HEALTH; Personal Health
By Jane E. Brody
Published: May 3, 1990
The problems may have cute names, like housemaid's knee, trigger finger, tailor's seat and tennis elbow, but the discomfort and the inconvenience they can cause are anything but cute. At times, in fact, the pain can be so bad that the sufferer may be unwilling or unable to move the affected joint.
Medically, the conditions are known as bursitis or tendinitis. Both involve inflammation of soft tissues surrounding a joint.
In the case of bursitis, the tissue affected is the bursa, a small sac that normally acts as a cushion under a muscle or tendon where it crosses another muscle or a bone. In tendinitis, the inflammation affects a tendon, the fibrous cord that attaches muscle to bone.
As if trouble with one were not enough, both the bursa and tendon in a joint can become inflamed simultaneously.
Although the conditions are less likely to afflict people under the age of 30, those who actively pursue a particular sport or whose jobs involve repetitive movements (like continually operating a gear shift) can develop bursitis or tendinitis at any age.
These conditions are related to arthritis, but there are two important differences. Whereas arthritis tends to be a permanent condition that affects several or all parts of the body, bursitis and tendinitis usually affect only one joint and result in only temporary discomfort, especially if the movement that caused them is stopped or modified.
How It Happens
Bursitis and tendinitis tend to be associated with occupations or activities that demand frequent repetitions of the same joint movement. In effect, they represent joint abuse.
Most tennis players are painfully aware of the risk to the elbow of their playing arm. Many factors contribute to the form of bursitis known as tennis elbow, the most important of which is improper stroking, hitting the backhand off-center with the elbow pointing toward the net. Other influences can include excess vibration in the racquet, using too heavy a racquet or chronically hitting the ball late. Some people's joints are naturally prone to injury, and if they play often or long enough, they will develop tennis elbow.
But you do not have to play tennis to have tennis elbow. Politicians are at risk from constant handshaking during campaigns. Or it can result from a sudden tightening of muscles in the hand and forearm, as in throwing a heavy object or trying to twist something.
Housemaid's knee can afflict any man or woman who spends a lot of time on his or her knees, for example, in laying floors, leaning against the rungs of a ladder while painting, working in a garden or even kneeling in church (hence, clergyman's knee). The problem involves inflammation of the bursa in front of the kneecap (or, in the case of the clergyman, just below the knee bone).
Bursitis of the hip, an inflammation of the bursa usually on the outside of the joint, is aggravated by climbing stairs, sitting too long or sleeping on the affected side. In some people it results from unevenness in leg length.
Tailor's seat, which also involves the hip, can be a recreational as well as an occupational hazard. Those addicted to attending sporting events that involve hours of sitting on a hard surface can develop inflammation of the bursa of the ischium, the hip bone you sit on.
Sometimes sedentary individuals are afflicted with a form of bursitis called weaver's bottom involving the bursa between the hip bone you sit on and the main muscle of the buttocks.
Bursitis under the heel is a common affliction of people who do prolonged walking, running or standing on concrete or other hard surfaces. Especially at risk are those who wear flat shoes (in particular if they are flat-footed) and people who walk with a heavy heel strike.
The ball of the foot and bunions at the base of the big toe are also common sites for bursitis, especially if one's shoes are tight or narrow in the toes.
But when most people hear bursitis, they think first of the shoulder, the joint most commonly afflicted. Despite its name, acute subacromial bursitis, the condition usually results from tendinitis of the rotator cuff, a group of five tendons that connect the shoulder and upper arm.
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Biceps tendinitis is another cause of shoulder pain, usually in front of the shoulder. The inflammation occurs in the large tendon that joins the biceps muscle in the front of the upper arm to the shoulder. While you may be able to move your shoulder, getting dressed can be quite a challenge. Tendinitis can afflict the hand - trigger finger is the result of inflammation of the tendons used in bending the fingers - and the ankle, as in Achilles' tendinitis, which involves a painful acute injury or tear of the Achilles' tendon that immobilizes the ankle.
What to Do
Sensibly handled, bursitis and tendinitis usually disappear within days or weeks and rarely leave lasting damage. But even with proper treatment, they can recur in the same joint or in different joints.
Specific treatment is determined by the joint that is affected. However, for virtually all forms of bursitis and tendinitis, there is a standard remedy: aspirin or a comparable pain reliever with anti-inflammatory properties.
The medication is usually taken in the largest dose a person can tolerate (usually two tablets six times a day, but check first with your physician, since you may have other health problems that make such treatment hazardous).
If over-the-counter medication is not adequate, prescription drugs like a nonsteroidal anti-inflammatory or a cortisone-type drug can be used. Sometimes cortisone is injected directly into the inflamed joint. Although the injection can bring dramatic relief, repeated injections can lead to joint deterioration, so they are best reserved for severely painful attacks or attacks that require immediate resolution.
At first, you would be wise to rest the painful joint for a few days, for example, by not playing tennis or by putting your arm in a sling to immobilize a painful shoulder. Then you should start specific exercises to maintain mobility of the joint and strengthen the muscles that support the joint.
A physical therapist can be a great help with exercises and, in the case of tennis elbow, a few professional lessons may be needed to improve your stroke and prevent a recurrence.
A physical therapist may also try deep massage to relieve tendinitis in the ankle, shoulder or elbow.
As for applying heat or cold, icing an inflamed joint for 20 minutes at a time three or four times a day is often recommended for the first 48 hours. Thereafter apply heat - moist heat is best, and even a hot shower can help - for 15-minute intervals three times a day. A physician or therapist may also recommend ultrasound, which is a deep-heat treatment.
People suffering from inflamed joints typically start with self-treatment. But if no improvement is noted within a few days, a visit to the doctor is advisable. Also see a doctor if the pain is severe and interferes with normal activities like work or sleep, if an inflamed shoulder becomes ''frozen'' and cannot be moved or if the affected joint is visibly swollen.
Diagrams illustrating what type of pain occurs around the joints (source: Arthritis Foundation)