Bursitis and tendonitis are two of the most common orthopaedic diagnoses, and they are often used interchangeably. However, they are somewhat different in the fact that a tendon is a structure that connects a muscle to a bone, whereas 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. Further, a bursa only forms where there are bony prominences. When the bursa is
irritated and inflamed, the word bursitis is used. This condition usually occurs under the shoulder muscles, at the elbow (“tennis elbow”), the heel bone, the hip socket or the kneecap. It can also occur in the buttocks or the thigh, although this is less likely. Bursitis can be acute, manifested by a sudden, sharp pain following an injury, or it can be chronic displaying a recurrent inflammation in the same area.
Tendons are rope-like structures and when the muscle contracts, it pulls the bone through the tendon. When a tendon becomes irritated and inflamed, the end result is tendonitis. This condition can occur in any tendon in the body, but it tends to occur in regions that are prone to injury,
resulting in problems with blood supply to the area of concern. Some of the areas of tendonitis that are seen most frequently include the wrist, the Achilles (back of the heel), the kneecap, the rotator cuff (shoulder) and the elbow. Much like bursitis, there is pain and swelling at the particular site.
Often times these two conditions are related. Inflammation does not have boundaries, and two closely approximated structures, such as a bursa and a tendon, can become inflamed simultaneously. They are different problems, but closely related, and the treatment for both conditions is the same. That is why the diagnoses “rotator cuff tendonitis” and “shoulder bursitis” are often used interchangeably. They are still different problems, yet very closely related.
Obviously treatment for both conditions will depend on the specific site of the problem, but the essential aspect of treatment is to relieve whatever is causing the inflammation and pain. It could be as simple as an activity modification, or as complicated as surgical intervention. The inflammatory condition, in both bursitis and tendonitis, require some basic treatment steps:
- Rest and protect the area. Avoid aggravating movements. This can be achieved by taking a break from a favorite activity so that the inflammation is allowed to subside.
- Apply an ice pack. The ice will help control the inflammation and decrease the swelling. This way the tendons and bursa can return to their usual state and perform normally.
- Take anti-inflammatory medication. NSAIDs (nonsteroidal anti-inflammatory drugs) will help reduce inflammation and pain.
- Cortisone injections. If the symptoms persist, an injection of cortisone may be necessary. This is a powerful anti-inflammatory medication, but it is given by injection directly to the site of inflammation.