and tendonitis滑囊炎和肌腱炎（PPT109）课件.ppt

Bursitis, Tendonitis, Fibromyalgia, and RSD Joe Lex, MD, FAAEM Temple University School of Medicine Philadelphia, PA joe@joelex.net Objectives Explain how bursitis and tendonitis are similar Explain how bursitis and tendonitis differ from from another List phases in development and healing of bursitis and tendonitis Objectives List common types of bursitis and tendonitis found at the: Shoulder Elbow Wrist 5. List indications / contraindications for injection therapy of bursitis and tendonitis Objectives Describe typical findings in a patient with fibromyalgia Describe typical findings in a patient with reflex sympathetic dystrophy Sports Society more athletic Physical activity ? health benefits Overuse syndromes increase 25% to 50% of participants will experience tendonitis or bursitis Workplace Musculoskeletal disorders from… …repetitive motions …localized contact stress …awkward positions …vibrations …forceful exertions Ergonomic design ? incidence Bursae Closed, round, flat sacs Lined by synovium May or may not communicate with synovial cavity Occur at areas of friction between skin and underlying ligaments / bone Bursae Permit lubricated movement over areas of potential impingement Many are nameless ~78 on each side of body New bursae may form anywhere from frequent irritation Bursitis Inflamed by… …chronic friction …trauma …crystal deposition …infection …systemic disease: rheumatoid arthritis, psoriatic arthritis, gout ankylosing spondylitis Bursitis Inflammation causes bursal synovial cells to thicken Excess fluid accumulates inside and around affected bursae Tendons Tendon sheaths composed of same synovial cells as bursae Inflamed in similar manner Tendonitis: inflammation of tendon only Tenosynovitis: inflammation of tendon plus its sheath Tendons Inflammatory changes involving sheath well documented Inflammatory lesions of tendon alone not well documented Distinction uncertain: terms tendonitis and tenosynovitis used interchangeably Tendons Most over