe enough to interfere with sleep.
Treatment
The mainstays of treatment for tendonitis and bursitis are non-steroidal anti-inflammatory medications (Motrin, Naprosyn, Dolobid, Ansaid, Orudis, Indocin, Clinoril, Feldene, Celebrex and Vioxx) and cortisone shots. Neither cures all cases. Some types of tendonitis and bursitis seem to respond better to medication and others are more amenable to cortisone shots. Both treatments have low risks associated with them. Anti-inflammatory medications can cause ulcer problems. Cortisone shots rarely cause a temporary increase in inflammation, rupture of tendons or depigmentation of the skin. Too many cortisone shots (usually more than six in one place) can increase the risk of rupture of a tendon. Rest and avoidance of repetitive stress to the inflamed area are also important.
