Flexibility

 Tendons * Ligaments * Bursa
 

What is the difference between Tendon, Ligament, and Bursa?

Tendons connect your muscles to the bone.  When muscle contrast, the bone would move and that is how you move a body part. 

Ligaments surround joints to provide stability to the joint.  If you have lax ligaments, often due to injury, your joint will be not as stable which would result in injury to the joint itself. 

Bursa generally is sandwiched between the ligament and the bone and softens the contact between the two structures.   

 

Why do I get pain from my tendon or ligament or bursa?

Throughout our life, we constantly move and as a result, our ligaments and tendons are working hard to stabilize the joint and allow the motion of that body part we move.  An example would be the shoulder joint.  The ligaments around the shoulder joint will provide the stability to the joint but your rotator cuff muscles, and tendon allow you to be able to move your arm in different directions.  We do have a bursa between the rotator cuff and the bone which softens the contact between the two structures and is prone to inflammation when you have tendon injuries or with repetitive use of the shoulder. As you may realize, the more you use your arm, the more you are using your bones, joints, tendons, ligaments, and bursa and as a result, it is possible to experience wear and tear, injuries, and as a result, pain. In fact, most patients over 65 have a degree of rotator cuff disease but they may not be aware of it.  

 

Tendinitis

Diagnosis of tendinitis is made based on a physical exam, ultrasonography or MRI. Tendinitis and bursitis is often managed conservatively.  Most patients benefit from a few days of anti-inflammatory medications and taking part in physical therapy.  If the inflammation does not calm down with such treatment, ultrasound-guided, tendon sheath or bursa injection with steroid can result in a reduction in inflammation and at times complete resolution of symptoms.  If the tendinitis is associated with a small tear in the tendon, then the steroid injections may just have a temporary effect and further treatment may be needed (Regenerative Treatment).  Surgery is not indicated for tendonitis 

 

 

Tendinosis

Chronic inflammation of the tendon may result in a change in the structure of the tendon which is called tendinosis.  Tendinosis is not an acute inflammation of the tendon and rather a chronic change in the substance of the tendon which results in stiffness and pain with moving of the joint.  This is common in tendons such as the rotator cuff, patellar tendon, Achilles tendon, and many other tendons in the body.  In some cases, chronic tendon changes result in calcification in that particular condition is called calcific tendinitis. Diagnosis of tendinosis is made based on physical exam, ultrasonography, MRI, and calcific tendinitis can be seen on x-ray.    Conservative care is always tried first for managing tendinosis.  This includes physical therapy and medication such as acetaminophen or ibuprofen.  If there is improvement in pain and range of motion, further treatment may not be necessary.  Steroid injections are not often effective in chronic tendon diseases such as tendinosis.  Before considering surgery, ultrasound-guided treatment such as tendon PRP injection, tenotomy of the tendon (Tenex), and shockwave therapy should be tried.

Bursitis

This may happen in major joints such as the shoulder, knee, and hip.  It is often affiliated with tendinitis or tendinosis and is rare to be seen in isolation.  The most common complaint is localized pain in the region of the bursa.  It is easily diagnosed with a physical exam and ultrasonography, and rarely testing such as MRI is indicated.  Treatment is similar to tendinitis, starting with physical therapy and NSAIDs and if there is a persistent symptom, localized injection of steroids with ultrasound can result in resolution of symptoms.  In rare cases of calcification, or persistent bursitis despite treatment, ultrasound-guided bursectomy or open bursectomy can be done to improve pain.

Procedural treatment:
Whether you have an  Tendonitis (inflammatory),  Tendinosis (Chrinic inflamatory), partial tendon tear or bursitis, you may benefit from procedural treatment to help your pain without need for surgery.  This may include :

 

  • Ultrasound-guided, steroid injection 

  • Regenerative treatments

    • PRP injection

    • Shockwave treatment.  

    • Tenex Tenotomy Procedure

    • Prolotherapoy 

Our experts can help you with appropriate procedural treatment in hopes of preventing aggressive surgical treatment.

We commonly treat tendinitis, tendinosis and bursa issues of the following structure:

1.  Rotator cuff  tendinitis/tendinosis/calcific tendinitis
2.  Biceps tendinitis/tendinosis
3.  Shoulder bursitis

4.  Tennis elbow  (lateral epicondylitis)
5.  Golfers elbow  (medial epicondylitis)
6.  Elbow bursitis

7.  Tenosynovitis of the wrist  (de Quervain )
8.  Tendinitis of the wrist

8.   Carpal Tunnel 

9.   IT band tendinitis 
10. Hip tendinitis  (gluteus medius, gluteus minimus)
11. Hip bursitis  (trochanteric)
11. Hamstring tendinitis/tendinosis
11. Hip bursitis
12. Calcific tendinitis, gluteus medius

13.  Tendinitis of the knee
14.  Knee bursitisn ( pes anserine)
15.  Quadricep tendinitis/tendinosis
16.  Patellar tendinitis/tendinosis

17.  Ankle tendinitis
18.  Peroneal tendinitis
19.  Achilles tendinitis/tendinosis
20  Plantar fasciitis.