- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet.
- In our opinion, of course.
- Brad, how's it feel
to have the skeleton taller than you even?
(Brad laughs)
- You should talk about-
- Brad, look at this. Yep, I got him beat.
All right, today, Brad, we're gonna talk
about the differences - The shoulder.
- Yeah, between- Do you mind if I say it?
- Say it.
- Tendonitis, bursitis, and-
What's the last one?
- Capsulitis. - Right.
We actually had one of our viewers came with a question
on this very specific question.
We thought, "Why don't we show 'em?"
- Yeah.
- Give a real example of what we're talking about.
We're gonna use a shoulder joint.
You could have all these itises
at different joints in the body,
but we're gonna go to the shoulder
because it is a very common-
- What does itis mean?
- Inflammation.
That's what all three of these have in common.
There's inflammation in a different anatomical structure.
- Right, in the capsule, it's the capsule.
- In the- - Tendon, it's the tendon.
In the bursa, that's actually-
When the bursitis, it's a bursa.
- Right. - We'll talk about all three.
- Right.
Let's start out. We've got the-
- The tendon.
- The tendon here, the milo tendon on the shoulder.
Let's get this little red thing off there for now.
We'll get back to that. Let's look at the tendonitis.
- Muscle is up here.
It narrows up and becomes this tendon.
- Right. We're not doing an anatomically-
- I'm sorry. We're doing the bicep, aren't we?
- Right. - The bicep.
- The bicep muscles down here, but either way,
the tendon goes right through this groove.
The tendon's not black by the way,
but just so you can see it on the film.
- She attaches up in here.
- Yeah. (laughs)
- When things contract, you can see-
Can you see that Matt?
Can you see that tendon slide through there? Yep.
Now what happens when that works
and gets overworked is this tendon can get irritated,
and then it can get inflamed and there you get the itis.
- [Bob] Right. - If you continue to use it,
say you're doing a job in a factory
and it's one of those repetitive jobs,
and you have to get your work done,
obviously, until you go home,
you might irritate it like this throughout the day,
go home and hopefully gets better, then the next day,
you can ride it again.
That's tendonitis. The tendon-
- Really get roughened up.
They can go to the point you can actually sever it.
- Right, right. That's an extreme.
- Yep.
- The next one is we're gonna talk about the bursitis.
- Right.
- Now, the bursa.
There's bursa sacs throughout your whole body.
What they do is they lubricate a tendon, or ligament,
from wearing out as it rubs over the top of a bone.
This is may not be exactly how it is in your body,
but let's pretend this red piece
of tape represents a little bursa sac.
- Yeah.
- Bursa sacs are flat,
but they're have fluid inside of them.
They provide the lubricant, so when tendon would go back
and forth like this, or it could go this way,
but it protects and lubricates the tendon
from rubbing on the bone and wearing out.
- On the hard surface.
- Right. - Right.
What happens is the bursa can get inflamed,
and there's nerve endings in there when it gets inflamed
that starts pain.
It goes to your brain and it says, "Ouches!"
Which means, "You're overworking me.
Give this part of your body a break."
- Again, a small fluid-filled sack.
- Right.
- That protects you from the bone.
- It's getting inflamed and it's saying-
- It's a bursa. - Right.
- I had a patient once, says,
"Yeah, my shoulder's talking to me."
He says, "It's hurting. I need to stop."
That's what happened.
Your bursa is telling your brain, "It hurts."
- Shoulder bursitis is fairly common too by the way.
- Now, the next one is capsulitis.
Every joint in your body has a capsule as well.
- Yeah, it's a tough, fibrous ligament
that covers the whole bone like this,
and covers it up and protects it.
- It seals it right up.
- It seals it up. It contains the synovial fluid.
- Right. - Like you said, Brad.
- Which lubricates the joint.
- Right. Holds it in.
- To get a model for this, I got one of these balls.
You can see it's got this yellow fluid in there,
which represents the synovial fluid.
If it could take this
and put it right over the top of that shoulder,
that's a good representation of the capsule.
The tough, fibrous material it's made out of.
- [Bob] Right.
- That capsule can get irritated as well.
If you injure it, it can get some scar tissue on it
and then get irritated.
One way or another, it's gonna affect your shoulder range
of motion, and it's gonna be painful as well.
- Well, you hear frozen shoulder.
That often is because of the capsule,
but there's also capsulitis.
- Right.
- Sometimes, it happens for no reason.
They don't understand why it does happen.
The capsule gets infected.
That can last a year and a half,
and then it gets better.
- Right.
- It's just a mysterious thing that
they really don't understand why it starts sometimes.
- One way or another, we were talking about this,
is how do you treat it?
Whether it's capsulitis, bursitis, or tendonitis.
Oftentimes, if you've got pain in there,
it gets treated the same, particularly,
if you're taking like NSAIDs or ibuprofen.
- Right.
- It doesn't matter where the tissue is irritated,
because it goes throughout your whole system
and it gets at the proper tissue.
- You wanna take some type of anti-inflammatory
usually a doctor's gonna recommend.
- Right.
With a therapist, do we have specific exercises
for bursitis versus tendonitis?
Typically not.
- Typically, not a lot of the same things we're gonna do.
We're gonna stress the tissues without irritating them.
- Strengthen the muscles around it.
Maintaining range of motion.
It's really all the same.
- Sometimes, it's hard to distinguish
which one it specifically is.
Is it a bursitis versus tendonitis?
- Right.
- We don't always know.
We just go by how the symptoms respond.
- Right.
We don't always admit that,
'cause patients really like to know-
- What they wanna have specific answers.
- Or another, but if you ask the doctor, the therapist,
in a dark room.
- Yeah.
- If they knew a 100%, sure, they'd say-
- With a light on their face.
- Yeah, they'd say, "No, it's just a pretty good guess."
- It could be that you have both.
- Right.
- Or more than one I should say.
- One way or another, they're gonna get you better.
- Right. That's exactly right.
- This is a whole complicated-
This is almost as hard as fixing a broken heart, Bob.
- I don't know if anything's that hard, Brad, but we'll try.
- Take care. - If you have one. (laughs)