Tendinitis & Bursitis

Tendinitis (sometimes spelled tendonitis) and bursitis are conditions that affect the tendons and bursae of the joints. The term tendon refers to the connective tissue that joins two muscle groups. Stability and flexibility are essential for healthy tendon function. The muscles and tendons power our joints, allowing us to move. The bursae (plural for “bursa”) are sac-like fluid filled structures that allow the tissue structures to glide smoothly against each other.

Since both tendons and bursae are located near joints, inflammation in these tissues will often be perceived as joint pain and mistaken for arthritis. The symptoms of bursitis and tendinitis are similar: pain and stiffness made worse by movement. Pain may be worse at night. Although tendinitis and bursitis are usually temporary conditions, they may become recurrent or chronic problems.

HOW COMMON ARE TENDINITIS AND BURSITIS?

Precise figures as to how many people suffer from tendinitis and bursitis are not available although it is believed to be close to 6 percent of the population. The condition affects the old and young alike.

WHAT ARE THE WARNING SIGNS?

The following symptoms may indicate that you have tendinitis or bursitis:

• pain, stiffness and swelling of the affected area
• pain that is worse in the evening/at night
• restricted movement in the area surrounding the injury
• pain that is usually worse after movement of the affected area

The diagnosis of tendinitis and bursitis requires a thorough medical history and physical examination. Although blood tests may be ordered to confirm underlying conditions such as rheumatoid arthritis or diabetes, they are generally not necessary to diagnose tendinitis or bursitis.

HOW ARE TENDINITIS AND BURSITIS TREATED?

If you have been diagnosed with tendinitis or bursitis, your treatment will depend on the specific cause and nature of the condition. Common treatments include rest or immobilization of the affected area/s and medication to control pain. Here are the most commonly used medications for tendinitis/bursitis, and how they work.

• ACETAMINOPHEN
  For mild to moderate tendinitis, doctors may recommend acetaminophen (Tylenol®, Panadol®, Exdol®, etc.) to relieve pain. Acetaminophen is only a pain reliever and has no anti-inflammatory properties. For this reason it can generally be safely combined with anti-inflammatory medications under a doctor’s advice. Acetaminophen can be purchased without a prescription and does not decrease the tendon damage. There are dosage limits of acetaminophen so caution should be exercised when taking this medication along with other medications that may contain acetaminophen. (Cold medications and drinks frequently contain acetaminophen.) Overdosing on acetaminophen can cause liver damage.
   
• NSAIDs
  Pronounced “ensayds,” these drugs help reduce pain and swelling associated with tendinitis, while decreasing stiffness. When a low dose is taken, NSAIDs control pain, but higher doses are required to reduce inflammation. The problem with NSAIDs is their side effects. Taking more than one NSAID at a time increases the possibility of heartburn and severe side effects such as ulcers and bleeding. NSAIDs inhibit the blood’s ability to clot properly and may therefore interact with blood-thinning medications such as coumadin. Kidney disease has also been reported as a side effect.
  
  Most NSAIDs require a prescription, including naproxen (Naprosyn®), nabumetone (Relafen®), indomethacin (Indocid®), diclofenac (Voltaren®), piroxicam (Feldene®) and sulindac (Clinoril®). Other NSAIDs are available over-the-counter; these include ASA (Aspirin®, Anacin® and others), and ibuprofen (Motrin IB®, Advil® and others.)
   
• COX-2 Inhibitors
  This sub-class of NSAID has recently been introduced to the North American marketplace. The most frequently prescribed Cox-2 inhibitors are celecoxib (Celebrex®), rofecoxib (Vioxx®), valdecoxib (Bextra®) and meloxicam (Mobicox®). Unlike standard NSAIDs, Cox-2 inhibitors do not inhibit proper blood clotting. Recent evidence, however, strongly suggests that Cox-2 inhibitors have the same degree of negative side effects as standard NSAIDs—including contributing to kidney failure—and may increase the risk of heart attack and other cardiovascular problems.
  
  *Important News Release September 2004
  Vioxx®, the cox-2 inhibitor made by Merck, has been pulled from the market because of severe lethal side effects due to heart attack and stroke.
   
• CORTICOSTEROIDS
  Oral corticosteroid drugs are frequently used to treat extreme inflammation, pain and stiffness. The most commonly used oral corticosteroid is prednisone. Long-term use of this drug may give rise to cataracts, high blood pressure, problems sleeping, muscle loss, bruising, osteoporosis (thinning of the bones), weight gain, immune suppression and increased susceptibility to infection. If you are prescribed a corticosteroid, your doctor will give you the lowest possible dose to begin with, slowly reducing this after six months use.
  
  Cortisone may be injected directly into the joint to relieve severe inflammation and swelling. Cortisone mimics the anti-inflammatory effects of cortisol—a hormone produced naturally in the body. A cortisone injection can provide almost immediate relief for a tender, swollen or inflamed joint. However, since corticosteroids can weaken cartilage and remove minerals from the bone, they should only be used rarely. Chronic use of corticosteroids may result in immune suppression and increase the risk of infection.
   
• Nutricol®
  Nutricol® available as Recovery® in many pharmacies and health retailers, is a food-based non-drug supplement proposed to improve quality of life*.
  
  Nutricol® (Recovery®) may be safely combined with other tendinitis and bursitis medications or taken on its own to help improve quality of life*. It does not produce unpleasant side effects. Since this product works to modify your body’s responses, it may take up to six weeks for you to experience relief, with most people noticing benefits within a month.
  
  View feedback from health professionals and users of Recovery® with Nutricol®.

• PROLOTHERAPY
  Prolotherapy is a treatment in which a solution of simple compounds (usually dextrose or calcium carbonate) is injected at the point of the injury. This triggers an inflammation response that increases the blood supply and delivers the nutrients necessary to promote the growth of new cells and repair damaged connective tissue.
  
  Click here for Tendinitis and Bursitis Risk Factors and Wellness Tips.