Tendinitis (tendonitis), bursitis, and impingement syndrome are 3 closely related shoulder problems that commonly affect your shoulder's tendons (def.)Tendons Tendons are cord-like structures made of collagen that connect muscles to bones.. They may occur separately or in combination.

View an animation of impingement syndrome.

Tendons are fibrous cords that connect muscles to bones. As a muscle contracts, it pulls on the attached tendon and causes the bone to move. The tendon is located between the humerus (upper arm) bone and the acromion (def.)Acromion The acromion is the front edge of the shoulder blade or "roof" of the shoulder. It's the highest point of the shoulder blade and forms a bony arch over the rotator cuff and humeral head (top of arm bone).. A layer of tissue sacs called bursae (def.)Bursae Bursae (singular = bursa) are filmy, sac-like structures that allow bones, muscles and tendons to glide smoothly over each other. In the shoulder, the bursae are located between the rotator cuff tendons and the shoulder blade (acromion). They help cushion the rotator cuff from the boney front edge of the shoulder blade. serves as a cushion between the tendon and the acromion.

Since both the tendon and bursae are so close to one another, it may be difficult to determine which one is the source of your pain. Most often, both are involved.

View the anatomy of the shoulder.

• Tendinitis and bursitis
• Impingement syndrome

Tendinitis is perhaps the most common shoulder problem you may experience. Tendinitis is inflammation of a tendon. When it happens in the shoulder, your rotator cuff (def.)Rotator Cuff The rotator cuff is a muscle tendon unit composed of four muscles that attach the humeral head ("ball" of the upper arm bone) to the scapula (shoulder blade). tendons or biceps (def.)Biceps The biceps is the large muscle at the front of the inner arm. It allows you to flex the arm.   tendons are inflamed, usually as the result of being pinched.

Bursitis often accompanies tendinitis, although it can occur independently. Bursitis is inflammation of the bursae, the sacs that help cushion the rotator cuff from the boney front edge of the shoulder blade (acromion).

Both result in shoulder pain.

Anyone can experience tendinitis and bursitis, but it's more common as you get older. As your tendons age, they are less elastic and become more susceptible to injury.

The problem is most likely to happen after recurring repetitive movement that causes minor injury to the shoulder:

• Spending the weekend painting the living room or playing your first tennis match of the season can bring on the pain of tendinitis
• Simple daily activities like lifting a bag of groceries into the car can inflame your bursa and cause bursitis. A bursa also can become inflamed from injury or an underlying disease such as rheumatoid arthritis
• Frequently lifting heavy items above your head can cause tendinitis and bursitis
• Participating in sports that require repetitive overhead movement such as swimming, playing baseball, or racketball can cause tendinitis and bursitis

When you have tendinitis and/or bursitis, you will experience pain at rest that worsens with certain shoulder movements.

To diagnose your condition, your doctor will examine your shoulder and ask you about recent activities that may have caused your symptoms. An x-ray may be useful to show if a bone spur is compressing your tendon. Your doctor also may suggest an MRI (def.)MRI (Magnetic Resonance Imaging) MRI is a special diagnostic study that uses strong magnetic fields to visualize bony and soft tissue structures. MRI creates images of bone, muscle, tendons, ligaments and all other soft tissues. to see if your rotator cuff is torn. If bursitis is suspected, an MRI may show if there is fluid or inflammation in the bursae.

To treat your tendinitis and/or bursitis, your physician may suggest NSAIDs (def.)NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) These medications help reduce pain, fever and inflammation. to treat the pain and inflammation. It also may be advisable to modify some of the activities that caused your symptoms in the first place. Physical therapy may be helpful. Your physician also may suggest a corticosteroid injection (def.)Corticosteroids These anti-inflammatory drugs may be injected into the shoulder area to reduce inflammation. into the space above the rotator cuff to decrease painful symptoms and make physical therapy easier. If you have bursitis, sometimes your doctor may recommend removing the bursa fluid by a needle and syringe (aspiration).

Most tendinitis and bursitis can be managed without surgery. If symptoms are not well controlled with rest, medication, or injections, then surgery may be recommended to remove the inflamed bursa and bone spurs.

• Prepare for your doctor visit with the Shoulder Symptoms Checklist.

Over time, tendinitis and bursitis often go away by themselves. If the problem persists, check with your doctor for additional options, including surgery.

If you and your surgeon decide on surgery, your surgeon can advise you if the surgery can be done arthroscopically. This form of minimally invasive surgery allows your orthopaedic surgeon to see inside your shoulder and to carry out procedures through tiny incisions in your shoulder. Recovery time generally is faster.

Impingement syndrome, related to tendinitis and bursitis, also is one of the most common causes of pain in the shoulders of adults. It also can lead to further shoulder problems.

Here's what happens when you have impingement syndrome:

• Your rotator cuff and bursae become inflamed and thickened
• They can be compressed under the acromion (front edge of shoulder blade). This pinching of the rotator cuff is called "impingement" — giving the condition its name
• Sometimes a bone spur projection can cause the impingement problem

View an animation of impingement syndrome.

Impingement syndrome can become a chronic inflammatory condition that may lead to a weakening of your rotator cuff tendons. This may eventually result in a torn rotator cuff. Shoulder impingement syndrome also is closely related to shoulder instability, such as dislocation.

Diagnosing impingement syndrome is similar to the steps your doctor takes to diagnose tendinitis. Your physician will do a thorough physical examination of your shoulder and may ask you to go through certain movements, such as raising your arm above your shoulder. Your physician also may order x-rays to look at the front edge of your shoulder blade to check for calcium deposits — a condition called "calcific tendinitis." An MRI may be useful to show fluid or inflammation in the bursa or rotator cuff.

• Prepare for your doctor visit with the Shoulder Symptoms Checklist.

Initial treatment for an impinged shoulder usually includes rest, ice, and anti-inflammatory medications. Your physician also may recommend a corticosteroid injection.

If pain continues and your symptoms don't improve, your doctor may suggest surgery. The surgery is designed to remove any bone spurs that are "impinging" the rotator cuff. Inflamed bursae may also be removed.

• If you and your surgeon decide on surgery, your surgeon can advise you if the surgery can be done arthroscopically. This form of minimally invasive surgery allows your orthopaedic surgeon to see inside your shoulder and to carry out procedures through tiny incisions in your shoulder. Recovery time generally is faster.

Shoulder impingement may require more aggressive treatment if conservative management doesn't improve symptoms after several months of treatment. Your orthopaedic specialist (def.)Orthopaedic Surgeon (Orthopaedic Specialist) orthopaedic surgeon specializes in the diagnosis and treatment of disorders of the body's bones, joints, ligaments, muscles, and tendons (musculoskeletal disorders.) will advise you if surgery is necessary.