DEAR DR. GOTT: I have osteoarthritis, bursitis and tendinitis in both shoulders and upper arms. I hurt both shoulders while lifting weights. What is the best treatment to reduce the inflammation? Is it ice or ultrasound? Would it help to immobilize my shoulder joints with arm slings? Lifting my arms away from my body and above my head causes the most pain.
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.
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