Repetitive Motion Injuries
Exams and Tests
The diagnosis of tendinitis is most often made based on history and a physical examination.
Imaging studies may help confirm the diagnosis. The imaging study of choice is the MRI. An MRI gives a very detailed picture and can identify a tear, rupture, inflammation, or other disease processes. An MRI is not useful in visualizing inflammation of the tendon sheath, tenosynovitis, unless fluid is present within the sheath itself.
Your doctor will check if your bursitis has an inflammatory or an infectious cause. The elbow and knee have a higher risk of having an infectious cause, so fluid will probably be drained from your joint to be checked for bacterial infection.
Conditions that place you at a higher risk for infectious bursitis include:
- Chronic alcoholism
- Manual labor
- Chronic obstructive pulmonary disease
Self-Care at Home
Home care for a painful or swollen joint should include elevation and not moving it until your doctor can be contacted. You can also use ice for relief of pain and swelling.
- Most authorities recommend icing 2-3 times a day for 20-30 minutes each time.
- Wrap ice or a bag of frozen vegetables in a towel and place it on the area.
If your shoulder is involved, you should not keep it immobile for more than 24-48 hours because your shoulder may become frozen and have decreased range of motion.
Tendinitis is best treated with immobilization and ice during the early phase and moist heat during the long-term phase.
- Bands placed around the elbow may be used for tennis elbow and golfer's elbow.
- Nonsteroidal anti-inflammatory drugs (NSAIDs, such as aspirin, naproxen, or ibuprofen) may be prescribed to reduce the inflammation. All NSAIDs should be taken with food or milk to avoid stomach upset.
- If your tendinitis or bursitis is not helped by NSAIDs, the doctor may choose to inject steroids into the surrounding area of inflammation. As a rule, you should not have more than 3 injections into the same area within a 12-month period.
- You should begin graduated range-of-motion exercise once your symptoms begin to improve.
- An exception to this type of treatment is shoulder involvement.
- The shoulder should not be immobilized for more than 24-48 hours in order to minimize frozen shoulder, called adhesive capsulitis.
- You should have physical therapy in addition to ultrasound and warm water baths.
- The goal in treatment of shoulder tendinitis is first and foremost to maintain full range of motion of the shoulder joint. Relieving the symptoms is secondary.
The treatment of inflammatory bursitis is similar to that of tendinitis.
- Use rest and ice, and elevate your arm or leg.
- Alternative treatments include pain-killing creams, capsaicin cream (an over-the-counter pain relief cream made from an ingredient of cayenne pepper), and steroid medications if you are able to take them.
- If your bursitis is caused by an infection, treatment will include the appropriate antibiotics.
- Steroid injection may be used but only for inflammatory bursitis. Steroid injections should be avoided in infectious bursitis because they may increase the body's susceptibility to infection.