Tri State Hand and Occupational Therapy

Newsletter - November, 2004

DIFFERENTIAL DIAGNOSIS-BURSITIS, TENDINITIS, OR NEURITIS?

People have pain, that’s a fact no one can deny. However deciding what is causing the pain and where it is coming from can be like a who done it murder mystery. Some cases, like a broken bone or shoulder surgery, have a fairly predictable rehabilitation (therapy outcome) and if all goes well, a good result. We see both types of patients everyday.

Things get more complicated where there is no obvious cause. Suddenly your neck is painful. You wake up one day and you have pain in your arm that is stubborn and sticks around. A very pleasant elderly patient complained of her left hand having a burning sensation that goes up to her elbow that comes and goes for no apparent reason. Aching shoulders, tingling fingers, and so on we see each day. What is going on here? The doctor may have diagnosed the patient with tendinitis or carpal tunnel. Often we are asked by the physician to get more information and evaluate the patient and provide information that can assist with the diagnosis.

Before we get into a discussion on evaluation and treatment let’s define a few terms. Bursitis is the inflammation of fluid filled sacks that lubricate areas where tendons or muscles pass over boney areas. They are found in the shoulder between the bones and over the shoulder blades in your upper back. They are located in the elbow, wrist, and hands. When these are inflamed they are quite painful and when you lift, grip or use your arms it hurts. Tendinitis is the inflammation of the tendons themselves which can occur in a variety of locations. Rotator Cuff Tendinitis is an inflammation of the tendons and muscles that hold the arm bone to the socket in the shoulder blade. Tennis elbow is inflammation of the tendons on the outside part of the elbow. Golfer’s elbow is the inflammation of the tendons and muscle on the inside of the elbow.

The tendons of the carpal tunnel can also become inflamed and swollen. The carpal tunnel itself is the size of a dime. Nine tendons and the median nerve pass through this tiny space. If the tendons are swollen and inflamed this puts pressure on the nerve causing tingling in the first 3 ½ fingers.

When tendinitis goes on for more than 6-8 weeks it is called Tendinosis. Tendinosis is the actual degeneration of the tendon when the tendinitis is not treated. By this time it not only hurts when you use the body part, it hurts when you are at rest. Sleep can be affected by pain. This is a problem because proper sleep allows proper healing.

Neuritis is a condition where the nerve itself becomes irritated/inflamed and swollen. Neuritis can occur at the elbow from tennis elbow and radiate into the back of the thumb and index finger. If golfer’s elbow gets bad, it can affect the ulnar nerve and cause tingling into the last two fingers. Shoulder tendinitis can inflame tendons around the shoulder and may cause pain to radiate to the elbow level but rarely into the hand.

Circulation problems are affected by diabetes, thyroid disorders, alcoholism and collagen vascular disorders such as Lupus. These all can affect numbness and tingling in the hands and feet and, if left untreated can cause permanent nerve damage. Pregnancy can cause gestational carpal tunnel which we have treated frequently, with generally good success.

Diagnosing these problems is a challenge for anyone. We love it when physicians and patients offer us the opportunity to provide information to help sort out these problems. Bursitis and Tendinitis are characterized by tenderness with activities at first. They usually feel better with rest early on. As time goes by and you continue to use a body part with tendinitis or bursitis it begins to hurt all the time, usually aching at rest. Sleep may be disturbed. Neuritis is touchier because it may be caused by the nearby tendons being inflamed or some other cause. We use a two point discrimination test and Pressure Specified Sensory Device to test for sensory nerve loss. Certain patterns of loss may indicate carpal tunnel, a pinched nerve in the neck, peripheral neuropathy or other source of the problem. The testing itself is painless and inexpensive. It is not designed to replace standard nerve testing but rather to complement and help screen patients who need help to avoid nerve injuries from becoming permanent.

If you have a tenderness in the shoulder, elbow, or wrist that is recent (within last six weeks) you should try some ice, with a moist towel to protect the skin, for 20 minutes after activity. If it helps, do it more often up to three times a day.

If you wake up and the body part is stiff and sore try some heat to ‘warm the body part’. However be careful with heat. Too much heat can worsen inflammation and pain to the tissues around the nerves.

If it’s been over six weeks see your doctor or give us a call. Either way you don’t want to put it off too long. Permanent nerve, tendon or bursa damage may result.

If you can pace your activity, then leave shoveling and raking go if you are in pain. It will be there tomorrow. Pacing yourself allows the tissues time to heal and receive the nutirition and blood supply it needs in between activities.

Computers are seen as a hobby but watch your posture. Keep the home space bar at sitting elbow height. Stretch frequently, if you need a stretching program give us a call.

Respect pain. Pain is a protective device of your body. Pain is your body’s way of saying “oops we are hurt, slow down or stop!” Too often for the sake of a paycheck, our own stubbornness, etc. we block out the messages our bodies are sending us. Take care of yourself if you wish to truly help those you love and care about.

Good nutrition and sleep. If you are going to run your body hard and high then run it on high octane, nutrient dense foods. Almonds, pecans, cashews, are good examples of easy-to-eat on-the- run healthy foods. You wouldn’t put bad oil or gas in your car would you? I found as I age if I’m going to work hard good nutrition is vital. I also advocate the use of B-Complex vitamins regularly. Also get 7-8 hours of sleep per night. Seems like common sense but it takes a commitment to want to feel good to abide in taking care of yourself. Only you can make this commitment.

If you or someone you know has nagging pain give us a call for an evaluation. We treat people with bursitis, tendinitis, tendinosis and neuritis. We also can evaluate aches and pain and work with you and your patient to get healthy again. If your patients are missing the freedom to work and live without pain or problems give us a call. You will find a listening ear and we will take all the time your patients need. Call us today!