Bursitis and tendonitis are frequent complaints evaluated in the Emergency Department. Bursitis represents an acute or chronic inflammation of the bursa. Similarly, tendonitis involves inflammation surrounding the bony insertion sites of the tendons. Typically, these complaints are treated conservatively with reduction of inflammation as the goal. Treatment often includes rest, elevation, application of cold and heat, and the introduction of anti-inflammatory agents. However, joint and soft tissue injections are helpful for both the diagnosis and therapy of a variety of musculoskeletal complaints. Diagnostic goals include a means for fluid aspiration and to provide symptom relief of the affected body part. Therapeutic goals include delivery of local anesthetics for acute pain relief, delivery of corticosteroid for suppression of inflammation, and increased mobility.1 Injection therapy along with the above generalized treatment guidelines are a critical component of a multifaceted treatment regimen that should be considered by the Emergency Physician.
Definitive care can often be easily initiated by the administration of a steroid injection during the patient's earliest presentation. It has been shown that the clinical response to injectable corticosteroids is quite positive.2–5 The techniques of aspiration and injection are easily mastered. These techniques are generally safe and effective when appropriate guidelines are followed.1 While injection therapy can be effective, it must be remembered that this treatment should not replace cessation or modification of the offending activity if identified.
Bursae are round, fluid filled, pad-like sacs or cavities. There are roughly over 160 bursae in the body. They are usually located at sites of friction such as joints, or in areas where tendons pass over bony prominences. Bursae are lined with a synovial membrane and contain synovial fluid. Their primary purpose is to reduce friction when movement occurs and to provide a mechanical advantage for tendon function. Bursitis often results from trauma, chronic overuse, inflammatory arthritis such as rheumatoid arthritis, crystal deposition, and infection.
Tendons are fibrous connective tissue bands attaching muscles to bones. A synovial sheath containing synovial fluid surrounds most tendons. Tendons mainly transmit forces from muscle to the skeleton. Pathologic findings are typified by inflammation, mucoid degeneration, and fibrinoid degeneration.6
Bursitis and tendonitis are often grouped together because the history, symptomatology, physical examination findings, and the treatment for these two inflammatory processes often coincide. Corticosteroid injections serve to decrease inflammation, provide pain control, and promote healing. The goal of injection into tendon sheaths and bursae is to attain concentrated steroid levels to maximize the local anti-inflammatory effect while minimizing systemic effects.
Injections of corticosteroids should be performed for an inflammatory bursitis or synovitis when systemic therapy is contraindicated and as an adjunct to physical therapy or systemic therapy. Many inflammatory conditions, including articular and nonarticular processes, are improved with local corticosteroid injection therapy.1,7,8 The articular processes that are helped by injection therapy include gout, pseudogout, spondyloarthropathies, rheumatoid arthritis, neuritis, osteoarthritis, and ...