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What is the difference between tendonitis and bursitis?

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Updated June 10, 2009

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.

  • 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.

  • 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.

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:

  • 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.

  • 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.

  • 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.

  • 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.

Sources:

Almekinders, LC. "Tendinitis and other chronic tendinopathies" J. Am. Acad. Ortho. Surg., May 1998; 6: 157 - 164.

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