Almost everyone over the age of 50 has experienced some musculoskeletal pain. Unfortunately, “arthritis” has been a common label used to diagnose this symptom. The fact is that not all musculoskeletal pain is the result of arthritis. Tendinitis, bursitis and myofascial pain can produce the same discomfort.
Tendons are made up of tough, fibrous, ropelike tissues that link muscles to bones and are one of the most commonly injured structures in the body. Tendinitis occurs when the tendon or some of its fibers are torn, thus creating inflammation and pain. The more severe the injury, the more amounts of fibers are torn, and the greater the pain. Because tendons have very little blood supply, they can take a long time to heal. When a healed tendon is stressed again, it often can re-tear, usually healing poorly and creating much scar tissue. Inflamed tendons, which are due to minor trauma without tearing, are a less serious type of tendon injury. This type of injury usually can heal on its own within a short period of time.
ROTATOR CUFF TENDINITIS
The rotator cuff consists of four muscles that move the shoulder from the side and turn it inward and outward. Rotator cuff tendinitis occurs when the tendons become pinched between structures that are involved in shoulder motion. Patients can experience severe pain in the upper shoulder or upper third of the arm, difficulty sleeping on their sides or pain when lifting the arm over their head.
LATERAL EPICONDYLITIS OR “TENNIS ELBOW”
The epicondyle is the area where the forearm muscles are attached to the outside bone of your elbow. Overuse of these muscles occurs in tennis and other sports that require forced extension of the wrist or hand. Gardening, using tools or clenching your hand excessively, such as when carrying suitcases, may also cause epicondylitis. Patients can experience aching on the outside of the elbow that can travel down the forearm from a simple handshake, movement of the fingers or bending of the wrist.
DeQuervain’s tendinitis is a condition that involves the thumb tendons, often caused by repetitive pinching of the tendon while moving your wrist such as with writing or gardening. Patients can experience pain over the wrist on the side of the thumb, especially with thumb motion.
A bursa is a fluid-filled fibrous sac that lies between a tendon and a bone. It acts as a small cushion between the muscle and the bone and allows the tendon to glide smoothly over the bone without becoming irritated or torn. An irritated bursa can produce swelling and can cause pain as the bone is moved and the tendon glides over the bursa.
The trochanteric bursa is located over the prominent bone on the side of your hip. It most commonly affects women and middle-to older-aged people and is most often caused by injury, degeneration or calcification of the bursa region. In addition, walking abnormally due to leg length differences or due to arthritis of the hip, knee, ankle, foot or back can stress this the trochanteric bursa. Patients can experience pain on the side of their hip, when sleeping on their side, getting out of a chair, sitting in a car, climbing stairs, and even when walking.
The myofascial tissue is a connective tissue, which surrounds muscle sheaths, ligaments, joint capsules, and nerve sheaths. The myofascia acts like a tent, covering and protecting other body parts. It is often associated with tender, hard areas called trigger points which when pressed upon cause immediate or radiating pain. Mechanical stresses can create trigger points in most patients with persistent myofascial pain syndrome. The most common source of such physical stress is skeletal asymmetry and disproportion. Other sources of muscular stress, such as misfitting furniture, poor posture, abuse of muscles, and prolonged immobility, are frequently common and nearly always correctable. Frequently, patients with myofascial back pain, a dull, aching pain located in the muscles of your lower back and buttocks that can travel down your buttocks into your thighs, are misdiagnosed with sciatica. Patients with myofascial pain syndrome, the most common cause of neck and back pain, can experience pain in areas of muscle, often in the buttocks, back, neck and shoulders.
THE KEY TO PROPER TREATMENT
Because the treatment and prevention of arthritis is quite different from that of tendinitis, bursitis and myofascial pain, it is important to have a correct diagnosis. Treatment can include a non-steroidal inflammatory drug (NSAID), corticosteroid injections, local heat or cold pack applications, appropriate rest, therapeutic exercise, and physical therapy. As tendinitis and bursitis often subside once you stop the aggravating activity, prevention of re-injury is the best treatment of all.
KNOWING THE DIFFERENCES
In general, the pain associated with arthritis is limited to the joints, whereas tendinitis and bursitis are usually confined to one area of the body such as the shoulder, elbow, wrist, and hip, while myofascial pain can affect any portion of the body. Because the chief symptom of tendinitis, bursitis and myofascial pain is pain, diagnosis depends on the exclusion of arthritis and the identification of the inflamed tendon or bursa or trigger points. Your ability to relay your medical history to your doctor is important in making the correct diagnosis.
If tendinitis, bursitis and myofascial pain are treated properly and early, pain can be minimized and recurrence can be prevented. If you have local musculoskeletal pain in your back, shoulders, neck, elbows, or wrists, do not just accept the fact that it could be arthritis and you need to live with. Make sure it is not something else.