Tendinitis and bursitis

How they present

You may have pain in the shoulder, elbow, hip area, knee or heel. Pain increases with a particular movement or pressure on the area; in tendinitis there may be a creaking sensation during movement. Bursitis can cause swelling (edema), warmth and local tenderness. Causes include overuse, repetitive actions, trauma and some inflammatory diseases (arthritis, gout). Not all pain near a joint comes from the tendon or bursa; pain felt in one area may come from another joint or from the spine.

Inflammation and overload are not always the same thing

A tendon adapts to load, but a sudden increase or insufficient recovery can cause pain. In chronic tendinopathies there may be changes in the structure of the tendon and its load tolerance, not just inflammation. This explains why a pain treatment used alone may not solve the problem.

Bursitis can result from repeated pressure, trauma, an inflammatory disease or infection. When the area is hot and red, especially with fever, infection must be excluded before considering a corticosteroid injection; an infected bursa is treated with antibiotics and not injected with steroids.

How assessment is done and what ultrasound shows

The doctor reviews the activity that provokes the pain, injuries and limitation of movement. Clinical examination of strength, movement and sensation helps to tell tendon problems from arthritis or pain of another origin and to avoid treating the wrong site.

Joint ultrasound can show fluid in a bursa, thickening, changes in the tendon or a tear in certain cases. The result is interpreted together with the examination, because some structural changes can also be seen in people without pain; an image alone does not determine the need for a procedure. Other imaging is recommended only when the clinical question remains unresolved or when it changes decision-making. If infection is suspected, tests and sampling at the relevant service may be recommended.

Treatment and why rehabilitation is gradual

Treatment may include temporarily reducing load, local cooling wrapped in cloth and then adapted exercises. Return to activity is gradual; prolonged complete rest may limit function. Pain medicines are chosen according to the condition, especially when there are stomach or kidney problems or use of anticoagulants. Injections (corticosteroid, under ultrasound guidance when indicated) are not suitable for every case, are not done over a suspected infection and do not always replace rehabilitation.

After the acute phase settles, the tendon needs to regain tolerance to load. Physiotherapy sets the exercises and progression according to site, duration and function. Returning too fast to the same load may bring the symptoms back, while prolonged avoidance of any movement can reduce strength. Sudden severe pain with loss of function calls for investigation for a tear, not continuing exercises without assessment.

A practical step-by-step recovery program

In the first phase (the first days up to two weeks), the aim is to calm the pain without stopping movement entirely. Avoid movements that provoke the pain and repetitive load, but keep up light movement within tolerance, because complete immobilization weakens the tendon and muscle. Local cooling for 10–15 minutes, wrapped in cloth and not directly on the skin, can ease pain; warmth may help later with chronic stiffness, but not when the area is red and hot.

In the second phase, progressive loading exercises begin: isometric contractions (without joint movement), then slow eccentric exercises, which have better evidence in chronic tendinopathies such as those of the Achilles, knee or elbow. Load increases gradually, over a week or more, with the rule that pain during exercise is mild to moderate and settles within 24 hours. In the third phase, work or sport activities return, with attention to technique, suitable footwear and warming up beforehand. In bursitis of the elbow or knee avoid repeated leaning on the area and use soft protectors.

Recovery time varies: acute bursitis often settles within weeks, while chronic tendinopathy may require three months or more of continued exercise. Patients who abandon exercises as soon as the pain falls often repeat the problem.

When to seek assessment and what to do at the visit

Seek assessment if pain does not improve after two to three weeks, if it wakes you at night, if it keeps returning, if there is visible swelling or if it appears after an injury. Bring a description of the activity that causes the pain, the time of onset and any treatment tried. Before a corticosteroid injection, discuss benefit and risk: it may relieve pain for a limited time, but repeated injections into the same tendon can weaken it, which is why they are limited. If you have diabetes, tell the doctor, because the injection can temporarily raise glucose.

Preventing recurrence

Adapt your work or sport technique, load and rests. Report if the pain does not improve, returns or repeatedly wakes you at night. Do not force the area to work through severe pain. The plan should make clear what you can do now and the criteria for returning to work or sport. Checks are done as needed, every 6 months to a year when there are coexisting diseases, or sooner when the doctor considers it reasonable.

Care at Tirana Polyclinic: we offer rheumatology consultation, joint ultrasound and physiotherapy as indicated. The plan is set after examination, with guidance for specialized investigation or treatment when needed.