Bursitis

Sorry, but I really must complain here for a minute. I have had nasty bursitis in both my hips for a good three years now. It started when I had a severe sprain in my ankle which developed into RSD, reflex sympathetic dystrophy which I believe is now called regional pain syndrome or something to that effect. Anyway, I was in a cast and on crutches for 3 months. I ended up having 6 epidural shots for the RSD. That's not what caused the bursitis, I guess it was all the limping and such.

Anyways, I have done 3 or 4 rounds of physical therapy for the bursitis. I have had many cortisone injections into my hips. I try to do the stretches and stuff they taught me at physical therapy but it continues to be a really painful pain in my hips!

I went to Costco last night and we walked around the store for about 30 minutes or so and my hips hurt SO bad, again, last night that I couldn't even lay on my side. I can not breath when I lay on my back so I am forced to sleep in my recliner. Forget stomach sleeping.

So, can I blame the sarc for the bursitis or is this a whole different issue? I have read something about some surgery they can do for it, I am going to go google that some more as I just can't tolerate it anymore. Anyone else have bursitis issues? To my understanding its an inflammation of the bursa and you can have bursitis in many locations. I was hoping the remicade might help with this problem but no such luck. I can't take any of the anti inflammatory drugs like Motrin and such because I get bleeding gastritis after just a couple of days. My vicodin really doesn't do anything to help it either! I don't even know what kind of doctor to consult for this problem?

By theGardener
Posted September 4, 2008 at 11:59 am

Bursitis is one of those terms that has become a catch-all for joint pain. Technically it means that the Bursa (the sac of fluid that eases joint friction) becomes inflamed. And inflammation equals pain. But the real question then becomes... what is causing the inflammation? Is it Sarc? Over-use? Under-use? Weight bearing stress? Good ol' old age? Et-cetera...

However, many folks with Sarc (myself included) will tell you that they have had incidence of severe joint pain where nothing out of the ordinary shows up in diagnostic tests and imaging. Often, no inflammation... so what is going on then?

So then perhaps Sarc nerve issues may enter into the mix... and anyone who has had the come-and-go symptoms of skin pain/tingle/burning and or paralysis, would not discount that Sarc may very well also be responsible for nerve pain issues in joints. I myself have had excrusiating knee pain come out of the blue. last a day or two, resolve, jump to the other knee and disappear without a trace. I would like to say that I was involved in teenage gusto that involves knee burns, but that would be self-flattery and a sweet daydream filed under "i wish".

Currently, I am in the on-off "bursitis" -like issue involving my shoulder. At first, I thought it was a rotor-cuff injury from weightlifting... but it is inconsistent, and I can not seem to duplicate the pain with exertion or movement. Freaky Sarc nerve pain? who knows.

Thanks for your post!

—TeeGee

By micheleb
Posted September 4, 2008 at 2:18 pm

Yeah, I get what bursitis is just not why the heck its not going away. I just found a cd rom of an MRI I had done on my right hip 3 years ago-dx bursitis.

I have the freaky joint pain, actually that was one of my first complaints that sent me on the quest for a dx way back when. A lot of that has improved with the more remicade I get. Don't get me wrong, I still have joint pain but its nothing like it was. However, the hip pain is unfazed. Its there everyday, obviously some days its much worse than others. I even have two flat gel things that go in the freezer that I can lay on at night to help with the pain.

I found this page
http://www.orthogate.org/patient-education/hip/trochanteric-bursitis-surger y.html

which explain the hip bursitis real well and the surgery to correct it. I was hoping the surgery would be a little less involved, meaning less recovery time. Looks like it would mean a lot of time off work which isn't possible as there is no one else to work for me. I work for a small office, just me and the eye doc. I am still trying to sort out the mess from last fall when I was in the hospital and he had a temp in here! Aye, Aye, Aye, what a disaster that was!!

Guess I have some pondering to do. We are planning to close the office for a week next March for vacations. Do I sacrifice my only vacation for recovery of my hip? Its been two years since my last vacation. That would only be one hip, I am pretty darned sure I would need them both done, so what about the other one?? Jeeze, sure would be nice if money wasn't such a big issue and I didn't HAVE to work. Guess I should pick up a lotto ticket after work!

By priscurl
Posted September 5, 2008 at 7:13 am

Hi MicheleB,

I have been getting bursitis in both hips and both shoulders since 2000. I have had three shots of dexamenthasone into my left hip and one into my right shoulder. I had an attack of bursitis in April and now have adhesive capsulitis in my left shoulder. The report said subacromial bursitis and tendinosis. However, the technician went and called the radiologist because she thought I had the beginnings of adhesive capsulitis then, but it wasn't mentioned in the report. I am anti steroids now, so I have not had the suggested injection. I have just started physio for the capsulitis. I cannot see how someone could get concurrent and recurrent bursitis in major joints and have it put down to age, overuse or injury. In all cases with me it started spontaneously. In any case, if it were an overuse injury it ought to show up in an x-ray. My hips certainly show evidence of osteophytic lipping and osteoarthritis but there is absolutely no evidence of either in my shoulder joints. I have osteoarthritis in my knee joints but have no pain or discomfort there whatsoever. When the bursitis in my left leg gets bad, I find it difficult to lift up my leg. I find I drag the toe, trip, and have to lift the leg into the car. I can't lift it up and extend it when sitting without enormous effort. I believe the problem is due to sarcoid. For a while there my immunologist thought I may have psoriatic arthritis because I had onycholysis. I certainly have psoriasis, and three in ten people with psoriasis who develop pitting or onycholysis of the nails have arthritis. I believe my grandmother had it. I have not ruled this out as a cause of the problem, but my immuno and a 2nd rheumatologist I saw, believe it is caused by sarcoid. Certainly, it is all fixed by prednisone. The first rheum I saw told me I had fibromyalgia, but the pain and problem resolve with prednisone and that does not happen with fibromyalgia. Fibro pain does not respond to prednisone. I belong to another support group online, and there are other people in it who also have a problem with recurrent bursitis. I also have enthesitis of the achilles which is inflammation where the tendon inserts into the bone. This is also a feature of psoriatic arthritis. I have it in both feet, again the left side is worse than the right. I believe there is a left-sided predilection because of the lymphatics. The physio I saw on Wednesday said it was common in women aged between 40 and 50. I believe it is also common in diabetics. This might be the case for isolated instances of bursitis, but not when it occurs in so many joints at once. I will see if I can find some on-line literature on it and report back. It sounds as if you are having a bad time with it. Mine is bearable.

Pris

By priscurl
Posted September 5, 2008 at 7:33 am

Hi MicheleB,

Although they are few and far between, it would appear that both enthesopathies and tendinopathies as well as bursitis can be associated with sarcoidosis.

As I say, I know of a few people who get it on the other forum I frequent, and many of these have it in more than one place at one time. Such a thing could not really be put down to injury or overuse syndromes. Most say it starts spontaneously, i.e. it is not there and the next day it is.

http://www.sforp.org/Lecture%20Archives/Foot%20and%20Ankle/Foot%20and%20Ank le%20Tendon%20Pathology_Shaffer_2006.ppt#306,85,Insertional Tendinopathy

http://www.podiatrym.com/cme/Apr08CME.pdf

This is an excellent article:

http://radiographics.rsnajnls.org/cgi/content/full/23/6/1389

And so is this:
http://www.ajronline.org/cgi/content/full/185/1/154

Pris

By Two_Labs
Posted September 5, 2008 at 10:25 pm

I have bursitis in both knees and now in my shoulders.
oon 30 mg pred and 7.5 Mtx.
Received a bone scan, showed stresses in all of my joint areas (sholders, knees, feet, hands,etc), the Rheum assumed it was due to my physical activity in the military, and disregarded that it was a beginning of bone issues with my sarc. Did I mention I haven't done any sort of running, push-ups, and weight lifting in 8 months and my joint issues started in Feb? I hate Rhuemotologists.

Here's a link that talks about tests they should be running to diagnose sarc in bursitis:
http://www.inspire.com/groups/stop-sarcoidosis/discussion/bursitis-xrays-mr s-and-sarc-muscleskeletal-sarc/

By micheleb
Posted September 8, 2008 at 11:52 am

How much prednisone do you have to take before bursitis responds to it? I was on it for over a year and now just take it occasionally for a few days when the sarc gets super bad, usually just before an infusion. The steroids have never seemed to help it at all.

I will ask my sarc doc is he thinks I should get another MRI done. I am not sure it will change my treatment outcome though.

By Two_Labs
Posted September 9, 2008 at 1:55 am

For me it hasn't been responding to the pred. One of the reasons I'm on the mtx. Only been on 7.5mg for five weeks. I have noticed the swelling in my jaw area has decreased and I don't have a constant sore throat anymore. haven't noticed any difference in the joints yet, perhaps when they step mw up to the next dosage level...I know it can take a while for the mtx to build up in your system.

By dmackwell
Posted September 9, 2008 at 8:50 am

My Hips kill at times. I have been a skier my whole life.
Before dx w/ sarc I went out for the first day of the year and had to leave after one run. I hear your pain, although mine is not as bad in everyday life.

By mrsnj91
Posted September 9, 2008 at 6:48 pm

I want to jump on the bursitis band wagon! I have had mine for 6 years. My sarc diagnosis for a year. BUT which came 1st the chicken or the egg?? I have no clue what caused it. I have no clue if the sarc has been camping out for a while having a party in there. I have asked the exact same question. Who knows. In the end, I just treat and move onto the next issue. *sigh* It feels terrible to be falling apart so early in life!

PT has been helping me. The steroids didn't. And the injections didn't. But in my case I also had a "band tightening" (sorry can't remember the exact name.) which lays over the bursa. So we are working on streching that and that has helped a lot. Not all better but on the right road.

By micheleb
Posted September 10, 2008 at 4:30 pm

I am going to have to google some good stretches for the hips. I also have the band tightening you refer to and I admit the bursitis is better when I have been good about my stretching. It just seems I can never quite stretch enough to get rid of it for good.

My hips hurt so bad, my hubby tells me that I have been rolling on to my back during the night and snoring something terrible-that might explain why my throat has been more sore lately! Ugh

By Krissy
Posted September 11, 2008 at 6:34 pm

I have had trochanteric bursitis on both sides. This is what you are referring to as bursitis (I assume). I am a former elite marathon runner. At the time of the original bursitis, I probably had mild sarc symptoms, undiagnosed. I was running 120 kilometers weekly and teaching 10 group fitness classes. Since then I had had the left hip problem come & go. My theory is the chicken before the egg means either the sarc attacked the bursitis site, or the bursitis started because of the sarc. My left hip would now be sarcoid and not bursitis. The "band" you are describing would be the ileo- tibial band. It is the longest tendon in our bodies, the origin is on the outside of the hip, running down the outside of our thigh and inserting into the bony protrusion on the outside of the knee. I regularly becomes tight in active people. When tight this band tends to "rub" back and forth as we walk. This means the bony protrusion on the outside of your knee and the hip area feel pain and swelling. People often think that they have a hip or knee problem because of this pain when it can simply be the tightness in this tendon. Stretching this band will relieve this. I have a good stretch for this, but it is hard to describe.

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