Bursitis and Tendinitis

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Latest Edit: Hector 2013-09-13 (EDT)

Bursitis and tendinitis are often considered together because they share body locations, etiologies, and treatment principles. Both processes involve pain or tenderness over the affected bursa or tendon, active range of motion is commonly limited and painful with painless passive range of motion, and blood tests and x-rays are commonly normal.[1]

Bursitis and Tendinitis

Bursitis and Tendinitis
Causes Posture, Movement, Trauma, Infections
See Also Musculoskeletal Conditions, Arthritis, Rheumatoid Arthritis
Books Books on Muscle, Joint and Bone Conditions
Articles Articles on Musculoskeletal Conditions

Naturopathic Assessment

Causal Factors

In order to stimulate the innate ability of the body to heal the causes of disease must be identified and addressed. With bursitis and tendinitis, the causes are variable. A detailed assessment is needed to identify external factors and behaviors that may contribute to the development and progression of bursitis and tendinitis.


  • Repetitive activities associated with work, sport, and recreation may cause tendinitis and/or bursitis.[2]
  • Overuse of a joint can cause bursitis or tendonitis.

Medical Interventions

  • Prescription Medications
  • The use of fluoroquinolone may predispose individuals to tendinopathies.[2]


  • Septic bursitis is most commonly caused by Staphylococcus aureus.[2]
  • Trauma
  • Direct trauma as well as repetitive microtrauma are common causes of bursitis and tendinitis.[3]

Diagnostic Testing

Burisitis and tendinitis are diagnosed based on clinical observation and assessment as blood tests and x-rays are usually normal.[1]

The following diagnostic testing can be used to rule out alternate pathologies when bursitis is suspected:[4]

  • Imaging Studies
  • Imaging studies including plain radiography, and MRI can be used to rule out other joint problems. Ultrasound may be used to aid aspiration or injection therapies.
  • Other Studies
  • Gram stain, culture and sensitivity, crystal analysis, and cell count and differential, can be performed from bursal fluid aspiration to rule out other pathologies and guide treatment.

Related Symptoms and Conditions

Bursitis and tendinitis are often associated with the following conditions:[4][5]

  • Repetitive Injury
  • Arthritis
  • Rheumatoid Arthritis
  • Infection
  • Impingement Syndrome (shoulder)
  • Biceptial Tendinopathy
  • Calcific Tendinopathy
  • Lateral Epicondylitis
  • De Quervain’s Tensynovitis
  • Achilles tendon rupture


A bursa is a synovial fluid filled sac near joints. It is found in areas with high potential of friction such as between tendons, ligaments, and bone. Bursitis refers to inflammation of the bursa. It commonly occurs at the elbow, knee, behind the knee, and on the buttocks. Bursas assist movement and reduce friction between moving parts.[2]

Tendinitis refers to an injury to tendinous structures – structures composed of collagen that attach muscle to bone. Although the term tendinitis suggests an inflammatory process, inflammation is not always present and some experts suggest the use of the term tendinopathy is more appropriate. In general, tendinitis is caused by repetitive microtrauma often associated with occupational or recreational activity.[2]

The Common Symptoms indicating bursitis or tendinitis include:

  • Joint pain and tenderness when you press around the joint
  • Stiffness and achiness when you move the affected joint
  • Swelling, warmth or redness over the joint

Naturopathic Treatment

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. Bursitis and tendinitis are typically chronic issues and need ongoing treatment and modification of risk factors.

It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.

Home Care

  • Temporary rest or immobilization of the affected joint is often required.


Lifestyle recommendations include:

  • With tendinopathies and bursitis, rehabilitation programs are specific to the area of concern, but generally focus on strengthening and increasing functional range of motion.[2]
  • Avoiding aggravating activities is recommended acutely, with suitable changes in repetitive movements in sport, occupation, or hobbies to reduce recurrence long term.[5]
  • In some instances a change in posture, ergonomics, or footwear is required to treat and prevent bursitis and tendinitis. This may include night splinting, shoe lifts, or use of heel cups. [6]

Naturopathic Therapies

Naturopathic Therapies for bursitis and tendinitis include:

Article Efficacy of a Systemic Enzyme Formulation in the Treatment of Shoulder Tendonitis, 2010 February Natural Medicine
Article Guided Longitudinal Percutaneous Tenetomy, A Safe and Effective Procedure for Treating Tendinosis , 2011 July NDNR
  • Studies suggest that acupuncture may help to promote healing in cases of tendinopathy by increasing blood flow and promoting fibroblastic activity.[10]
  • Compression taping can reduce recurrent swelling in cases of bursitis.[2]
  • Hydrotherapy treatments including alternating hot and cold applications are beneficial in cases of tendinitis and bursitis.


  1. 1.0 1.1 Colburn KK (2012) Bope and Kellerman: Conn’s Current Therapy 2012 1st ed Bursitis, Tendinitis, Myofascial Pain, and Fibromyalgia Saunders
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Schmidt MJ, Adams SL (2009) Marx: Rosen’s Emergency Medicine 7th ed Chap 115 Tendinopathy and Bursitis Mosby
  3. Hanada E, Keplinger FS, Gupta Navneet (2008) Frontera: Essentials of Physical Medicine and Rehabilitation 2nd ed Chap 62 Knee Bursitis
  4. 4.0 4.1 Yuvienco C (2012) Ferri: Ferri’s Clinical Advisor 2013 Bursitis Mosby
  5. 5.0 5.1 Drezner JA, Harmon KG, O'Kane JW (2011) Rakel: Textbook of Family Medicine, 8th ed Chap 29 Sports Medicine Saunders
  6. Wilkins AN, Sipple D, Hudgins TH (2008) Frontera: Essentials of Physical Medicine and Rehabilitation 2nd ed Chap 74 Foot and Ankle Bursitis Saunders
  7. Gaby AR (2011) Nutritional Medicine Fritz Perlberg Publishing
  8. Hoffer Abram, Prousky Jonathan Naturopathic Nutrition, A Guide to Nutrient-Rich Food & Nutritional Supplements for Optimum Health CCNM Press
  9. Godfrey Anthony, Saunders Paul Richard, Barlow Kerry, Gilbert Cyndi, Gowan Matthew, Smith Fraser (2010) Principles and Practices of Naturopathic Botanical Medicine, Vol 1: Botanical Medicine Monographs CCNM Press
  10. Neal BS, Longbottom J (2012) Is there a role for acupuncture in the treatment of tendinopathy? Acupunct Med [Epub ahead of print]