Bursitis / Tendinitis

A bursa (plural bursae) is a small, jelly-like sac of synovial fluid that acts as a cushion between a bone and other moving parts, such as muscles, tendons or skin to help reduce friction.

The human body has 160 bursae. The major ones are located next to the tendons near the large joints, such as the hands, wrists, elbows, shoulders, hips, knees, ankles and feet. Tendons are strong, fibrous cords mainly made of collagen that anchor muscles to joints in the human body. The human body has hundreds of tendons, but fortunately, only a small portion of them are affected by tendonitis.

Bursitis vs. Tendinitis

Bursitis is different from tendonitis (also spelled as tendinitis). Tendonitis involves inflammation or irritation in the cord-like structure (tendon) attaching muscle to bone. The suffix, “itiis”, is derived from Greek and it means inflammation. Tendinopathy is a blanket term used to describe the various tendon injuries (e.g., tennis elbow, golfer’s elbow, Achilles tendonitis, etc.). The suffix, “pathy”, is derived from Greek and it means disorder or disease. Bursitis is the inflammation of one or more bursae. Symptoms for bursitis may include localized pain or swelling, tenderness, fever (feels hot to the touch) and pain with motion of the tissues in the affected area.

Pain for tendonitis is sudden and is usually felt where the tendon attaches to the bone, but can also be felt where the muscle and tendon connect. Other symptoms may include:

  • Swelling and usually redness and fever (warm to the touch)
  • Tenderness directly over the inflamed tendon
  • Pain and a cracking or grating with movement
  • A lump or bulge on the inflamed tendon
  • Stiffness

A chronic tendon problem is called tendinosis because, at this point, the tendon is damaged at a cellular level – noninflammatory degeneration of the structure or composition of the affected tendon. The suffix, “osis”, is derived from Greek and it describes a process, condition, or state – usually abnormal or diseased. Unlike tendonitis, which is acute (pain that comes suddenly or results from a specific injury to the tendon), tendinosis pain is chronic (develops slowly and persistently lasts over the long term or persistently re-occurs over time). Tendinosis is the result from continued overuse of a tendon without giving it time to heal and rest.

Tendonitis is typically caused by overuse and characterized by repetitive movements. For example, overuse of the wrists tendons on a computer keyboard or an elbow tendon on a tennis court. Bursitis can be caused by repetitive, minor impact on the bursa or by a sudden, more serious injury. Age can also be a factor because aging tendons are less able to tolerate stress, are less elastic and are easier to tear. Tendonitis can occur anywhere in the body and is identified by where it is found (e.g., tendonitis in the Achilles tendon – the tendon between the calf muscle and the heel – is called Achilles tendonitis, etc.). Bursitis is most commonly found in the shoulder, elbow and hip but can sometimes be found elsewhere, like the knee.

Shoulder Bursitis

Subacromial bursitis is a common cause of shoulder pain, typically related to shoulder impingement of the bursa between the rotator cuff tendons and bone (acromion). Bursitis to the subdeltoid bursa is not as common. Shoulder bursitis is usually caused by a repeated minor trauma, such as overuse of the shoulder joint and muscles or a single more significant trauma, such as a fall.

Elbow Bursitis

Elbow bursitis is also sometimes referred to as olecranon bursitis because of which bursa is most commonly inflamed: the bursa at the back of the elbow over the olecranon. The olecranon is the bony part of the back of the elbow – the top part of the ulna. Olecranon bursitis is characterized by a thickness and swelling over the back of the elbow. Most elbow bursitis cases are painless or are only mildly painful and elbow joint movement is not affected.

Hip Bursitis

The greater trochanter and iliopsoas bursae are the two bursae in the hip that most typically become irritated and inflamed. The trochanteric bursa is located on the greater trochanter – the outer bony point of the hip bone. Inflammation of this bursa is called trochanteric bursitis. The other bursa (iliopsoas bursa) is located on the inside (groin side) of the hip. Bursitis of this bursa is sometimes called hip bursitis, even though the pain is in the groin area.

Bursitis often develops as a result of strenuous and/or repetitive activity, particularly among:

  • Manual workers, due to heavy lifting, repetitive motion and working for extended periods of time without a break.
  • Athletes, after running, throwing, jumping or from aggressive arm motions made in such sports as tennis, baseball, football or even bowling.
  • Sedentary people who suddenly push their bodies past their limits.

Aspiration (removal of bursa fluid with a needle) or surgery is rarely necessary. Bursitis is typically treated by one or more of the following methods:

  • Protection (from any blow to the affected bursa/bursae), Rest, Ice, Compression, Elevation, Medication (PRICEM).
  • Physical therapy.
  • Ice and moist heat are used for recurring or persistent bursitis pain.

Treatment for tendonitis may include:

  • Rest and restriction of movement
  • Reduce the inflammation
  • Rehabilitate the affected tendon, joint and muscle

Physical Therapy for Bursitis/Tendinitis