Diagnosing Bursitis & Tendinitis

Bursitis and tendinitis occur when inflammation, or severe swelling, affects the soft tissue that helps muscles and bones move. Inflammation is part of the body’s natural response to injury and can also result from repeated irritation or stress to tendons and joints.

Bursitis is inflammation in the thin, fluid-filled sacs called bursae located throughout the body in between bones and surrounding soft tissue, such as tendons and muscles. Bursae lubricate and cushion tendons and other tissues and help them move smoothly during movement. Tendinitis is inflammation in a tendon, a tough cord of tissue that connects muscle to bone. Tendons and muscles work together to move bones. 

Bursitis and tendinitis are common conditions that often occur at the same time. Inflammation may occur in bursae or tendons in any part of the body, but bursitis and tendinitis are most often diagnosed in the knee, elbow, shoulder, hip, or heel. 

Causes and Symptoms

Symptoms of bursitis and tendinitis include redness, swelling, tenderness, and pain in the affected part of the body. The skin around the affected area may be warm to the touch. Often, symptoms are more noticeable during and after physical activity and worsen over time. 

These conditions tend to occur as a result of overusing tendons and muscles and often affect athletes and people whose jobs require the same movements over and over for long periods. For example, bursitis or tendinitis may develop in the shoulder as a result of the repeated hammering and painting motions required in carpentry or the throwing and swinging motions required in baseball. These conditions may also affect a person who suddenly increases physical activity without gradually building endurance beforehand. 

Bursitis and tendinitis can affect people of any age, though the risk increases as people get older and tendons become less flexible. Some conditions, such as rheumatoid arthritis and diabetes, increase the risk of bursitis and tendinitis because they weaken soft tissue and make bursae and tendons more susceptible to irritation and inflammation. 

Bursitis and tendinitis are progressive conditions, meaning that symptoms become more severe over time without treatment. Inflammation in a bursa may lead to chronic pain and swelling, and inflammation in a tendon may lead to a tear that, in severe instances, may cause a tendon to separate from the bone. Early diagnosis of bursitis and tendinitis allows doctors to begin treatment before serious damage occurs.

Doctors at NYU Langone Orthopedic Center can diagnose bursitis and tendinitis during a physical examination, even soon after an injury. If more detail is needed to confirm a diagnosis, doctors may recommend imaging tests, such as MRI scans and X-rays.

Physical Examination

Doctors examine the affected area to look for swelling, redness, or warmth. They also feel for bumps beneath the skin, which may indicate swollen bursae. Doctors use their hands to gently move the affected part of the body to see if bursitis or tendinitis are limiting range of motion or causing pain. You may be asked to stand and walk a few steps or perform other motions as your doctor assesses whether symptoms affect your ability to move. 

Your doctor can usually differentiate between bursitis and tendinitis based on the location of the pain and swelling in relation to the anatomy of the affected area, but he or she may recommend imaging tests to confirm the diagnosis.

Medical History

During the examination, doctors ask about your current and past health as well as the nature of your injury. They may want to know when you first noticed discomfort, whether symptoms resulted from a specific incident, or whether they worsen during activity—especially if repeated motions are involved. They also ask if you have had surgery on the affected part of the body. 

MRI Scans

MRI is an advanced imaging technique that uses a magnetic field and radio waves to create detailed two- and three-dimensional pictures of soft tissue inside the body. MRI scans provide clear images of inflammation in the affected bursae and tendons and may be used to confirm the extent of an injury.

X-rays

X-rays use high-energy beams of light to create images of bones and other structures. Doctors use X-rays to examine bones to rule out other causes of pain and inflammation, such as stress fractures, which are tiny surface breaks in the bone.