Differential Diagnosis – Bursitis, Tendonitis, 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 tendonitis 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. Tendonitis is the inflammation of the tendons themselves which can occur in a variety of locations. Rotator Cuff Tendonitis 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 tendonitis goes on for more than 6-8 weeks it is called Tendonosis. Tendonosis is the actual degeneration of the tendon when the tendonitis 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 tendonitis 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. We offer Anodyne light therapy to increase blood flow to help heal the body on its own. This infrared light causes the release of nitric oxide which relaxes the muscles in the arteries increasing blood flow. It is painless and has helped many of our patients with these problems. The key is to treat it early before the damage is done. 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 tendonitis 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 tendonitis 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. 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. If you or someone you know has nagging pain give us a call for an evaluation. We treat people with bursitis, tendonitis, tendonosis and neuritis. We also can evaluate aches and pain and work with you to get healthy again. If you 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 you need. Call us today at 301-759-4263. |
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