A bursa is a closed, fluid-filled sac that functions as a cushion and gliding surface to reduce friction between tissues of the body. The major bursae are located adjacent to the tendons near the large joints, such as in the shoulders, elbows, hips, and knees. When the bursa becomes inflamed, the condition is known as bursitis.
Bursitis is usually a temporary condition. It may restrain motion, but generally does not cause deformity.
Bursitis is often a result of overuse. It can be caused by a change in activity level, such as training for a marathon or by being overweight. It can also be a sign that biomechanically, there is a dysfunction in your body. This may be due to a muscle imbalance, a flat arch in your foot or a leg length discrepancy due to pelvic tilting or hip rotation.
Bursitis can also be caused by trauma. On rare occasions, the cause cannot be found.
Bursitis commonly occurs in the following locations:
- Shoulder (Subacromial)
- Elbow (Olecranon)
- Pelvis (Ischeal)
- Hip (Trochanteric)
- Knee (Infrapatellar/Suprapatellar, Pes anserine)
- Ankle/Foot/Achilles (Retrocalcaneal)
Inflammation of a tendon (the tissue by which muscle attaches to bone) which most commonly occurs as a result of injury, such as to the tendons around the shoulder or elbow. Tendinitis is synonymous with tendonitis.
More frequently, Doctors are using the term tendinopathy to describe many tendon injuries, such as tennis elbow, golfer’s elbow, Achilles tendon injuries, etc. Experts now recognise that typical tendon injuries are more often caused by long-term overuse that results in a deterioration of the tendon without any associated inflammation.
Tendonitis, on the other hand, refers to an inflammation of the tendon. This distinction is important because the inflammation of tendinitis is treated differently than the deterioration of tendinopathy (tendonosis).
Inflammation from acute tendonitis often respond quickly to medications and anti-inflammatory treatment. However, if the injury is due to tendon tissue degeneration, treatment may be quite lengthy and will be focused on improving the strength of the tendon and rebuilding tissues.
The following are the most common locations of tendinitis:
- Shoulder (Biceps, Rotator cuff tendons especially Supraspinatus)
- Elbow (elbow extensor/flexor common tendons-tennis/golfers elbow)
- Hip/Pelvis (adductor, quadrecips and hamstring tendons)
- Wrist (De Quervain’s)
- Knee (Patellar, Semimembranosus, pes anserine and popliteus tendons)
- Ankle/Foot (Achilles and peroneal tendons)
- Joint pain and tenderness when you press around the joint
- Stiffness and aching when you move the affected joint
- Swelling, warmth or redness over the joint
Bursitis can cause pain, localised tenderness, and limited motion. Swelling and redness may occur if the inflamed bursa is close to the surface (superficial).
Chronic bursitis may involve repeated attacks of pain, swelling, and tenderness, which may lead to the deterioration of muscles and a limited range of motion.
The following are the most common symptoms of tendonitis. However each individual may experience symptoms differently. The main symptoms of tendonitis are pain and inflammation in the affected tendon and may include:
- pain that is worse when you move the affected area
- a sensation that the tendon is grating or crackling as it moves (this may be felt on examination)
- swelling, sometimes with heat or redness
- weakness in the affected area
- a lump that develops along the tendon
If your symptoms persist, the tendon may deteriorate and be associated with tendon tissue degeneration.
Approximately 80% to 95% of patients have success with nonsurgical treatment. At Spinal and Sports Care, we utilise a combination of the following:
- Rest. The first step toward recovery is to give your arm proper rest. This means that you will have to stop participation in sports or heavy work activities for several weeks.
- Non-steroidal anti-inflammatory medicines. Drugs like aspirin or ibuprofen to help reduce pain and swelling.
- Exercises. Wrist stretching exercise with elbow extended that are eccentric (a muscle contraction with the muscle/tendon lengthening) in nature has been reported in research to be most effective and superior to concentric exercises (muscle contraction with the muscle/tendon shortening) and to stretching. However, benefits are often experienced only after three months of treatment.
- Extracorporeal shock wave therapy. Shock wave therapy sends sound waves to the elbow. These sound waves create “microtrauma” that promote the body’s natural healing processes. Shock wave therapy has an increasing amount of research to support its effectiveness, and is rapidly becoming the treatment of choice for tendinopathies/tendinosis’.
- Chiropractic & Physical Therapy. Specific exercises prescribed by your Physio or Chiropractor may be helpful for strengthening the muscles of the forearm. Your therapist may also perform an ultrasound, ice massage, dry needling or muscle-stimulating techniques to help improve muscle healing.
- Brace. Using a brace centered over the back of your forearm may also help relieve symptoms of your condition. This can reduce symptoms by resting the muscles and tendons.
- Equipment check. If you participate in a racquet sport, your practitioner may encourage you to have your equipment checked for proper fit. Stiffer racquets and looser-strung racquets often can reduce the stress on the forearm, which means that the forearm muscles do not have to work as hard. If you use an oversized racquet, changing to a smaller head may help prevent symptoms from recurring.
- Steroid injections. Steroids, such as cortisone, are very effective anti-inflammatory medicines. After consultation with your GP, your doctor may decide to inject your damaged muscle with a steroid aimed to relieve your symptoms. At Spinal and Sports Care, we recommend that all injections, where necessary, are undertaken under ultrasound guidance.
If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your doctor may then recommend surgery.
Most surgical procedures for tennis elbow and bursitis involve removing diseased muscle and reattaching healthy muscle back to bone.
The right surgical approach for you will depend on a range of factors. These include the scope of your injury, your general health, and your personal needs. Talk with your doctor about the options. Our practitioners are also available to discuss the results previous patients have had, and any risks associated with each procedure.