Bursitis, Tendinitis, and Other Soft Tissue Rheumatic Syndromes.

Last updated Thursday, February 10, 2005

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Causes and effects

What causes bursitis and tendinitis?

• Play 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)
• Infection

What types of bursitis are there?

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.

What types of tendinitis exist?

Rotator cuff tendinitis and impingement syndrome

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 tendinitis 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.

Bicipital tendinitis

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 tendinitis

DeQuervain's (pronounced "duh-KUR-vans") tendinitis 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 tendinitis

The achilles tendon attaches the calf muscle to the heel and lifts the heel off the ground. Achilles tendinitis 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.

What other types of soft tissue rheumatic syndromes exist?

Myofascial pain

Myofascial pain occurs in areas of muscles, often in the back, neck, and shoulders. It is associated with tender, hard areas called trigger points. When the trigger points are pressed, you may feel pain that spreads away from the points. Myofascial pain is associated with a firm knot or band within the affected muscle.

Myofascial back pain is a dull, aching pain located in the connective tissue (fascia) or in the muscles of the lower back and buttocks. Causes include minor injury or strain to the back without an actual herniated disc or fracture. This condition may be associated with degenerative arthritis of the back. Symptoms include painful muscle or fatty and fibrous bumps that, when pressed, may produce pain that travels down the buttocks and into the thigh.

Carpal tunnel syndrome

In carpal tunnel syndrome, the median nerve that passes between the wrist bones and a strong ligament on the bottom of the wrist may be compressed. This nerve supplies sensation to the first three fingers and part of the ring finger. This nerve also provides strength to the thumb muscles. Causes of carpal tunnel syndrome include injury from repetitive use or overuse, thyroid disease, diabetes, pregnancy, infection, rheumatoid arthritis, and other types of inflammatory arthritis.

Symptoms include numbness or tingling in the hand, initially only at night or when the wrist is flexed for a long time; feelings of swelling in the hand; weakness of the thumb upon pinching; and unexplained hand pain.

For more information, see our carpal tunnel syndrome article.

A similar condition called tarsal tunnel syndrome can affect the nerve located in the inner part of the ankle that supplies sensation to the toes and the sole of the foot. Compression on the nerve at the ankle can occur with ankle fractures, rheumatoid arthritis, or foot deformities. Symptoms include painful burning feelings in the foot, often at night or after standing; pain or burning on the sole of the foot or toes; and pain partially relieved by movement of the foot, ankle, or leg.

Tennis elbow (lateral epicondylitis)

The epicondyle is the area where muscles of the forearm attach to the outside bone of the elbow. Overuse of these muscles occurs in sports like tennis that require forced extension or rotation of the wrist or hand. Gardening, using tools, or clenching your hand for a long time may also cause epicondylitis.

Symptoms include aching pain on the outside of the elbow that can travel down the forearm, and pain with handshakes, movement of the fingers, lifting with the wrist, turning doorknobs, or unscrewing jar tops.

Golfer's elbow (medial epicondylitis)

Golfer's elbow is similar to tennis elbow, but less common. It is caused by overusing the muscles that clench the fingers. Symptoms include pain in the inner part of the elbow and pain when bending the fingers or wrists.

Tenosynovitis

Thickening of the lining around the tendons of the fingers can result in a condition called stenosing tenosynovitis or trigger finger. Bumps may develop on the tendon sheath from overuse. Symptoms include the locking of a finger in a painful bent position that suddenly snaps open (the other hand may need to straighten the finger). Symptoms include tenderness, swelling, or small bumps in the palm of the hand, and aching in the middle joint of the affected finger.

Plantar fasciitis

The plantar fascia is made up of thickened fibrous tissue that spans the sole of the foot from heel to toes. Running, prolonged standing, flat feet, heel spurs, and excessive weight can stress the fascia. Symptoms include pain in the sole of the foot and pain when walking.

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