Bursitis or Tendinitis?

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Written By Dr. Marcus Yu Bin Pai

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

Bursitis and tendinitis are distinct conditions that affect different structures within the body, despite some similarities in symptoms and causes.

Bursitis is characterized by the swelling of a bursa, which is a small, fluid-filled sac that acts as a cushion between bones and soft tissues, such as tendons and muscles. The swelling in bursitis is due to inflammation in the bursa. Bursitis often occurs as a symptom rather than a primary disease and can sometimes be differentiated from calcareous deposits in ligaments and tendons, which may or may not involve calcification (Carpenter, 1958).

Tendinitis, on the other hand, involves the severe swelling of a tendon. Tendons are the thick, fibrous cords that attach muscle to bone. Conditions like anserine syndrome, which is a combination of tendinitis and bursitis, highlight the interconnected nature of these disorders in causing joint pain (Helfenstein & Kuromoto, 2010). However, they are distinct in terms of their primary affected structures: tendons in tendinitis and bursae in bursitis.

Both conditions can develop in various joints throughout the body, including the heel area, which is a common site for both disorders (Cunningham, 1994). Moreover, tendinitis, along with conditions like Haglund’s deformity and bursitis, are different forms of Achilles tendon injuries, demonstrating the complexity and overlap of these conditions in certain areas of the body (Lesić & Bumbasirevic, 2004).

How do I know if I have bursitis or tendonitis?

The symptoms of tendonitis and bursitis are very similar, and both involve:

  • Tenderness and pain in the affected part of the body;
  • Redness;
  • Bloating;
  • Feeling of elevated temperature due to inflammation;
  • Difficulty and stiffness aggravated by movement;
  • Noticeable worsening at night, during, and after activity;

To determine whether you have bursitis or tendonitis, you should consider the following factors:

  1. Location of pain: Bursitis typically occurs near joints, such as the shoulder, elbow, hip, or knee. Tendonitis can occur in various locations, including the rotator cuff (shoulder), Achilles tendon (ankle), and patellar tendon (knee) 6.
  2. Onset of symptoms: Bursitis often develops gradually, with pain and stiffness increasing over time. Tendonitis can have a sudden onset, with pain and inflammation appearing after an injury or overuse of the affected area6.
  3. Range of motion: Bursitis may cause limited range of motion in the affected joint, while tendonitis may cause pain and stiffness when moving the affected tendon6.
  4. Swelling and warmth: Bursitis can cause visible swelling and warmth over the affected area, while tendonitis may not have these symptoms6.
  5. Response to treatment: Both bursitis and tendonitis can be treated with rest, ice, compression, and elevation (RICE), as well as nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. However, if your symptoms do not improve with these treatments, it may be necessary to consult a healthcare professional for further evaluation and possible imaging studies, such as an ultrasound or MRI, to confirm the diagnosis6.

Understanding Bursitis

Bursitis is the inflammation of the bursa, a small fluid-filled sac that provides cushioning and protection to soft tissues from rough bone surfaces. There are three main types of bursitis: infectious, acute, and chronic.

We will focus on the latter two types, as they are commonly associated with shoulder pain.

  1. Acute Bursitis: This occurs due to repetitive motion or tissue overload, leading to swelling, friction, and an inflammatory response. Acute bursitis is usually associated with a specific event or activity that caused the inflammation, such as painting a ceiling or cleaning a car.
  2. Chronic Bursitis: This is often associated with tendonitis and occurs due to chronic overuse, poor posture, and self-use habits. The bursa becomes overworked, trying to nourish and heal the injured tendon.

Mechanism of Bursitis

The mechanism of bursitis involves several factors:

  1. Trauma and Overuse: Repetitive mechanical trauma or overuse is a common cause of bursitis. For example, bicipitoradial bursitis often results from repetitive mechanical trauma (Lui, 2013); (Choi & Lui, 2014).
  2. Mechanical and Static Stress: Bursitis in certain locations, like retrocalcaneal bursitis, can be caused by mechanical and static stress, possibly exacerbated by anatomic variants such as those in the calcaneus (Gaulke & Suppelna, 2000).
  3. Infections and Systemic Diseases: Bursitis can also occur due to infection, metabolic diseases, rheumatoid arthritis, and systemic sclerosis (Setoyama et al., 1995); (Ishikawa et al., 1997).
  4. Inflammatory Process: Bursitis is fundamentally an inflammatory process affecting the synovial walls of the bursa, leading to symptoms like pain, limited mobility, swelling, fever, and redness (Stepchenkov, 2022).
  5. Muscular Atrophy and Altered Biomechanics: In some cases, muscular atrophy or altered biomechanics, as seen in quadriparesis, may contribute to the development of bursitis (Seol & Han, 2015).

How do I find out if I have tendonitis?

The main manifestations of tendonitis are pain, local swelling, and difficulty or inability to perform specific movements.

For example, if the inflammation affects the tendons of the fingers of the hands, the person may be unable to write and type quickly or even turn a door handle.

  1. Clinical History and Physical Examination: A detailed history of possible precipitating causes and precise localization of symptoms are crucial. Identifying historical features and specific physical examination maneuvers can assist in accurate diagnosis (Thorson & Szabo, 1989); (Wilson & Best, 2005).
  2. Imaging Techniques: Diagnostic imaging plays a key role. For instance, MRI and ultrasound are effective in diagnosing tendon conditions, particularly for conditions like Achilles tendon disorders (Weinfeld, 2014). Radiographic findings can be pivotal in diagnosing specific types of tendonitis, such as calcific tendonitis of the longus colli muscle, by showing calcification and swelling in specific areas (Kerkhove, Geusens, & Knockaert, 2007).
  3. Understanding the Mechanism of Injury and Anatomy: Knowledge of the anatomy, biomechanics, and common mechanisms of injury associated with specific tendons can guide diagnosis. For example, patellar tendonitis is often diagnosed based on these factors (Pezzullo, Irrgang, & Whitney, 1992).
  4. Differentiation from Other Conditions: It’s important to differentiate tendonitis from other musculoskeletal conditions. For example, in the upper forearm where there are no tendons, a diagnosis of tendonitis might not be appropriate for pain in this area (Freiberg, 2008).
  5. Bone Scan and Musculoskeletal Ultrasound: Bone scans can reveal degenerative tendonitis, even in patients who appear otherwise normal (Peereboom & Peereboom, 2020). Musculoskeletal ultrasound is particularly effective for diagnosing and guiding treatment, as seen in cases of extensor hallucis longus tendonitis (Jena, 2021).

What are the leading causes of bursitis and tendonitis?

People are sedentary, getting older and obese, and the body lacks the necessary maintenance. This generates imbalances that will begin to show up in the joints, such as tendinitis, bursitis, and sometimes even arthrosis, which is the wear and tear of the cartilage.

Find below some possible causes of bursitis or tendonitis.

Heavy bags

It offers some problems, the first is the spine, in which the person hangs down to one side and tries to pull with their spine to the other side.

The other problem is not so much bursitis that people are used to thinking about, which is inside the shoulder, but it is more of a palpable joint called the clavicular acromion.

Sometimes this heavy bag starts to cause pain in the clavicular acromion joint. The idea is to try to balance, reduce weight, carry in another way, and alternate the shoulders.

Heavy backpacks

If the backpack pulls you back, you need to strain your abdominal muscles. Generally, the person does not have as much good strength in the abdomen, which ends up pulling the shoulders forward. The recommended thing is to try to make the strap short.

Computer and mouse

They get in the way because they inflame the wrist and elbow. Changing some things in the keyboard posture sometimes makes it easier, such as using office tables, where the keyboard is slightly down, so that the person is not so much with the fist extended but a little more bent or straight.


Some people like to run. This can injure the ankle tendon (Achilles tendon). Running on uneven surfaces also hurts the ankle tendon.

Flat sandals

People work a little better with one or two little toes in heels on their shoes. Using flat shoes increases the pressure between the Achilles tendon and the calcaneus bone, causing retro-aquilean bursitis and is sometimes quite painful.

Treatment possibilities

The treatment of these two conditions is based on the cause itself.

The initial goal of treatment is to decrease and, if possible, inhibit pain. For this, joint rest is the primary basis, achieved through removing the causal factor and activities that may lead to the aggravation of the injury.

A proper warm-up and taking care of your posture are essential. Using “splints” (plastic splints) on the affected area as immobilization, moist heat, and other physical therapy modalities help improve acute pain.

Over-the-counter painkillers or opioids may be employed, but non-hormonal anti-inflammatory drugs are regularly the most commonly used. In severe cases, short periods of corticosteroid use may be necessary or even intra-articular infiltration has its indication.

Physical rehabilitation should be performed to remove pain. Still, above all, it is used to recover range of motion and prevent relapses through specific exercises guided by trained professionals.

If an infection is present, an antibiotic is needed.

Non-Pharmacological Treatments for Bursitis

Non-pharmacological treatments for bursitis focus on managing symptoms and promoting healing without the use of medication. These treatments can be effective for various types of bursitis, including olecranon, prepatellar, and lower extremity bursitis. Here are some key non-pharmacological approaches:

  1. Rest and Activity Modification: Resting the affected area and avoiding activities that exacerbate the condition are fundamental for reducing inflammation and pain associated with bursitis. Activity modification may also include altering movements or techniques that put stress on the affected bursa (Butcher, Salzman, & Lillegard, 1996).
  2. Ice Therapy: Applying ice to the affected area can help reduce swelling and pain. Ice therapy is often used in the acute phase of bursitis to control inflammation (Aaron, Patel, Kayiaros, & Calfee, 2011).
  3. Compression and Elevation: Using compression bandages and elevating the affected area can also help reduce swelling.
    • Compression: Using an elastic bandage or wrap to provide gentle pressure can help reduce swelling and provide support to the affected area.
    • Elevation: Elevating the affected limb above the level of the heart, especially during rest, can aid in reducing swelling.
  4. Physical Therapy: Structured rehabilitation programs, including exercises to improve range of motion and strengthen surrounding muscles, can facilitate healing and reduce pain (Butcher, Salzman, & Lillegard, 1996).
    • Range of Motion Exercises: Gentle stretching and mobility exercises help maintain joint flexibility and prevent stiffness.
    • Strengthening Exercises: Strengthening the muscles surrounding the affected joint can provide better support and reduce stress on the bursa.
    • Ultrasound or Heat Therapy: Physical therapists may use modalities like ultrasound or heat therapy to promote healing and reduce pain.
  5. Orthosis Wear: Wearing orthotic devices or protective padding can help reduce pressure on the affected bursa, particularly in cases like olecranon bursitis (Nchinda & Wolf, 2021).
    • Padding and Protective Gear: Wearing protective padding or braces can help cushion the affected area and prevent further trauma, especially in cases like olecranon bursitis where the elbow is prone to bumps and pressure.
  6. Ultrasound Therapy: Ultrasound therapy can be effective in treating recurrent noninfectious bursitis, providing a convenient and effective treatment option (Aswinprakash et al., 2018).
    • Procedure: Ultrasound therapy uses sound waves to generate heat deep within tissue, which can help reduce pain, inflammation, and muscle spasms.
    • Frequency and Duration: The therapy is often administered in short sessions (5-10 minutes), over several weeks.

Is Surgical Intervention needed?

Surgical intervention for tendinitis or bursitis is infrequent.

Surgical Intervention: In severe, refractory, or chronic cases of bursitis, surgical treatment may be considered. This is typically reserved for cases that do not respond to conservative treatments (Baumbach et al., 2014).

Indication: Surgery is considered when conservative treatments fail, particularly in chronic or recurrent bursitis cases.

Procedures: Surgical options may include bursectomy (removal of the bursa), drainage of excess fluid, or repair of any associated injuries.

Recovery: Post-surgery, rehabilitation is often necessary to restore function and strength to the affected joint.


Once the acute attack has been controlled, Patients must initiate work to prevent and correct the causal factors.

Improvement of ergonomics, muscle quality, and especially self-esteem are fundamental to prevent new injuries and recurrences of old ones.

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MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

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