Soft tissue (non-articular) rheumatism: bursitis, tendinitis, fibromyalgia

1. Big picture

Soft tissue rheumatism means pain arising from structures around the joint, not primarily from the articular cartilage or synovial joint cavity. The most exam-relevant groups are:

1. Bursitis — inflammation of a bursa.
2. Tendinitis/tendinopathy/tenosynovitis — pain from tendon or tendon sheath pathology.
3. Fibromyalgia — chronic widespread pain due to altered pain processing, not tissue inflammation.

The key exam idea:

Localized soft tissue pain = think bursitis/tendinopathy. Widespread pain + fatigue + poor sleep + normal labs = think fibromyalgia.

Soft tissue rheumatism is common, often benign, but the examiner expects you to avoid three dangerous mistakes:

• Missing septic bursitis.
• Injecting steroid into/around a tendon when rupture risk is high.
• Misdiagnosing inflammatory disease, malignancy, endocrine disease, or myositis as fibromyalgia without checking red flags.

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