Bursitis, Tendinitis, and Other Soft Tissue Rheumatic Syndromes.

Last updated Thursday, February 10, 2005

Management and treatment

How is bursitis and tendinitis treated?

Treatment for soft tissue conditions focuses on reducing pain and inflammation, and on preserving mobility and preventing disability and recurrence.

What can the patient do to treat or manage bursitis and tendinitis?

Cold compresses can help reduce the initial swelling and pain in acute (short-term but severe) soft tissue conditions. Cold therapy is usually most effective during the first 48 hours after swelling begins. Guidelines for cold therapy include:

• Use a cold gel pack, a bag filled with ice cubes, or even a bag of frozen vegetables.
• Wrap the pack in a towel if the cold temperature is too painful.
• Place the cold pack over the area for 20 minutes, three to four times a day.
• Rub an ice cube over smaller painful areas for a short time.

After 48 hours, or for chronic (long-term) pain, dry or moist heat may be more helpful than cold compresses. Follow these guidelines:

• Use a hot pack, a heating pad, or a damp towel heated in the microwave (make sure it's not too hot or it may burn your skin).
• Place a hot pack over the painful area for 15-20 minutes, three to four times a day.
• Never use analgesic creams or rubs with heat packs because the combination could severely burn your skin.
• Take a warm shower or bath.

What health care professionals may help treat or manage bursitis and tendinitis?

Can exercise, therapy, rest, posture, or stretching help treat bursitis and tendinitis?

Can physical therapy or exercise help treat bursitis and tendinitis?

A doctor may refer a patient with soft tissue rheumatic syndrome to a physical therapist, who can provide the following therapies:

• Ultrasound (sound waves) provides deep heat to help ease some forms of tendinitis, bursitis, or myofascial shoulder or back pain. Occasionally, using ultrasound to activate cortisone cream applied to the skin may provide relief.
• Muscle massage can ease myofascial pain.
• A personalized exercise program can help regain motion, strength, and function in the injured area.
• Water therapy can allow the patient to move a joint more comfortably.
• A physical therapist may recommend an exercise program that will help the patient regain motion in an injured area. Once the initial pain eases, the patient will need to strengthen the area to prevent re-injury. Conditions such as frozen shoulder and iliotibial band syndrome depend on exercise as a main form of treatment.

Can occupational therapy treat or manage bursitis and tendinitis?

Occupational therapists can identify modifications for daily activities and work habits to prevent re-injury. These therapists can also create hand and wrist splints and they can suggest devices to make daily activities easier. Occupational therapists can recommend exercises for fingers, wrists, and elbows.

Can bursitis and tendinitis be prevented?

Because many soft tissue conditions are caused by overuse, the best treatment is prevention. It is important to avoid or modify the activities that cause problems. Underlying conditions such as leg length differences, improper position or poor technique in sports or work must be corrected.

Be aware of potential overuse or injury in your daily activities and change your lifestyle to prevent problems. Otherwise, problems may persist or occur repeatedly. Following are some ways you can avoid future problems.

To protect your shoulders:

• Avoid activities that require you to reach overhead for long periods.
• Don't move your shoulder repeatedly for a prolonged period (such as when vacuuming or doing push-ups).
• Do range-of-motion exercises to maintain strength and flexibility.
• Use good posture.

To protect your elbows:

• Don't grip tools or pens too tightly.
• Don't clench your fists.
• Avoid repeated hand and finger motions.
• Don't lean on your elbows, and avoid bumping them.
• Use a forearm band (tennis elbow strap) during physical activity.

To protect your wrists and hands:

• Avoid repeating the same hand movement for long periods.
• Use your forearm or entire arm instead of just your wrist or hand.
• Take frequent breaks from doing fine handiwork or writing.
• Englarge handles on tools, utensils, pencils, and pens with tape or foam so your grip won't be too tight.
• Carry objects with your palms open and flat.
• Wear a splint during prolonged activity.

To protect your knees:

• Use kneepads when gardening or kneeling on floors.
• Do daily thigh-strengthening exercises (straight-leg lifts). Strong thigh muscles (quadriceps) provide added support for your knees.
• Don't sit for long periods of time; get up and walk around every 20 to 30 minutes.
• Do proper warm-up exercises before exercising or playing sports.
• Turn your entire body rather than simply twisting at the waist.

To protect your hips:

• When bending down to lift an object, bend and straighten your knees instead of your back or hips.
• Sit on cushioned chairs.
• Get a shoe lift if there is a difference in the lengths of your legs.

To protect your ankles and feet:

• Wear walking or jogging shoes that provide good support. High-top shoes provide support for people with ankle problems.
• Wear comfortable shoes that fit properly.
• Wear heel cups or other shoe inserts as recommended by your doctor.
• Exercise on level, graded surfaces.

What medications are used to treat or manage bursitis and tendinitis?

A doctor may prescribe medication or may suggest that a patient with a soft tissue condition try over-the-counter drugs to help relieve pain and/or inflammation.

Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation and pain. There are many different NSAIDs, including aspirin, ibuprofen, naproxen, and ketoprofen. These drugs are available by prescription and over the counter. A doctor will determine which drug is appropriate for a patient's condition based on factors such as age, other medical problems, daily habits, other medications taken, side effects, and cost of the drug.

Side effects of NSAIDs can include heartburn, nausea, diarrhea, easy bruising or bleeding, and dizziness. More severe side effects may include ulcers, kidney problems, and liver inflammation. Call a doctor if any of the following signs are noticed while taking NSAIDs: stomach pain or cramps; pain that decreases after eating or after taking antacids; bloody or black, tarry stools; vomiting blood. Most people with soft tissue syndromes do not need to stay on NSAIDs long because the condition being treated usually lasts only a few weeks.

Glucocorticoids are synthetic forms of cortisol, which is a hormone found naturally in the human body. Glucocorticoids reduce inflammation. Most soft tissue rheumatic syndromes can be treated with glucocorticoids injected into a bursa, joint, or tendon sheath to reduce inflammation and pain. These injections typically are used if NSAIDs or other therapies don't provide relief after three to four weeks of treatment (pill forms of glucocorticoids are not used for soft tissue conditions). Symptoms may improve or disappear within several days of an injection.

Risks of glucocorticoid injections may include bleeding, infection, tendon rupture, or skin atrophy. Frequent injections into the same area are not recommended.

Can surgery help treat bursitis and tendinitis?

Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.

Can splints or braces help treat or manage bursitis and tendinitis?

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