Saturday, January 14, 2006

bursitis (tendonitis, "tennis elbow")

Bursitis is the inflammation of the bursa, a fluid-filled sac in the tissue, which usually prevents friction. The bursa facilitates the gliding of muscles and tendons over bony surfaces.
The most common joint affected by bursitis is the shoulder, although the elbow, foot, knee, and hand can be affected. Bursitis is the most common cause of shoulder pain in older people. With recurring inflammation of the area, calcium deposits and fluid may remain, which may lead to a chronic condition. Often, inflammation of the underlying tendon of the rotator cuff is the primary cause of shoulder pain in adults. Any abnormality of the rotator cuff results in a frozen shoulder where the range of motion is restricted with extreme discomfort when movement exceeds a few degrees in any direction.
Symptoms of bursitis include localized pain, limitation of motion, swelling, and redness. Pain may be so severe that the person will immobilize the affected area, which rapidly leads to stiffening of that joint.
Treatment of bursitis includes anti-inflammatory agents, analgesics, and in severe cases injection of steroids into the affected area. Physical therapy and range of motion exercises may be beneficial. In severe cases, it may be necessary to remove calcium deposits or repair bursa tears surgically. A shoulder rotation done under anesthesia loosens adhesions in a frozen shoulder that does not respond to more conservative treatment. Tennis elbow is seen in older individuals and is more common in men than in women. Any activity that involves forceful turning of the hand or forceful extension of the wrist can produce tennis elbow. Pain may radiate upward from the elbow toward the shoulder and down into the hand or may be localized in the elbow.
This condition is treated by resting the affected area, avoiding activities that cause pain, and wearing an elbow guard. It is important to avoid activities that put stress on the wrist and finger extensors until pain has been absent for several weeks.
Steinberg, F. U. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co., 1983.

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