What is the difference between tendonitis and bursitis?

Question: What is the difference between tendonitis and bursitis?

Tendonitis and bursitis are two of the most common orthopedic diagnoses, and these words are often used interchangeably. I often hear patients say they were diagnosed with rotator cuff tendonitis or shoulder bursitis, or both. So which is it? Tendonitis or bursitis?

Answer: The words tendonitis and bursitis both mean inflammation of a soft-tissue structure.
  1. Tendonitis
    A tendon is a structure that connects a muscle to bone. When the muscle contracts, it pulls the bone through the tendon. Tendons are rope-like structures. When a tendon becomes inflamed and irritated, the word tendonitis is used. (see below)

  2. Bursitis
    A bursa is a slippery structure that exists in places where tendons pass over bones. These spots are points of potential friction if the tendons were to rub against the bone. The body creates a bursa where tendons rub over a bone to allow the tendons to glide smoothly. When the bursa is inflamed and irritated, bursitis is the result. (see below)


Are bursitis and tendonitis related?

Often tendonitis and bursitis are related. Inflammation does not have boundaries, and two closely approximated structures, such as a tendon and bursa, can become inflamed simultaneously. That is why the diagnoses “rotator cuff tendonitis” and “shoulder bursitis” are often used interchangeably. They are different problems, but closely related. And most importantly, the treatment of both problems is the same.

Does every tendon have an associated bursa?

No. A bursa only forms where there are bony prominences, such as in the shoulder, the outside of the hip, and the kneecap. Many tendons do not have a bursa.

What is the treatment of tendonitis or bursitis?

Treatments of these conditions depends on the specific site of the problem. However, the essential aspect of treatment is to relieve whatever is causing the inflammation. This may be as simple as an activity modification, or as complicated as surgical treatment.

Treatments of inflammatory conditions usually starts with some simple steps, and becomes more advanced as needed. Some basic treatment steps include:

  1. Rest and Protect The Area
    Treatment must begin by avoiding aggravating movements. This may mean taking a break from a favorite activity for a period of time, but this is a necessary step to allow the inflammation to subside.

  2. Apply an Ice Pack
    Icing the area of inflammation is an important aspect of treatment. The ice will help control the inflammation and decrease swelling. By minimizing inflammation and swelling, the tendons and bursa can return to their usual state and perform as usual.

  3. Take Anti-Inflammatory Medications
    Nonsteroidal anti-inflammatory medications (NSAIDs) can help reduce inflammation and ease painful symptoms. Use anti-inflammatory medications under the direction of your physician.

  4. Cortisone Injections
    If the symptoms of tendonitis or bursitis are persistent, an injection of cortisone may be considered. Cortisone is a powerful anti-inflammatory medication. But instead of being given by mouth, it is injected directly to the site of inflammation. This can be extremely helpful for situations that are not improved with rest.

What is cortisone?

Cortisone is a type of steroid that is produced naturally by a gland in your body called the adrenal gland. Cortisone is released from the adrenal gland when your body is under stress. Natural cortisone is released into the blood stream and is relatively short-acting.

Injectable cortisone is synthetically produced and has many different trade names (e.g. Celestone, Kenalog, etc.), but is a close derivative of your body’s own product. The most significant differences are that synthetic cortisone is not injected into the blood stream, but into a particular area of inflammation. Also, the synthetic cortisone is designed to act more potently and for a longer period of time (days instead of minutes).

How does the cortisone injection help?

Cortisone is a powerful anti-inflammatory medication. Cortisone is not a pain relieving medication, it only treats the inflammation. When pain is decreased from cortisone it is because the inflammation is diminished. By injecting the cortisone into a particular area of inflammation, very high concentrations of the medication can be given while keeping potential side-effects to a minimum. Cortisone injections usually work within a few days, and the effects can last up to several weeks.

How does a cortisone injection help?

Cortisone shots work by decreasing inflammation. Once the inflammation subsides, pain relief follows. Cortisone starts to work immediately following the injection, and inflammation usually begins to subside within a few days. Depending on how quickly the inflammation subsides, timing of pain relief can vary from a few days to a few weeks.

If the inflammation is severe, or if the inflammation has been around a long time (chronic), the cortisone injection may take longer to take effect and may require more than one injection. Not every patient will respond to a cortisone injection, but the good news is that most people find this to be an excellent treatment for many common inflammatory conditions.

Can a cortisone injection make inflammation worse?

Some patients may have a reaction to the cortisone injection called a ‘cortisone flare.’ A cortisone flare is a condition where the injected cortisone crystallizes and can cause a brief period of pain, worse than before the shot. This usually lasts a day or two and is best treated by icing the injected area.


All About Tendonitis

A tendon is a tough yet flexible band of fibrous tissue. The tendon is the structure in your body that connects your muscles to the bones. The skeletal muscles in your body are responsible for moving your bones, thus enabling you to walk, jump, lift, and move in many ways. When a muscle contracts it pulls on a bone to cause movements. The structure that transmits the force of the muscle contraction to the bone is called a tendon.

Tendons come in many shapes and sizes. Some are very small, like the ones that cause movements of your fingers, and some are much larger, such as your Achilles tendon in your heel. When functioning normally, these tendons glide easily and smoothly as the muscle contracts.

Sometimes the tendons become inflamed for a variety of reasons, and the action of pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon is impaired, the tendon will become inflamed and movement will become painful. This is called tendonitis, and literally means inflammation of the tendon.

Causes of Tendonitis

There are hundreds of tendons scattered throughout our body, but it tends to be a small handful of specific tendons that cause problems. These tendons usually have an area of poor blood supply that leads to tissue damage and poor healing response. This area of a tendon that is prone to injury is called a “watershed zone,” an area when the blood supply to the tendon is weakest. In these watershed zones, they body has a hard time delivering oxygen and nutrients necessary for tendon healing–that’s why we see common tendon problems in the same parts of the body.

Tendonitis is most often an overuse injury. Often people begin a new activity or exercise that causes the tendon to become irritated. Tendon problems are most common in the 40-60 year old age range. Tendons are not as elastic and forgiving as in younger individuals, yet bodies are still exerting with the same force.

Occasionally, there is an anatomical cause for tendonitis. If the tendon does not have a smooth path to glide along, it will be more likely to become irritated and inflamed. In these unusual situations, surgical treatment may be necessary to realign the tendon.

Symptoms of Tendonitis

Tendonitis is almost always diagnosed on physical examination. Findings consistent with tendonitis include:

  1. Tenderness directly over the tendon

  2. Pain with movement of muscles and tendons

  3. Swelling of the tendon

X-rays & MRIs: Are They Necessary?

Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon.

MRIs are also good tests identify swelling, and will show evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem that could be causing the symptoms.

Once the diagnosis of tendonitis is confirmed, the next step is to proceed with appropriate treatment. Treatment depends on the specific type of tendonitis. You can learn more about these specific types of tendonitis and treatments of tendonitis on the following pages.


What is a bursa?

Every person has hundreds of bursa scattered throughout the body. The function of a bursa is to decrease friction between two surfaces that move in different directions.

The bursa can be thought of as a Ziplock bag with a small amount of oil and no air inside. Imagine rubbing this bag between your hands; movement of your hands would be smooth and effortless. That is what a bursa functions as–a smooth, slippery surface between two moving objects.

You tend to find a bursa at points where muscles and tendons glide over bones. Without the bursa between these surfaces, movements would be painful.

What is bursitis?

Bursitis is the inflammation of a bursa. Normally, the bursa provides a slippery surface that has almost no friction. A problem arises when a bursa becomes inflamed. The bursa loses its gliding capabilities, and becomes more and more irritated when it is moved.

When the condition called bursitis occurs, the normally slippery bursa becomes swollen and inflamed. The added bulk of the swollen bursa causes more friction within an already confined space. Also, the smooth gliding bursa becomes gritty and rough. Movement of an inflamed bursa is painful and irritating.

What causes bursitis?

Bursitis usually results from a repetitive movement or due to prolonged and excessive pressure. Patients who rest on their elbows for long periods or those who bend their elbows frequently and repetitively olecranon bursitis. Similarly in other parts of the body, repetitive use or frequent pressure can irritate a bursa and cause inflammation.

Another cause of bursitis is a traumatic injury. Following trauma, such as a car accident or fall, a patient may develop bursitis. Usually a contusion causes swelling within the bursa. The bursa, which had functioned normally up until that point, now begins to develop inflammation, and bursitis results. Once the bursa is inflamed, normal movements and activities can become painful.

Systemic inflammatory conditions, such as rheumatoid arthritis, may also lead to bursitis. These types of conditions can make patients susceptible to developing bursitis.