JOINT PAIN/BURSITIS/TENDONITIS

BURSITIS

Whether you're at work or at play, if you overuse or repetitively stress the areas around your body's joints, you may eventually develop a painful inflammation called bursitis.

You have more than 150 bursae in your body. These small, fluid-filled sacs lubricate and cushion pressure points between your bones and the tendons and muscles near your joints. They help your joints move with ease. Bursitis occurs when a bursa becomes inflamed. When inflammation occurs, movement or pressure is painful.

Bursitis often affects the areas around the joints in your shoulders, elbows or hips. But you can also have bursitis by your knee, heel and even in the base of your big toe. Bursitis pain usually goes away within a week or so with proper treatment, but recurrent flare-ups of bursitis are common and can be frustrating.

SIGNS AND SYMPTOMS

• A dull ache or stiffness in the area of your elbow, hip, knee, shoulder, big toe or other joints
• A worsening of pain with movement or pressure
• An area that feels swollen or warm to the touch
• Occasional skin redness in the area of the inflamed bursa

Bursitis of the hip doesn't cause any visible swelling or skin redness because the bursae are located beneath some of your body's bulkiest muscles. In this type of bursitis, pain is primarily over the greater trochanter, a portion of your thighbone (femur) that juts out just below where the bone joins the hip.

CAUSES

Common causes of bursitis are overuse, stress or direct trauma to a joint, such as with repeated bumping or prolonged pressure from kneeling. Bursitis may also result from an infection, arthritis or gout. Many times, the cause is unknown.

Other forms of bursitis are caused by repetitive motion related to certain activities:

• Shoulder. Bursitis of the shoulder often results from injury to the rotator cuff, the muscles and tendons that connect your upper arm bone to your shoulder blade. Causes of the injury may include poor posture, falling, lifting and repetitive overhead arm activities. Sometimes it's hard to distinguish between the pain caused by bursitis and that caused by a rotator cuff injury.
• Elbow. This type is associated with actions requiring you to repeatedly bend and extend your elbow. You may get such an inflammation by pushing a vacuum cleaner back and forth. Throwing a baseball and swinging a tennis racket or a golf club are other examples of repeated physical activities that may lead to bursitis or tendinitis of the elbow or shoulder. Simple repeated leaning on your elbows could lead to bursitis over the tip of your elbow.
• Buttocks. This type of bursitis describes an inflamed bursa over the bone in your buttocks. It may result from sitting on a hard surface for long periods, such as on a bike.
• Hip. Bursitis of the hip is frequently associated with arthritis or a hip injury. The pressure from standing or sitting for a prolonged time also may lead to bursitis of the hip.
• Knee. In this form of bursitis, a soft, egg-shaped bump occurs on the front of your knee, the result of repetitive kneeling while installing tiles, scrubbing a floor, gardening or doing other activities that place pressure on your knees. A sharp blow to the knee can cause inflammation of the bursae around the kneecap. People with arthritis who are overweight often develop bursitis of the knee.
• Ankle. Inflammation of the bursa in the ankle commonly occurs as a result of improper footwear or prolonged walking or in sports, such as ice-skating.

You may not be able to pinpoint a specific incident or activity that led to your bursitis. In fact, in some cases the inflammation may stem from a staphylococcal infection or, rarely, tuberculosis.

RISK FACTORS

If you work in a profession or have a hobby that requires repetitive motion, you're at an increased risk of developing bursitis. The occurrence of bursitis also increases with age. In addition, certain diseases and conditions increase your risk of developing bursitis, such as:

• Arthritis
• Gout
• Staphylococcal infection
• Tuberculosis, although rare

Tendonitis is the inflammation of a tendon, a tough rope-like tissue that connects muscle to bone. Tendonitis usually occurs in individuals in middle or old age because it is often the result of overuse over a long period of time. Tendonitis does occur in younger patients as a result of acute overuse.

Tendons that commonly become inflamed include:

• tendons of the hand
• tendons of the upper arm that effect the shoulder
• achilles tendon and the tendon that runs across the top of the foot
• Causes and symptoms

Sudden stretching or repeated overuse injures the connection between the tendon and its bone or muscle. The injury is largely mechanical, but when it appears, the body tries to heal it by initiating inflammation. Inflammation increases the blood supply, bringing nutrients to the damaged tissues along with immunogenic agents to combat infection. The result is swelling, tenderness, pain, heat, and redness if the inflammation is close to the skin. Some tendon injuries are superficial and easy to identify. These include "tennis elbow" (extensor tendinitis) over the outside of the elbow, and Achilles' tendinitis just above the heel of the foot. There are several tendons in the shoulder that can be overused or stretched, and usually a shoulder will have more than one injury at a time. Tendinitis in the biceps, the infraspinatus, or the supraspinatus tendon may accompany a tear of the shoulder ligaments or an impingement of one bone on another. Careful pressure testing and movement of the parts is all that is necessary to identify the tendinitis.