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Tendinitis - How is it diagnosed and treated?

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Posted 4/23/2012 5:53 PM (GMT 0)
Hi,

I've had sacroilitiis for almost 20 years.  The past month or so, my left arm has been really hurting between my shoulder and elbow.  When mentioned it to my rheumatologist briefly he responded that it's probably tendinitis, but we left it at that (since my main issue is the sacroiliitis).  But since seeing him, it's gotten quite painful...esp at night.

So I'm wondering...

1)  How is it diagnosed?  I'm waiting for an MRI of my spine.  Should I call to have it expanded to my arm (or would that not help for tendinitis?)

2)  How it it treated? 

3)  Will using it cause more damage?  i.e. is it like standard arthritis conditions where you should use the joint and do exercise?  Or should I try and keep it still?  Will using an eliptical do more harm (i.e. arm movement)?  It's been almost a month though so I don't think this is going away. 

Thx

 

Posted 4/23/2012 8:11 PM (GMT 0)
I often get bicep enthesitis. People with spondyloarthropathy associated with IBD, get enthesitis. It is where the tendon inserts into the bone. It gets inflamed. My rheumy injects steroids near the tendon under ultrasound guidance. Where on your upper arm does it hurt?

My rheumy said if enthesitis inflammation was left untreated it could over time cause the tendon to calcify. Several tendons in my knees and shoulders are calcified at the ends. It effects range of motion in my case.

I would call the rheumy back and say you need the tendonitis treated. Usually rest and NSAIDs are prescribed for tendonitis. Hwever, I bet you can't take NSAIDs because of your UC.
Posted 4/23/2012 8:38 PM (GMT 0)
Hi.  Thanks for your replly.  Actually, my pain is exactly at my biceps.  Sometimes it radiates down my inner arm to my elbow, but that's when I've been typing for awhile (I have a computer job).  I've never heard of bicep enthesitis...will look it up.  Can I ask how it was diagnosed for you?  I do have a prescription for celebrex that I take when my sacroiliitis is acting up (had my colon removed so no longer have UC, but am at risk for pouchitis and other IBDs). 

What kind of pain do you get?  Is it worse at night (mine is, which I don't udnerstand why)?  Is it very painful to lift your arm when irrirated?  I hope that the pain is minimal for you.

Posted 4/24/2012 9:21 PM (GMT 0)
A tendon connects the muscle to the bone or cartilage. Tendonitis is inflammation of the tendon. Enthesitis is specifically only where the tendon inserts to the bone or cartilage.

My rheumatologist diagnosed mine. He listened to my description of the pain, noted it was very localized and suspected enthesitis. Not a reach because I have had multiple episodes of enthesitis, most notably in my Achilles tendon. It is very calcified and I can get lots of pain at the back of my heel if not careful. To confirm his diagnosis and treat my biceps problem, he used ultrasound and then injected steroids. There are not many rheumys in the US that use ultrasound to diagnose and guide treatment.

Currently, I am not suffering with bicep tendon problems. I found it impossible to put my arm towards the back, put on my seatbelt, lift the arm over the head - just about everything.

Be careful and don't make any sudden movements until it heals. The same goes for repetitive movements like sweeping or raking.
hope you get relief soon.
Posted 4/24/2012 10:44 PM (GMT 0)
My Doctor put his finger right on top of my sore spot and said is this where you hurt and I said yes. Then it's tendonitis.

He put his finger on top of the knot of my elbow, right at the bend.
Posted 4/27/2012 2:36 AM (GMT 0)
I agree usually when I get tendonitis if it doesn't go away on its own with a bit of rest and ice I get my rheumy to give me a steroid shot into the pain. I've also had calcified tendons and had this treated with steroids too. I see a physio as well and depending which tendons are involved I sometimes need specific exercises to help it heal too. Hips need small steps and swinging exercises. Elbows usually settle once injected, shoulders are too mobile and seem to take months to settle and a course of shots.
Now its my wrists! Haven't gone back to the rheumy with them yet!
Try rest and ice first, support bandage can help.
Goodluck, golitho
Posted 5/2/2012 1:58 PM (GMT 0)
Well, my arm was feelign better (still felt it when I lifted something or used it, but the pain was manageable), but today it's quite sore again.

couchtater, where is the spot that hurt? Mine is on the outside of my arm, just below the shoulder (near bicep but top part of my arm)

golitho, hope your wrist pain has subsided.
Posted 5/2/2012 10:55 PM (GMT 0)
Mine is at the bend of my elbow, outer side
Posted 5/3/2012 12:12 AM (GMT 0)
Ok...mine does radiate to the elbow when working (i.e. typing for awhile) but in the inside of where it bends.
Posted 5/3/2012 3:17 AM (GMT 0)
When I had it in the shoulders it was agonising to lift my arms above shoulder height or lift any weght or go across my body. I guess it depends which tendon too, as you must have a few different ones in a shoulder joint.
Golitho
Posted 5/4/2012 12:14 AM (GMT 0)
Sounds very similar when it was really bad. On better days (it's all relative), I feel it when lifting or raising my arm up or across to reach but it's manageable.
Posted 5/4/2012 3:00 AM (GMT 0)
I got rid of my tendonitis with shots of steroid into the joint, surprisingly not painful, they were done during an ultrasound to direct the needle where it was needed. Got brilliant relief after about 3 days.
But I know rest and ice can work too, hard to rest a shoulder though.
Best of luck with it, golitho
Posted 5/4/2012 12:12 PM (GMT 0)
Great to hear that the steroid shot helped. I will mention to my dr if it gets/stays bad. I've had the steroid shot in my SI joints once. For me, the pain relief was short, but I think that was because I exercises too soon and stressed my joints out. Hope it continues to be good for you.
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