Pain due to tendonitis or bursitis, commonly involving the shoulder, elbow, wrist, hip, knee and ankle, may be quite severe, often occurs suddenly and is usually made worse by movement. This inflammation of the soft‐tissue tendons and bursae located near joints often will be mistaken for arthritis. However, while it can be recurrent or chronic in some cases, it is usually a temporary condition, particularly if treated early.
Tendonitis is inflammation 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. Inflammation of the tendon (increased blood flow through the area with warmth, swelling, pain and loss of function) can be spelled “tendonitis” or “tendinitis.”
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).
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 a tendonitis or bursitis in the shoulder. A typist who spends long hours working 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. Crystals, which are associated with gout, can sometimes be found in a bursa, and, like infection, may occur without any precipitating event.
Tendonitis or bursitis may occur in individuals with diseases such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disease and diabetes.
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 also should take breaks.
Stretching and strengthening are very helpful to address any areas of muscle imbalance. Proper posture and body mechanics are important at work or during exercise. Proper conditioning of involved muscles is another component of treatment.
It is important to complete a daily range of motion exercise program to preserve mobility, particularly in the shoulder joint, as a tendonitis or bursitis in the shoulder not infrequently becomes a greater problem if the shoulder becomes stiff.