Bruising related to inflamed tendons?

I saw my rheumy recently and asked her about bruising. At that point, I hadn't fully made some connections regarding the bruising. I also have been thinking that it may be time to switch rheumies. I've been less than happy with how much time and energy she gives me, and that I need to go in for EVERY discussion, and then she doesn't give me a lot of time and consideration. You get the picture. So here is the story.

In the last month plus, I've had a few really bad bruises. I started to put together the location. They are all where the tendon enters muscle, in my calf, bicep, and on my hand. I'm actually not bruising easily overall. I have a very active almost 6 year old, and I've definitely been whacked hard enough with hard objects that I SHOULD have bruised, and didn't. I'll also point out that I have a lot of inflammation in MANY tendons right now, and this has been going on for a few months.

I'll be seeing my GP this week. . . I'm curious if anyone has any experience with this type of bruising. TIA. Oh, and I started MTX 6+ months ago, but just switched to leflunomide. I'm on plaquenil and diclofenac as well.

Hi Stoney. Had a lot of tendon insertion inflammation back in August. Had one bruise on my hand at a tendon insertion, remember being confused about where it came from, because it was in a spot that doesn't bruise easily. Didn't put two and two together at the time. Didn't have bruises over the other tendons though. Did have a spot over the quadriceps tendon insertion that felt like a cigarette burn if you touched it or put any pressure on it. Interesting conversation to bring up with my rheumy in November.

It's too bad you're rheumy isn't treating you well. It's important for them to listen to the patient and spend time with them.

I have had bruises over the tendon insertions on my hands in the past, especially when I was way overdoing typing etc. I do not see them elsewhere but I am not thin, my tendon insertions are well padded elsewhere. I have never seen them on my hands since I have been much more conscious about taking better care of myself.

Thanks Michael and Heidi. It's funny that you mentioned the sore spot Heidi. I spent a few weeks looking for the bruise on my leg, as there was an area on the outside just over my knee that felt like it had a bad bruise. Finally it dawned on me that it was a tendon, and I realized that was just the sorest part of the ileo-tibial band, but the whole thing was inflamed and sore.

Michael, I'm not thin either. These bruises looked like I had taken a really hard hit. I think there was some minor tearing, and the bleeding worked its way to the surface. They were VERY sore, and the bruises lasted for close to two weeks, and went from black to all sorts of pretty colors.

I'm glad to know that other people have experienced this. I'm going to bring it up with the doctor. My concern is whether this could be an early warning of sorts, of a rupture, or if there is any fraying of the tendons.

Enthesitis and bruising are very common (especially with AS which can be related or a seperate condition THOUGHT to be PsA, although the treatment is the same) Its really not the same as tendonitis but sure feels the same (worse)

Okay tntlamb, I thought I knew a lot of the abbreviations. But AS? What is that?

Ankylosing Spondylitis (ankylosing means fusing from the damage and sponylitis means spinal involment the two together have a different meaning OR NOT depending on your doc. There is Sponylitis version of PsA

Thanks. I've been dealing with tendon issues since early on, but since the spring this has really picked up. I have pretty minimal spinal involvement, and what I have is more likely related to having back surgery in my 20's. For some reason AS was not popping into my head when you said that, although I certainly have heard of it.

The tendon thing is pretty common.......

I had what I thought was "hernia" a few years back the pain was increible) Had a urologist telling me it was likely a hernia compounded by an undescended testicle. (There was one missing but I know exactly where it went and how) and wanted to do immediate surgery in order "to save it." (why????) Had general surgeon say yeah probably but have you asked your Rheumy?

Anyway I did and this cute little seemingly 20 year old girl who purports to be my rheumy informs me that she hadn't been poking in that area in some time takes a poke (almost giggling) says its PsA arranges for an injection somewhere by the hips and presto I'm cured and my dreams of having three testes are dashed.

It was enthesis of that tendon.....

Lamb you are too funny! I also had what I thought was a hernia that started while pregnant with my son 18 years ago. I am glad they did not go looking for an undescended testicle on me as I am female; I really don't want 1 or 3, it would complicate my life terribly! I broke my ribs on the left 2 weeks before I delivered him so my mind was on other things. I had a back injection for hip pain in May and my "hernia" disappeared. Apparently it was coming from my lumbar arrea though my back doesn't hurt at all but my right hip hurts terribly, I walk with a cane.

I have to ask, despite being a nurse, what is the difference between enthestisis and tendonitis I have had a number of injections in my hands for what I thought was tendonitis. Unfortuanetly it doesn't help for long for me. And now with this tainted steroid injection scare it will be awhile before I dare do it again. Forgive my awful typing, my hands really hurt.

Enthestisis is the inflammation of the enthesis which is the point at which a tendon, ligament or muscle inserts into the bone. It is an awful like tendinitis. Remember that itis is medical suffix for inflammation. These little buggers are right next joints and is frequently the reason why injections are not always effective for PsA folk. It is also the reason why imaging studies show "no reason" for pain. Its iffy even if an MRI with contrast will show it......

michael in vermont said:

....I have to ask, despite being a nurse, what is the difference between enthestisis and tendonitis I have had a number of injections in my hands for what I thought was tendonitis........

So tendinitis would be inflammation along the tendon just not at the insertion, right? I find sometimes I have pain and swelling at an insertion other times it seems to run the length of the tendon, especially if I have way over done whil in my pretend phase, as in pretending I do not have PsA until it knocks me over!

You can also add tenosynovitis in to the mix, this is the inflammation of the tendon sheath, was thought to be a different issue but is now considered by a lot of rheumatologists to be another facet of PsA.
I’ve never had bruising like you Stoney and now I think of what you’ve said, the feeling when I press these tendon areas does feel like when you press a bruised area.

I’ve always considered myself lucky with my presentation of PsA as most of the pain issues I have are tendon based and have been for over 20 years, and I apparently have a high pain threshold according to my dentist and GP (GP thinks this is why I was so long undiagnosed) I have very few joints with bone erosion, although lots of ‘lumps’ from swelling of tendon tissue.

My partner has recently had problems with ‘golfers elbow’ and said he didn’t realise how painful tendons could be. He’s always treated me with great consideration, but I think he now sees me ‘afresh’…it made me see that just because “its ok, its only tendons” this is how one doctor expressed his opinion! It doesn’t mean it doesn’t hurt or impede your everyday life and the business of living.

With the tendons, I've discovered that there are a lot of different degrees of pain. For example, there was one time when I reached for something, and I would have sworn that I broke my finger that's how painful it was. I felt a snap and everything! But it was "just" a tendon issue, no rupture, and it improved within a few days.

I’m so used to those ‘snaps’, for me they happen over a tendon that’s been tender for some time and usually stay painful for months or years. I never get any answers to exactly what occurs, but was informed some years ago that I had got quite a lot of calific tendons so I presume its something to do with that, but who knows,

I'm glad you guys brought this up! My rx is very recent, less than 2 years ago. I've been having a TON of pain in my hips, mostly after being stationary, but it works out enough over the course of walking that I can walk normal. I've been thinking it was just the PsA attacking my hip joint. Now I'm thinking it's the bruising where the tendons attach to joints. It hurts bad enough to scream if my kids put any pressure on it, like using me for leverage to get up. But now that you've made me think of it, when I walk it just feels sore, not excruciatingly and not feeling of grinding. Thanks for bringing this topic up, now I think I might know what's up!

Hope everyone else is doing well today!

This is a very interesting conversation thread. I have brought it to my old and new rheumy's attention that both of the inner and outer tendons in my elbows hurt - to bend and even to simply touch. This has been going on for over a year. My old rheumy said it is not related to PsA and was just golfer's elbow and tennis elbow (covering inner and outer points on my elbows). Said it was age related. Okay? Really? I mentioned this to new rheumy. He said it was golfer's elbow from over use and gave me exercises to help relieve the tennis elbow pain. I am doing those exercises but i am not really buying the source as 'over use'. I don't play tennis - haven't touched my golf clubs since my ACDF neck surgery - and cannot think of anything I do repeatedly that could cause this level of burning pain.

I am reading these threads and wonder if we can take a count of the number of folks who have the same issue in their elbows?

This is an interesting thread. I have both medial and lateral pain (golfer's and tennis elbow-though i have never played either) with swelling at times. I thought my upper arm was getting flabby so I worked it gently in the water; it was not flab it was a "puddle" of swelling. I noticed years before that I had a lot of snapping in my elbow. Now these symptoms have started in my shoulder which i have never had pain in before. PsA is always surprising!

Been there, and still there. I have had both golfer's and tennis elbow, with no overuse AT ALL. Right now the tendons going into my upper arm are swollen

Very interesting discussion. I haven’t had bruising but I too have often FELT like there is bruising for mo reason. interesting…

My disease also seems to be more of the tendon/enthesis variety than the joints, interesting that I’m not the only one, given my rheumy only seems to see my joints!