Bursitis and Tendonitis
Bursitis and tendonitis are conditions that are also known as soft tissue rheumatic syndromes.  A syndrome is a group of signs and symptoms that occur together and indicate a particular problem.  This type of syndrome produces pain, swelling, or inflammation in the tissues and structures around a joint, such as the tendons, ligaments, bursae, and muscles.

Anyone can develop soft tissue rheumatic syndromes because the causes are so common.  Soft tissue rheumatic syndromes like tendonitis and bursitis are very common in people who are otherwise healthy. Bursitis, tendonitis, and other soft tissue rheumatic syndromes typically result from one or more factors.

These include:

• Recreation or work activities that cause overuse or injury to the joint areas
• Incorrect posture
• Stress on the soft tissues from an abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a joint)
• Other diseases or conditions (rheumatoid arthritis, gout, psoriasis, thyroid disease, or an unusual drug reaction)
• Infections

Soft tissue rheumatic syndromes may affect the areas around the joints of the shoulders, elbows, wrists, fingers, hips, back, knees, ankles, and feet.  Most of these conditions occur suddenly, may last for days, weeks, or longer, and then go away. They can occur again in the same place or in other parts of the body.

Because the structures affected by soft tissue rheumatic syndromes are near joints, pain in these areas may be mistaken for arthritis.  The difference is that arthritis means inflammation in the joint itself, not in the structures around the joint.  Pain is the main symptom of soft tissue rheumatic syndromes.  Moving the involved joint can be extremely painful and may be difficult.  If fever, chills, persistent redness, or swelling occur in a person with a soft tissue rheumatic syndrome, the person should see a doctor immediately to evaluate for the possiblity of infection.

Bursitis
Bursitis is inflammation or irritation of a bursa, a small sac located between a bone and muscle, skin, or tendon.  The bursa allows smooth gliding between these structures.  Below are some of the specific types of bursitis.

Subacromial Bursitis
The subacromial bursa lies just above the rotator cuff.  Bursitis often develops due to injury, impingement (pinching), overuse of the shoulder, or calcium deposits. Symptoms include pain in the upper shoulder or upper third of the arm, and severe pain upon moving the shoulder.

Trochanteric Bursitis
The trochanteric bursa is located over the prominent bone on the side of the hip.  Women and middle-aged to older people are more often affected by this type of bursitis.  It may occur spontaneously without specific injury.  Also, it can be caused by walking abnormally due to arthritis in the hip, knee, ankle, foot, or back.  Symptoms include pain gradually occurring over the side of the hip (and sometimes traveling down the thigh); pain when sleeping on the side affected by bursitis, rising from a deep chair, sitting in a car, or climbing stairs; and occasionally, pain when walking.

Ischial Bursitis
The ischial bursa is located below the bone in your buttock called the ischium.  Inflammation may occur as a result of injury or prolonged sitting on hard surfaces.  Symptoms include pain when sitting or lying down on the buttocks and pain that travels to the back of the thigh.  Ischial bursitis is also called "weaver's bottom" or "tailor's seat."

Olecranon Bursitis
Swelling of this small sac at the tip of the elbow is caused by injury, gout, rheumatoid arthritis, infection, or prolonged leaning on the elbows.  Symptoms include painful swelling and redness at the tip of the elbow.

Prepatellar Bursitis
The prepatellar bursa is located beneath the skin and in front of the kneecap.  It becomes inflamed as a result of infection, injury, gout, or repeated irritation from kneeling.  Symptoms include swelling in the front of the knee that may be painful.  Redness and/or warmth may occur with infection or gout.  Infrapatellar bursitis (clergyman's knee), a similar condition, affects the infrapatellar bursa, located just below the kneecap.

Pes Anserinus Bursitis
This bursa is located just beneath the knee on the inner part of the leg.  It can irritated in people who jog, have "knock-knees" or osteoarthritis of the knees, or in those who are overweight.  Symptoms include pain on the inner part of the knee, pain when sleeping on the side if the knees touch each other, pain while climbing stairs, and pain that travels to the back and inside of the thigh.

Retrocalcaneal Bursitis
This bursa is located at the back of the heel. Bursitis in this area is often associated with conditions such as ankylosing spondylitis or rheumatoid arthritis. It can occur in healthy individuals who wear improperly fitted shoes.  Symptoms include painful swelling that develops at the back of the heel.

Calcaneal Bursitis
This bursa is located at the sole or bottom of the heel.  Inflammation usually produces pain in the heel when standing.  Causes include heel spurs, excess weight, injury, and wearing improperly fitted shoes.

Tendonitis
Tendonitis is inflammation or irritation of the tendon, which is a thick cord that attaches muscle to bone.  Tendons transmit the power generated from muscles to help move a bone.  Some types of tendonitis are listed below.

Rotator Cuff Tendonitis
Four muscles make up the rotator cuff.  These muscles move the shoulder away from the side of the body and turn it inward and outward.  Rotator cuff tendonitis occurs when shoulder injury or overuse causes tendons to become irritated or inflamed. Impingement (pinching) occurs when the tendons are pinched between structures that are involved in shoulder motion.  Symptoms include sudden, severe pain in the upper shoulder or upper third of the arm, aching in the shoulder region, difficulty sleeping on the shoulder, or pain when lifting the arm overhead.

Bicepital Tendonitis
The biceps tendon is located in the front of the shoulder and helps bend the elbow and turn the forearm.  Overuse or injury typically causes inflammation in the tendon.  Symptoms include pain in the front or the side of the shoulder that can travel down to the elbow and forearm.

DeQuervain's Tendonitis
DeQuervain's tendonitis results from overuse of the thumb tendons, often caused by repeated pinching with the thumb while moving the wrist.  It can occur with activities such as writing, gardening, or fine handiwork.  It commonly occurs in women during and after pregnancy.  Symptoms include pain over the wrist on the side of the thumb, especially with thumb motion.

Achilles Tendonitis
The Achilles tendon attaches the calf muscle to the heel and lifts the heel off the ground.  Achilles tendonitis usually occurs as a result of a sports injury or improperly fitted shoes.  Symptoms include ankle stiffness and pain or swelling in the back of the ankle when pushing off the ball of the foot.

When properly treated, most soft tissue rheumatic syndromes do not result in permanent damage or disability.  They do not cause arthritis.  If neglected, however, these syndromes may become quite problematic.  Because bursitis and tendonitis may affect different parts of the body, each has a different treatment.  If you suspect that you may have bursitis or tendonitis, consult your orthopaedic physician or therapist regarding your options.