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Tendons are cord-like structures located where a muscle narrows down to attach to a bone. The tendon is more fibrous and dense than the elastic, fleshy muscle. A tendon transmits the pull of the muscle to the bone to cause movement. Tendinitis is often very tender to the touch.
Tendinitis or bursitis often involves the shoulder, elbow, wrist, hip, knee and ankle. The pain it causes may be quite severe and often occurs suddenly. As in arthritis, the pain is worse during movement. Unlike arthritis, the pain is often in parts of the body far from a joint. Tendinitis often results from repetitive use (overuse). Though the problem can recur or be chronic (long term) in some people, it is most often short term, mainly if treated early.
Bursitis is inflammation of a bursa. This small sac acts as a cushion between moving structures (bones, muscles, tendons or skin). If a muscle or tendon is pulling around a corner of a bone, or over a bone, a healthy bursa protects it from fraying and stress. When a bursa is inflamed, it becomes very painful, even during rest.
Tendinitis can occur from a sudden intense injury. Most often, though, it results from a repeated, minor injury of that tendon. Doctors call this repetitive stress or overuse. For example:
To prevent these overuse injuries, follow the tips in the Joint Protection Table.
Persons with gout, pseudogout, or blood or kidney diseases often develop bursitis as part of that disease. Older persons are more prone to get tendinitis and bursitis. Rarely, some drugs can cause tendinitis and tendon rupture (spontaneous tear). These include fluoroquinolone antibiotics and statins drugs that lower cholesterol).
To determine the cause of these problems, a health care provider asks about your medical history and does a careful physical exam. Tenderness along the tendon or its sheath (outer covering), or at one specific point in the tendon, suggests tendinitis. Pain occurs when the muscle to which the tendon is attached is worked against resistance as part of the exam.
Most patients at first do not need imaging tests like X-rays, magnetic resonance imaging (often referred to as MRI) or ultrasound scans. Imaging and blood tests are done only if the problem recurs or does not go away. A blood test also can help detect an infection. Signs of an infection include redness, warmth and swelling. If bursitis is the result of infection, fluid must be drained from the bursa at once and promptly studied.
Treatment depends on the cause. In overuse or injury, you must reduce the causing force or stress. If tendinitis is job related, the doctor or physical therapist should review proper ergonomics, so you can work safely. Some patients may need joint protection advice and support of the involved region. There is little proof that therapeutic ultrasound helps these problems, and most doctors do not recommend it. Treatment can consist of any of the following:
Corticosteroid injections may provide short-term benefit in certain forms of tendinitis, and may be considered if you are unable to take NSAIDs. If an infection is present, you most often will need a proper antibiotic. (Daily drainage of fluid with a needle also may be needed.) If crystals of gout are found in joint fluid, there is medicine that controls the disease.
For ankle tendinitis, you may need orthotics to reduce the stress at the ankle or in the foot. An orthotic is a device that goes inside the shoe, which changes the support and the angle of the foot. This improves foot mechanics and relieves pain or pressure. They can be custom made or off the shelf.
A possibly serious complication of tendinitis is rupture of a tendon. The most common rupture is a tear of the Achilles tendon in the lower calf. It most often needs surgery.
There are ways you can prevent these problems from occurring. These tips apply to all joints:
The Table shows how to protect certain joints.
Tendinitis or bursitis in the shoulder can become a greater problem if the shoulder becomes stiff. It is important to do range of motion exercises, such as stretching, each day. This preserves movement in the shoulder joint.
Tendinitis or bursitis can be painful. Seek medical attention early to prevent joint stiffness and chronic problems that may follow. It also is important to rest the limb or the joint, at least until movement is free of pain. Failure to rest it most often delays full healing.
Tips for living with tendinitis or bursitis include:
Reviewed May 2015. Written by Robert P. Sheon, MD, FACP, and reviewed by the American College of Rheumatology Communications and Marketing Committee. This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.
©2015 American College of Rheumatology