Joints and tendons
Bursitis and tendonitis
A bursa is a small fluid-filled sac that reduces friction where a tendon or muscle passes over bone. Bursitis is irritation of that sac; tendonitis is irritation of the tendon itself. The two frequently occur together because they sit alongside one another and are loaded by the same movements, and at several sites — the shoulder and the outer hip in particular — it is not always possible or necessary to separate them. In tendons the underlying change is often degenerative rather than inflammatory, which is reflected in how they are treated.
Where they occur
A few sites account for most presentations, each with a recognisable pattern.
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Shoulder
Subacromial bursitis and rotator cuff tendinopathy, producing pain on reaching overhead and when lying on that side.
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Outer hip
Greater trochanteric pain syndrome — gluteal tendinopathy with or without bursitis — causing pain on the side of the hip, worse lying on it and when climbing stairs.
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Elbow and knee
Olecranon and prepatellar bursitis, often related to pressure from leaning or kneeling, and typically producing visible swelling.
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Heel and ankle
Achilles tendinopathy and retrocalcaneal bursitis, producing pain at the back of the heel.
Causes and risk factors
Most cases relate to load, pressure or a change in activity rather than to a single injury.
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Repetitive or sustained load
Overhead work, running, kneeling and leaning on an elbow are each associated with irritation at the corresponding site.
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A change in activity
A sudden increase in volume or intensity, or an unfamiliar task, commonly precedes onset.
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Direct pressure or trauma
A fall onto a joint, or prolonged kneeling and leaning, can inflame a superficial bursa directly.
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Underlying conditions
Inflammatory arthritis, gout and, rarely, infection can cause bursitis. Infection is important to exclude where a bursa is hot, red and acutely painful.
Diagnosis
Usually clinical, with imaging used to characterise the tissue or to exclude other causes.
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Examination
Localised tenderness, pain reproduced by loading the relevant tendon, and assessment of the joint and the structures that refer pain to it.
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Ultrasound
Shows bursal fluid and tendon change directly and allows dynamic assessment, and can guide an injection where one is indicated.
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Excluding infection
A bursa that is hot, red and rapidly painful, particularly with fever, is assessed urgently, as septic bursitis requires different treatment.
Common questions
Is it inflammation or wear?
Both terms are used loosely. Bursitis often does involve inflammation, while long-standing tendon problems are usually degenerative. The distinction matters because anti-inflammatory treatment alone rarely resolves a degenerative tendon.
Should I rest?
Aggravating load is usually reduced temporarily, but prolonged rest tends to leave the tendon less tolerant than before. Graded loading is the mainstay for tendon problems.
Will a steroid injection cure it?
It can relieve pain, particularly in bursitis, but relief is often temporary and repeated injections around tendons carry risks. It is generally used to enable rehabilitation rather than instead of it.
How long does recovery take?
Bursitis from a single episode of pressure may settle in weeks; tendinopathy commonly takes several months of consistent loading work.
General reference information, and not advice about your own case. It may not reflect the most recent guidance or what is offered on a given day — call (201) 408-5151 to check.
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