Aches and Pains

As a young TV news reporter in the 1970s, I was often needed to help carry what was, at the time, very heavy equipment. In my first job in Scranton, Penn., the tripod was an oversized affair made of wood and metal. The cameraman carried the camera. I carried the tripod. In addition to that, if the shooter and I were going out of town on a multi-day shoot, this involved carting any and all equipment we might need, such as a very heavy light kit: a metal "suitcase" filled with assorted lights and stands.

It only took two years of this daily assault on my joints for me to start experiencing chronic shoulder pain. Over the years, it was alternately diagnosed as bursitis, tendinitis, and finally, an offshoot of osteoarthritic changes in my neck.

Until that diagnosis, I tried to address the stabbing pain in my shoulder with steroids, therapeutic massage, hot compresses, and even triggerpoint injections: The physiatrist (sports medicine doctor) identified the most painful spot, and injected Novocain. Twice. It actually did the trick for a couple years.

Today, at age 58, I just live with my achy shoulder. If it really bothers me, I take an Advil.

So how to tell the difference between arthritis, bursitis and tendinitis without an MRI? Magnetic Resonance Imaging finally revealed the bone spurs in my neck vertebrae that narrowed the canal through while the spinal cord passes - thus causing my shoulder problems.

According to the Cleveland Clinic, symptoms of arthritis include pain and limited function of joints. Inflammation of the joints from arthritis is characterized by joint stiffness, swelling, redness, and warmth. Tenderness of the inflamed joint can be present.

Many of the forms of arthritis, because they are rheumatic diseases, can cause symptoms affecting various organs of the body that do not directly involve the joints. Therefore, symptoms in some patients with certain forms of arthritis can also include fever, gland swelling, weight loss, fatigue, feeling unwell, and even symptoms from abnormalities of organs such as the lungs, heart, or kidneys.

Who Is Affected By Arthritis?

Arthritis sufferers include men and women, children and adults. Approximately 350 million people worldwide have arthritis. Nearly 40 million persons in the United States are affected by arthritis, including over a quarter million children!

More than 21 million Americans have osteoarthritis. Approximately 2.1 million Americans suffer from rheumatoid arthritis.

More than half of those with arthritis are under 65 years of age. Nearly 60 percent of Americans with arthritis are women.

How Is Arthritis Diagnosed And Why Is A Diagnosis Important?

The first step in the diagnosis of arthritis is a meeting between the doctor and the patient. The doctor will review the history of symptoms, examine the joints for inflammation and deformity, as well as ask questions about or examine other parts of the body for inflammation or signs of diseases that can affect other body areas. Furthermore, certain blood, urine, joint fluid and/or x-ray tests might be ordered. The diagnosis will be based on the pattern of symptoms, the distribution of the inflamed joints, and any blood and x-ray findings. Several visits may be necessary before the doctor can be certain of the diagnosis. A doctor with special training in arthritis and related diseases is called a rheumatologist (see below).

Many forms of arthritis are more of an annoyance than serious. However, millions of patients suffer daily with pain and disability from arthritis or its complications.

Earlier and accurate diagnosis can help to prevent irreversible damage and disability. Properly guided programs of exercise and rest, medications, physical therapy, and surgery options can idealize long-term outcomes for arthritis patients.

It should be noted that both before and especially after the diagnosis of arthritis, communication with the treating doctor is essential for optimal health. This is important from the standpoint of the doctor, so that he/she can be aware of the vagaries of the patient's symptoms as well as their tolerance to and acceptance of treatments. It is important from the standpoint of patients, so that they can be assured that they have an understanding of the diagnosis and how the condition does and might affect them. It is also crucial for the safe use of medications.

Bursitis, on the other hand, is the inflammation or irritation of the bursa. The bursa is a sac filled with lubricating fluid, located between tissues such as bone, muscle, tendons, and skin, that decreases rubbing, friction, and irritation.

What Causes Bursitis?

This condition is most often caused by repetitive, minor impact on the area, or from a sudden, more serious injury. Age also plays a role. As tendons age they are able to tolerate stress less, are less elastic, and are easier to tear.

Overuse or injury to the joint at work or play can also increase a person's risk. Examples of high-risk activities include gardening, raking, carpentry, shoveling, painting, scrubbing, tennis, golf, skiing, throwing, and pitching. Incorrect posture at work or home and poor stretching or conditioning before exercise can also lead to bursitis.

An abnormal or poorly placed bone or joint (such as length differences in your legs or arthritis in a joint) can put added stress on a bursa sac, causing bursitis. Stress or inflammation from other conditions, such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders, or unusual medication reactions may also increase a person's risk. In addition, an infection can occasionally lead to inflammation of a bursa.

Who Usually Gets Bursitis?

Bursitis is more common in adults, especially in those over 40 years of age.

What Parts of the Body Does Bursitis Affect?

• Base of the thumb
• Elbow
• Shoulder
• Hip
• Knee
• Achilles tendon

What Are the Symptoms of Bursitis?

The most common symptom is pain at the site of the bursa and beyond. The pain may be a gradual buildup or sudden and severe, especially if calcium deposits are present. Loss of motion in the shoulder - called "adhesive capsulitis" or frozen shoulder - can also be a sign of bursitis.

How Can I Prevent Bursitis?

Bursitis can be prevented with a gradual buildup in activities, with limited force and limited repetitions. Stop what you are doing if unusual pain occurs. Try again later and if pain recurs, do not continue the activity that day.

How Is Bursitis Treated?

Bursitis can be treated in a number of ways, including:

• Avoiding activities that aggravate the problem.
• Resting the injured area.
• Icing the area the day of the injury.
• Taking over-the-counter anti-inflammatory medicines.

If the condition does not improve in a week, see your doctor.

Your doctor can also prescribe medications to reduce the inflammation. Corticosteroids, also known as "steroids," are often used because they work quickly to decrease the inflammation and pain. Steroids are also one of the safest treatment methods and can be injected directly at the site of injury. Unfortunately, 30 percent of people may not get complete relief from one injection and two percent of people may even get worse. Another disadvantage is that for recurrent cases, it is not safe to administer steroids frequently (more than every three months).

Physical therapy is another treatment option that is often used, especially for a frozen shoulder. This includes range of motion exercises and splinting (thumb, forearm, or bands).

Surgery, although rarely needed, may be an option when bursitis does not respond to the other treatment options.

Warning:

Consult your doctor immediately if you have:

• Fever (over 100 Fahrenheit)
• Swelling, redness, and warmth
• General illness or multiple sites of pain
• Inability to move the affected area

These could be signs of another problem that needs more immediate attention.

According to the Clinic's Department of Rheumatic and Immunologic Diseases, tendinitis is an inflammation or irritation of the tendon, a thick cord that attaches bone to muscle.

What Causes Tendinitis?

Tendinitis is most often caused by repetitive, minor impact on the affected area, or from a sudden more serious injury.

There are many activities that can cause Tendinitis, including:

• Gardening
• Raking
• Carpentry
• Shoveling
• Painting
• Scrubbing
• Tennis
• Golf
• Skiing
• Throwing and pitching

Incorrect posture at work or home or poor stretching or conditioning before exercise or playing sports also increases a person's risk. Other risk factors include:

• An abnormal or poorly placed bone or joint (such as length differences in your legs or arthritis in a joint) that stresses soft tissue structures.

Stresses from other conditions, such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders, or unusual medication reactions.

• Occasionally an infection can cause Tendonitis.

Who Gets Tendinitis?

Anyone can get Tendinitis, but it is more common in adults, especially those over 40 years of age. As tendons age they tolerate less stress, are less elastic, and are easier to tear.

Where Does Tendinitis Occur?

Tendinitis can occur in almost any area of the body where a tendon connects a bone to a muscle. The most common places are:

• Base of the thumb
• Elbow
• Shoulder
• Hip
• Knee
• Achilles tendon

What Are the Symptoms of Tendonitis?

The symptoms of Tendinitis include:

• Pain at the site of the tendon and surrounding area. Pain may be a gradual buildup or sudden and severe, especially if calcium deposits are present.
• Loss of motion in the shoulder, called "adhesive capsulitis" or frozen shoulder.

How Can I Avoid Tendinitis?

When performing activities:

• Take it slow at first. Gradually build up your activity level.
• Use limited force and limited repetitions.
• Stop if unusual pain occurs. Do something else. Try again later and if pain recurs, stop that activity for the day.

How Is Tendinitis Treated?

Initial treatment includes:

• Avoiding activities that aggravate the problem.
• Resting the injured area.
• Icing the area the day of the injury.
• Taking over-the-counter and anti-inflammatory medication like Ibuprofen.

If the condition does not improve in a week, see your doctor. You may need more advanced treatments, including:

• Corticosteroid injections. Often called ‘steroids' - these injections are used because they act quickly to reduce inflammation and pain.
• Physical Therapy. This can be very beneficial, especially for a frozen shoulder. The therapy includes range of motion exercises .
• Surgery. Rarely needed, used only for conditions that respond to no other treatments.

How Long Will Recovery Take?

Tendinitis may take weeks to months to recover, depending on the severity of your injury.

Warning:

You should see your doctor if you experience any of the following:

• Fever over 100 degrees Fahrenheit.
• Swelling, redness and warmth.
• General illness or multiple sites of pain.
• Inability to move the affected area.

These could be signs of another problem that needs more immediate attention.

Source: American College of Rheumatology.