Diagnosis of Bursitis and Tendinitis
Each type of bursitis and tendinitis has distinct symptoms.
Because bursitis and tendonitis can affect any joint, the diagnosis will depend on a physical examination, careful history, and imaging tests. For the purpose of this review, we will break down the symptoms based on the location of the affected area.
Symptoms of common types of bursitis and tendinitis include:
The main symptom is pain at the hip, which usually extends to the outside of the thigh area. In the early stages, the pain is usually sharp and intense. Later, the pain may become more of an ache and spread across a larger area of the hip.
The pain is usually worse at night, when you lie on the affected hip, and when you get up from a chair after sitting for awhile. It may also get worse after you walk for a long time, climb stairs or squat.
- Pain with activity (but not usually at night)
- Rapid swelling on the front of the kneecap
- Warmth and tenderness when the knee is touched
- Knee bursitis caused by infection may produce fluid and redness.
The first symptom is often swelling. Since the skin on the back of the elbow is loose, you may not notice a small amount of swelling immediately.
As the swelling continues, the bursa begins to stretch. This causes pain, which often gets worse if you apply direct pressure on the elbow or bend it. The swelling may grow large enough to restrict the motion of your elbow.
Rotator Cuff Tendinitis
Rotator cuff pain often causes swelling and tenderness in the front of the shoulder. You may feel pain and stiffness when you lift your arm. You may also feel pain when you lower your arm from a raised position.
Rotator cuff symptoms may be mild at the beginning. These can include:
- Minor pain that is occurs whether you are active or resting
- Pain that radiates from the front of your shoulder to the side of your arm
- Sudden pain when you lift or reach
- Pain that occurs when you throw or serve a tennis ball
As rotator cuff tendinitis gets worse, symptoms can include:
- Nighttime pain
- Loss of strength and motion
- Difficulty doing activities that require you to place your arm behind your back, such as zippering or buttoning
Achilles Heel Tendinitis
- Pain and stiffness along the Achilles tendon in the morning
- Pain along the tendon or back of the heel that worsens when you are active
- Severe pain the day after you exercise
- Thickening of the tendon
- Swelling of the tendon that gets worse throughout the day when you are active
- A sudden "pop" in the back of your calf or heel may indicate you have ruptured your Achilles tendon. If this happens, see your doctor immediately.
The doctor will ask you a series of questions about your medical history, and do a physical exam. You will be asked about your pain—when and where it occurs, whether it varies in severity throughout the day, and what relieves it or makes it worse.
The doctor may use a test called a selective tissue tension test to see which tendon is involved, and will feel specific areas of the tendon to see where it is inflamed.
The doctor may order an x-ray to rule out bone problems or arthritis. An x-ray will not show tendons or bursae. An MRI may be used to confirm a tear in a tendon or bursa.
If bursitis is caused by an infection, the doctor will drain fluid from the bursa and study it to see whether it should be treated with an antibiotic.