Repetitive motion injuries are among the most common injuries in the United States. All of these disorders are made worse by the repetitive actions of daily living.

Repetitive motion injuries make up over 50% of all athletic-related injuries seen by doctors and result in huge losses in terms of cost to the workforce. Simple everyday actions, such as throwing a ball, scrubbing a floor, or jogging, can lead to this condition.

The most common types of repetitive motion injuries are tendinitis and bursitis. These 2 disorders are difficult to differentiate and many times may coexist.

A tendon is a white fibrous tissue that connects muscle to bone and allows for movement at all joints throughout the human body. Because tendons must be able to bear all of the weight of the attached muscle, they are very strong. 

Tendinitis is an inflammation of the tendon. (Whenever you see "-itis" at the end of a word, think "inflammation.") 

Common sites of tendinitis include the shoulder, the biceps, and the elbow (such as tennis elbow). 

Males are slightly more likely to have this disorder. 

The inflammation of the tendon usually occurs at the site of insertion into bone. 

Tendons run through a lubricating sheath where they connect into muscle, and this sheath also may become inflamed. This condition is known as tenosynovitis. 

Tenosynovitis is almost identical to tendinitis because both have identical causes, symptoms, and treatment. 

Tenosynovitis of the wrist may be involved in carpal tunnel syndrome, the most common compression nerve disorder, but this cause-and-effect relationship has never been proven.

Bursae are small pouches or sacs that are found over areas where friction may develop and serve to cushion or lubricate the area between tendon and bone. 

Bursitis is inflammation of a bursa sac. 

Over 150 bursae are in the body. 

Most bursae are present at birth, but some come into existence in sites of repetitive pressure. 

Common areas where bursitis can occur include the elbow, knee, and hip. 

Different types of bursitis include traumatic, infectious, and gouty. 

Traumatic bursitis is the type involved with repetitive motion injuries. 

Traumatic bursitis is most common in people younger than 35 years.

Repetitive motion disorders develop because of microscopic tears in the tissue. When the body is unable to repair the tears in the tissue as fast as they are being made, inflammation occurs, leading to the sensation of pain. 

Causes of repetitive motion injuries include these:

Repetitive activity

Trauma

Crystal deposits (such as in gout)

Friction

Systemic disease (rheumatoid arthritis, gout)

Tendinitis: The most common symptom associated with tendinitis is pain over the site involved. Tendinitis is made worse by active motion of the inflamed tendon. The skin overlying the inflamed tendon may be red and warm to the touch. 

Biceps: The painful spot is usually in the groove where the arm meets the shoulder. You can reproduce the pain by flexing your elbow at 90° and trying to turn your hand palm up (called supination) against resistance. 

Tennis elbow: This pain is in the elbow and is reproduced by cocking your wrist back (extending the wrist) as if you are bringing a tennis racket back to hit the ball. 

Golfer’s elbow: This pain also occurs in the elbow but is made worse by flexing the wrist forward as if you are hitting a golf ball. 

Rotator cuff: Raising your arm out to the side reproduces this pain. The painful area is usually over the affected shoulder.

Bursitis: Common symptoms include pain, tenderness, and decreased range of motion over affected area. Redness, swelling, and a crunchy feeling when the joint is moved (crepitus) may also be found. 

Knee: This condition involves swelling over the bottom part of the kneecap that is red and warm to the touch. Usually, the range of motion of the knee will be less because of the pain that bending and straightening the knee causes. 

Elbow: Pain, swelling, and redness are found over the elbow. The pain gets worse when you flex and extend your arm at the elbow. 

Hip: Your pain is increased by walking or by lying on the affected side. Bringing your leg away from and toward the midline of the body can also reproduce the pain.

When to call the doctor: 

Pain with movement of arms and legs 

Tenderness over a joint or where a tendon connects 

Redness and increased warmth over joint 

Pain that wakes you from sleep 

Inability to sleep on affected side 

Inability to carry on normal activities of daily living (such as brushing your teeth or taking a shower)

When to go to the hospital

Certain signs and symptoms may mean that you have an infection and should be seen by a doctor immediately. 

Joint pain or tenderness that is associated with fever, chills, nausea, or vomiting 

If more than 1 joint is involved at the same time or the joint pain migrates from 1 joint to another 

A history of high-risk behavior (unprotected sexual activity with multiple partners, IV drug use, history of sexually transmitted disease)

Any severe joint pain also needs a visit to your hospital’s emergency department.

The diagnosis of tendinitis is most often made based on history and a physical examination.

Imaging studies may help confirm the diagnosis. The imaging study of choice is the MRI. An MRI gives a very detailed picture and can identify a tear, rupture, inflammation, or other disease processes. An MRI is not useful in visualizing inflammation of the tendon sheath, tenosynovitis, unless fluid is present within the sheath itself.

Your doctor will check if your bursitis has an inflammatory or an infectious cause. The elbow and knee have a higher risk of having an infectious cause, so fluid will probably be drained from your joint to be checked for bacterial infection.

Conditions that place you at a higher risk for infectious bursitis include these:

Chronic alcoholism 

Diabetes 

Uremia 

Gout 

Manual labor 

Chronic obstructive pulmonary disease

Home care for a painful or swollen joint should include elevation and not moving it until your doctor can be contacted. 

Ice can also be used for relief of pain and swelling. 

Most authorities recommend icing 2-3 times a day for 20-30 minutes each time. 

Wrap ice or a bag of frozen vegetables in a towel and place it on the area.

If your shoulder is involved, you should not keep it immobile for more than 24-48 hours because your shoulder may become frozen and have decreased range of motion.

Medical Treatment

Tendinitis is best treated with immobilization and ice during the early phase and moist heat during the long-term phase. 

Bands placed around the elbow may be used for tennis elbow and golfer’s elbow. 

Nonsteroidal anti-inflammatory drugs (NSAIDs, such as aspirin, naproxen, or ibuprofen) may be prescribed to reduce the inflammation. All NSAIDs should be taken with meals to avoid stomach upset. 

If your tendinitis or bursitis is not helped by NSAIDs, the doctor may choose to inject steroids into the surrounding area of inflammation. As a rule, you should not have more than 3 injections into the same area within a 12-month period. 

You should begin graduated range-of-motion exercise once your symptoms begin to improve. 

An exception to this type of treatment is shoulder involvement. 

The shoulder should not be immobilized for more than 24-48 hours in order to minimize frozen shoulder, called adhesive capsulitis. 

You should have physical therapy in addition to ultrasound and warm water baths. 

The goal in treatment of shoulder tendinitis is first and foremost to maintain full range of motion of the shoulder joint, and relieving the symptoms is secondary.

The treatment of inflammatory bursitis is similar to that of tendinitis.

Rest, ice, and elevate your arm or leg. 

Alternative treatments include pain-killing creams, capsaicin cream (an over-the-counter pain relief cream made from an ingredient of cayenne pepper), and steroid medications if you are able to take them. 

If your bursitis is caused by an infection, treatment will include the appropriate antibiotics. 

Steroid injection may be used but only for inflammatory bursitis. Steroid injections should be avoided in infectious bursitis because they may increase the body’s susceptibility to infection.

The prevention of tendinitis and bursitis is similar in most respects.

Do adequate warm-up and cool-down maneuvers (crucial to proper tendon and bursae health). 

Avoid activity that makes your injury flare up. This will speed healing of both tendinitis and bursitis. 

If using a hedge clipper caused you pain, avoid this activity and others like it. 

If reaching overhead in your work has caused a repetitive motion injury, your occupational health manager may be able to redesign your job so you won’t have to reach overhead.

Practice range-of-motion exercises, especially in tendinitis. These are important to ensure minimal decrease in function. 

Use splints or bands to decrease the strain on a tendon that occurs with sporting activities, such as tennis and golf. These devices may be bought over-the-counter or obtained from your doctor.

Outlook

Tendinitis has an excellent prognosis with proper care. 

A great majority of bursitis cases heal well.

Repetitive bouts of bursitis may lead to long-term bursitis, which in turn may create a need for the fluid to be removed repeatedly. 

In cases in which treatment is not working, surgical removal of bursae may be necessary.

Author: Samuel J Haraldson, MD, Sports Medicine Fellow, Department of Sports Medicine, UT Southwestern/Methodist Charlton Hospital.