One day, your shoulder feels fine. The next day, the pain is as sharp as anything you've ever felt—a twisting, shooting pain that seems to have come from nowhere. Yes, you played softball over the weekend, but it's hard to equate a couple of hard throws from right field with the intense pain that you feel in your shoulder.
You know it's not
, because this pain is different than the swelling and stiffening that occurs with your occasional bouts of arthritis. So you call your healthcare provider, who asks you what you did over the weekend. You explain your symptoms, giving your doctor a good idea of where to look. The pain isn't arthritis, but almost certainly
, or both—two of the most common joint problems affecting people age 35 years and older. One study, in fact, says two-thirds of men who complain of muscle problems are suffering from one of the two.
It's important to keep in mind is that tendinitis and bursitis are different, although people tend to associate them as one. What they have in common is that they both cause pain, often in the same areas, like in the rotator cuff of the shoulder. But they are not the same condition.
In tendinitis, the tendons—tissues that attach muscles to bone—become inflamed. In bursitis, the bursae—fluid filled sacs that help the muscles and tendons glide smoothly over other underlying bones—become inflamed.
Tendinitis is almost always caused by overuse or misuse of the tendons, as in tennis elbow or sore knees among serious runners. The pain of bursitis, on the other hand, may be due to overuse, but may also be a reflection of underlying arthritis (or even gout).
Any physically active person is susceptible to bursitis or tendinitis, which is the more common of the two. The tendons and bursae may become irritated either from constant use or from unaccustomed demands of being a “weekend warrior.” The more active you are, the more likely you are to get tendinitis. Bursitis may occur with activity, or it may come on without known provocation. Each case is different, and there seems to be no correlation with a family history of bursitis or tendinitis.
That's one of the differences between these two conditions and arthritis, in which heredity does seem to play a role. Arthritis affects a different part of the musculoskeletal system by causing a swelling in the lining of the joints.
Since physical activity is one cause of bursitis and tendinitis, the best way to avoid the inflammation and pain is to avoid doing more than you can. Pain is a communication tool; it's the way your brain tells your body to change the way you exercise.
Consider your sore shoulder. Baseball fans will recognize your symptoms as the dreaded rotator cuff injury so common to pitchers. One reason pitchers are susceptible is because pitching—especially throwing so hard and throwing curve balls—is a very unnatural action.
You can avoid the pain in one of two ways. First, warm up before you start throwing. It sounds too simple to be effective, but life usually works out that way, doesn't it? If you make sure your tendons are loose, they are less likely to become inflamed. Second, be sure that your muscles are strong before you use them fully. Weight training, perhaps under the guidance of a personal trainer, can help you achieve appropriate levels of strength for the activities you wish to do. Working at full strength may help you reduce your risk for either tendinitis or bursitis.
If you do inflame the tendons or the bursae despite warming up, the best approach is to rest. This gives the body a chance to heal itself; any anti-inflammatory over-the-counter drug, like ibuprofen, helps, as does icing the affected area. Then, look at how you can change the way you throw to prevent the problem from happening again.
Keep in mind that anti-inflammatory drugs can cause ulcers, stomach, or bowel bleeding, and other serious complications if taken frequently over long periods of time. If tendonitis doesn’t improve within a few weeks, you should see your medical care provider. Many people find that topically applied anti-inflammatories containing the compound trolamine salicylate provide them with pain relief that may pose fewer risks compared to orally taken medications.
Cortisone can be injected into bursae and around tendons, which will reduce the inflammation. But this treatment is not going to eliminate the mechanical problem that caused the inflammation in the first place. While cortisone injections are frequently used for troubling and prolonged symptoms, there is at best limited evidence that they provide lasting relief or are more effective than injection with numbing medications alone.
That approach is the key to a successful rehabilitation. That is, to look at the biomechanical aspects: Is the bursitis or tendinitis caused by a training error? Can you change the way you do something? The key is to find out why the muscles aren't strong enough or why they are too inflexible.
Once that's under control, doctors say, you can throw as hard as you want from right field
remain pain free.
American College of Rheumatology
Alvarez CM, Litchfield R, Jackowski D, Griffin S, Kirkley A.
A prospective, double-blind, randomized clinical trial comparing subacromial injection of betamethasone and xylocaine to xylocaine alone in chronic rotator cuff tendinosis.
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