Bursitis is a painful inflammation of a bursa, one of the small sacs at the joints that cushion the tendons, muscles and bones. Bursae normally enable fluid movement, but when overtaxed they can inflame and fill with fluid. Once a bursa becomes irritated, gritty and rough, it can create painful friction in the joint. Bursitis usually results either from repetitive stress or sudden injury and presents with swelling, redness and deep, aching pain. The joints most commonly affected by bursitis are the shoulder, elbow, hip and knee.

Risk Factors for Bursitis

Bursitis may result from overuse of a joint during work or play. Aging increases the risk of developing bursitis because as the tendons become less elastic they are more likely to tear. Individuals who work at occupations or engage in activities in which they put repeated pressure on certain joints are potential candidates for the ailment. This includes people who regularly:

  • Plant or rake
  • Shovel
  • Paint houses
  • Do carpentry
  • Scrub floors
  • Lay tiles
  • Play golf or tennis
  • Pitch baseballs

Other risk factors for bursitis include:

  • Medical conditions that causes inflammation, such as arthritis
  • Anatomical abnormalities that put unusual stress on a joint
  • Certain infections
  • Obesity
  • Incorrect posture
  • Inadequate stretching before exercise
  • Reactions to particular medications

Treatment of Bursitis

Usually bursitis responds to simple remedies, although the inflammation may take a week or many weeks to subside. Patients should see their physicians to rule out more serious injuries. They are typically advised to rest the injured region, avoid activities that intensify discomfort, ice the area, and take over-the-counter anti-inflammatory medications. Sometimes stronger oral medications are prescribed to reduce inflammation and sometimes corticosteroid injections are administered. Physical therapy is often recommended to increase range of motion as healing takes place. Only in rare cases is surgery necessary to treat bursitis.

The bursae at the elbow and knee are located more superficially many others, and so are more prone not only to inflammation, as in "housemaid's knee," but also to puncture wounds that can lead to infection. Infection of a bursa is called septic bursitis and must be treated with antibiotics.


Tendinosis, as opposed to acute tendonitis, is a chronic degenerative disorder, involving tiny tears in the connective tissue of the tendons, the bands that connect muscle to bone. This condition can occur anywhere in the body, but most often affects the shoulder, knee, biceps and Achilles tendons. This condition frequently affects athletes and happens when too much stress is placed on the tendon as a result of overuse, improper movement technique or traumatic injury.

Tendinosis, unlike tendonitis, occurs gradually, but recurrent tendonitis may lead to the chronic deteriorative condition. Tendinosis is essentially a buildup of microscopic injuries that don't heal properly. Over time, symptoms of pain, swelling and stiffness may appear and worsen. Unfortunately, because tendons heal more slowly than muscles, physical rehabilitation for the condition may be relatively lengthy.

Risk Factors for Tendinosis

Risk factors for tendinosis include prolonged repetitive motion. A wide range of occupational or recreational activities involve such movements. Individuals at risk for developing this disorder include:

  • Athletes or sports enthusiasts
  • Computer programmers, writers, data entry processors
  • Musicians
  • Manual laborers or assembly line workers
  • Sign language interpreters

Taking prescribed antibiotics in the fluoroquinolone family, such as Cipro and Levaquin, also presents a serious risk factor for tendon injury for which the FDA now requires a "black box" warning.

Treatments for Tendinosis

Once tendinosis is diagnosed through physical examination and imaging tests, there are several treatment options available. For many patients, simple remedies like ice applications, oral anti-inflammatory medications and may be sufficient to relieve symptoms. Frequently these simple home remedies are helpful in combination with physical therapy, particularly eccentric exercise, and the following minimally invasive medical interventions:

  • Injections of corticosteroids
  • Injections of nonsteroidal anti-inflammatories
  • Injections of sclerosing agents
  • Extracorporeal shock wave treatments

Physical therapists not only help patients by alleviating symptoms, but instruct them in motion techniques that may be more efficient and less taxing on the body. If symptoms persist for 3 months with these conservative treatments, however, surgical intervention may be required.

Complications of Tendinosis

The most common complication of tendinosis is a ruptured tendon, a sudden serious injury resulting in severe pain, swelling and disability, that requires urgent care. While the injury may, in some cases, be treated noninvasively, most often surgery is necessary to relieve pain and improve function.

Prevention of Tendinosis

Individuals can minimize their risk of developing tendinosis by using ergonomic equipment on the job and employing proper movement techniques in their everyday lives. They will also reduce their risk by taking frequent breaks and not remaining in one position too long, by paying attention to early signs of pain or stiffness, and by avoiding antibiotics that increase risk of developing the disorder.


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