Would it hurt to try and do light exercise? Is it better to wait until the inflammation and pain go away? With proper treatment, how long do you think it will take to heal?

Would an MRI test on both shoulders help to determine how much inflammation is present and whether there are any muscle tears in the shoulder joints? I would appreciate any insight and information you can provide.

DEAR READER: Bursitis and tendinitis are common conditions that cause inflammation of the soft tissue around muscles and bones of the shoulders, elbows, hips, knees, ankles or wrists.

A bursa is a cushioning, fluid-filled sac located between bones, muscles, tendons or skin. Bursitis occurs when a bursa becomes inflamed. Bursitis is often caused by trauma or overuse.

A tendon is a flexible band of fibrous tissue that connects muscle to bone. Tendinitis is inflammation of a tendon that commonly occurs with the repetition of an act such as weightlifting, swinging a hammer, golfing, playing tennis or a musical instrument or other activities that place stress on joints.

There are two types of tendinitis that can affect the shoulder. Biceps tendinitis results in pain in the front or side of the shoulder. That pain may radiate to the elbow or forearm. Rotator-cuff tendinitis may result in shoulder pain at the upper outer arm and tip of the shoulder. Pain can be worsened by raising the arm above shoulder level or by lying on the affected side. Activity such as weightlifting can cause irritation to the bursa or rotator cuff and could lead to inflammation and impingement.

Diagnosis can be made through medical history and examination. Physicians and/or therapists might use manual testing known as selective tissue tension to determine which tendon is involved. X-rays might be helpful in ruling out problems with arthritis or bone but will not reveal tendons and bursae. Magnetic resonance imaging (MRI) should confirm or deny any tear and its extent. An anesthetic-injection test could also confirm the diagnosis of tendinitis. During this test, lidocaine hydrochloride is injected into the painful area. If the pain is relieved temporarily, the diagnosis is confirmed.

Treatment is directed toward healing the injured bursa or tendon.

Mild symptoms are commonly relieved with rest, elevation of the affected joint and over-the-counter medications such as ibuprofen or naproxen. Ice is often used following an initial injury for up to five days but isn’t generally helpful for chronic cases of either disorder. Corticosteroid injections may be given for control but should be used with caution because they can lead to weakening or rupture of tendons, primarily those that bear weight, such as the knees and ankles. In cases where bursitis is caused by infection, antibiotics will likely be ordered. Controlled, limited exercise or physical therapy can be performed prior to complete healing. When all else fails, surgery may be necessary.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I am most uncomfortable when I stand still, sit or lie down for any length of time. Using a heating pad several times during the night helps alleviate the muscle cramping, though. I have more pain in my lower back/sacral area, knees and thigh muscles than in the hips themselves. Who is right? Would the cortisone injections really help?

DEAR READER: I must side with the out-of-state specialist. Cortisone injections are often beneficial as one of the initial steps toward relieving the pain of arthritis. A randomized placebo-controlled trial of glucocorticoid injections for osteoarthritis of the hip demonstrated benefits lasting up to three months. Over-the-counter medications such as acetaminophen, ibuprofen or naproxen, topical capsaicin or menthol ointments (especially those made with castor oil), and ice packs or heat may also provide relief. If these options fail to provide satisfactory results, consider physical therapy, low-impact exercise programs or enter a chronic-pain class to learn other ways to manage the pain. A final option for those with severe joint deformity, pain and dysfunction is surgery, such as joint realignment or replacement.
Seek out another local specialist or return to the out-of-state physician for further advice and treatment.

To provide related information, I am sending you a copy of my Health Report “Understanding Osteoarthritis.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My current problem is inflammation of the bursa sacs in both of my hips. I have seen two physicians, three orthopedists and a physical therapist. I have had two cortisone shots, three different prescription anti-inflammatories and work out in a heated pool. So far nothing seems to be helping.

Ten years ago I took an office job and sit for eight hours a day. About that same time I started Lipitor. Two years ago I stopped for six weeks (with doctor approval) but the hip pain did not go away. My doctors keep telling me that it is hard to heal this type of problem but I am tired of hurting. I cannot lie on either side and am unable to walk even a single city block. Please help!

DEAR READER:
Bursa is a fluid filled, sac-like cavity that reduces friction between two tissues. There are several bursa within the body but those most commonly affected by inflammation are those within the joints. The common affliction of “water on the knee” is caused when excess fluid accumulates in the bursa at the knee. This is also common in the elbows and hips.

I am unsure how long you have been dealing with this problem. You repeatedly mention 10 years so I am assuming this has been going on for quite a while. If you have had this pain for that long a period, it is now time to explore other options such as acupressure, acupuncture, different non-narcotic or narcotic prescriptions, and others. Have your physicians ruled out excess fluid as a cause? If not, perhaps this is the root of the problem and a simple draining procedure would solve the problem. As a last resort, (which you seem to be nearing), surgical removal of the bursa in your hips is an option.

Speak to your orthopedist about what the next steps are.

To give you related information, I am sending you a copy of my Health Report “Managing Chronic Pain”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I went to my orthopedic doctor because of pain in my hip. It starts in the joint and travels down the thigh and is especially painful at the tendon along the shinbone. I also have right leg weakness when pressure is applied or when walking upstairs. He said the pain was caused by bursitis, not arthritis. He showed me an exercise to try and told me to continue my regular walks.

I take over-the-counter pain relievers, use castor oil and Castiva. Should I continue using these joint medicines or should I use muscle creams to relieve the nighttime pain? I am 88 and do not consider this worthy of surgery but it would be nice to sleep though the night. I’m tired of having to wake up to take another pill.

DEAR READER:
Arthritis and bursitis can be difficult to differentiate. Arthritis is joint inflammation with associated degeneration of connective tissue and bone. Bursitis is inflammation the bursa that is a sac-like cavity surrounding joints that is filled with fluid that reduces friction caused by movement. There are more than 150 bursa in the body. Most people have heard the term “water on the knee”. This is often caused by bursitis. Swelling and redness are often visible but if the hip is affected, the bursa simply appears to cause pain of the hip and thigh because it is located under bulky muscles.

Arthritis is more common in weight bearing joints such as the hips and knees. Bursitis is more common in the shoulders, elbows, big toe and hips.

Direct trauma, infection, joint or muscle stress, and arthritis are common causes of bursitis. Arthritis is generally caused by age-related wearing of cartilage and connective tissues leading to bone degeneration. It can also be caused by auto-immune disorders such as rheumatoid arthritis. Gout is a common cause of arthritis.

Treatment is similar for both arthritis and bursitis with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen sodium, ice, rest and steroid injections making up the primary course of therapy. If the cause is determined to be infection, treatment with antibiotics is necessary. For severe cases that last longer than a few weeks or if you have major swelling, the bursa may need to be drained. In rare instances removal may be necessary.

I recommend that you return to your orthopedist and ask for an X-ray if you have not had one already. Bursitis will not show on the film but other causes such as arthritis can be ruled out. Given your age, the most likely cause of your bursitis is age-related osteoarthritis. If you like, get a second opinion from another orthopedic specialist. You can then compare the results and go from there.

To give you related information, I am sending you a copy of my Health Report “Understanding Osteoarthritis”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.