Bursitis and Tendinitis: How to Tell Them Apart and Treat Them Right

Ever had pain around your shoulder, elbow, or knee that just won’t go away? You might think it’s just a strain. But if it lingers for weeks, gets worse with movement, or wakes you up at night, it could be bursitis or tendinitis - two common but often confused joint problems. They’re not the same thing, and treating them the wrong way can make things worse.

What’s the Difference Between Bursitis and Tendinitis?

Bursitis is inflammation of a bursa. These are tiny, fluid-filled sacs that act like cushions between bones and tendons or muscles. There are about 160 of them in your body, and they’re especially important where movement happens - like your shoulder, hip, knee, and elbow. When a bursa gets irritated from repeated pressure or motion, it swells up and hurts. You’ll feel a dull ache around the joint, and it often feels worse when you lie on the affected area at night.

Tendinitis, on the other hand, is inflammation of a tendon - the tough, fibrous tissue that connects muscle to bone. Think of your Achilles tendon at the back of your ankle or the rotator cuff tendons in your shoulder. When these get overused, they develop tiny tears and become inflamed. The pain usually follows the path of the tendon and spikes during specific movements - like lifting your arm, reaching behind you, or pushing off with your foot.

Here’s the catch: they often happen together. In fact, about 65% of shoulder pain cases involve both the rotator cuff tendon and the subacromial bursa. That’s why so many people get misdiagnosed. If your doctor assumes it’s just tendinitis and gives you strengthening exercises, but you actually have bursitis, those exercises can make the swelling worse.

Where Do These Problems Usually Show Up?

Some spots are way more prone to trouble than others. For bursitis, the most common culprits are:

• Shoulder - subacromial bursa, often from overhead lifting or reaching
• Elbow - olecranon bursa, nicknamed "student’s elbow" from leaning on desks
• Knee - prepatellar bursa, common in carpet layers or gardeners who kneel
• Hip - trochanteric bursa, especially in women over 40

For tendinitis, the usual suspects are:

• Shoulder - rotator cuff tendons, especially with repetitive overhead motion
• Elbow - tennis elbow (lateral epicondylitis) or golfer’s elbow (medial epicondylitis)
• Knee - patellar tendon, often called "jumper’s knee"
• Ankle - Achilles tendon, common in runners and people who suddenly increase activity

Over 30 million outpatient visits in the U.S. each year are for tendinitis alone. And bursitis sends about 1.7 million people to the doctor. Most of them are over 40. That’s because tendons and bursae lose their elasticity and resilience as we age. But it’s not just older adults. Musicians, construction workers, and even office workers who type all day are at risk.

How Do You Know Which One You Have?

Doctors don’t just guess. They look for specific signs.

With bursitis, you’ll usually feel:

• Swelling that looks like a soft lump around the joint
• Pain that gets worse when you press directly on the area
• Discomfort that’s worse at night, especially if you lie on the side
• Less pain when you move the joint gently - the pain is more about pressure than motion

With tendinitis, you’ll notice:

• Pain that follows the exact line of the tendon
• Sharp pain when you use the muscle attached to that tendon - like lifting your arm or standing on your toes
• Stiffness in the morning that improves with movement
• A creaking or crackling feeling (crepitus) when you move the joint

Ultrasound is the most accurate tool for telling them apart - it shows swelling in the bursa or tiny tears in the tendon. MRI can help too, but it’s expensive and often overused. A 2022 study found that 40% of people over 50 show signs of bursitis or tendinitis on MRI - even if they feel no pain at all. That’s why diagnosis isn’t just about images. It’s about matching the pain pattern to the movement.

What Actually Works for Treatment?

The good news? Most cases get better without surgery. Less than 5% of people need an operation.

First-line treatment for both is the same: rest, ice, and avoiding the motion that hurts. But here’s where they split apart.

Bursitis responds well to:

• Corticosteroid injections - these reduce swelling fast. Studies show 78% of people feel better within four weeks.
• Ice massage - rolling a frozen water bottle over the area for 10 minutes, 3 times a day, helps reduce inflammation.
• Padding - if you kneel a lot, use knee pads. If you sleep on your side, put a pillow between your legs to take pressure off your hip.

Tendinitis needs a different approach:

• Eccentric strengthening - this is the gold standard. For Achilles tendinitis, that means slow heel drops: stand on a step, rise up on both feet, then lower down slowly on just the injured foot. Do 180 reps a day for 12 weeks. Sounds extreme? It works - 68% of people report lasting improvement.
• Physical therapy - not just stretching. A good therapist will retrain how you move to stop putting stress on the tendon.
• Avoiding cortisone shots - injecting a tendon can weaken it. Only do this if other options fail, and never more than twice a year.

NSAIDs like ibuprofen can help with pain and swelling, but don’t take them longer than 10-14 days. They don’t fix the root problem and can hurt your stomach or kidneys if overused.

What to Avoid - The Big Mistakes

People make the same mistakes over and over.

• Doing stretches too early - if you have acute bursitis, stretching can flare it up. Wait until swelling goes down.
• Ignoring pain levels - if an exercise hurts more than 3 out of 10, you’re pushing too hard. Pain above that level means damage, not progress.
• Self-diagnosing as "tendonitis" - 68% of people who think they have rotator cuff tendinitis actually have bursitis. Don’t assume. Get checked.
• Waiting too long to act - untreated tendinitis can lead to a full tear. Bursitis can become chronic and turn into a thickened, scarred sac that’s hard to treat.

One study found that people who got the wrong treatment took 3.2 times longer to recover. That’s over 18 weeks instead of under 6. Don’t let that be you.

Real People, Real Results

On Reddit, one user with chronic shoulder pain thought it was rotator cuff tendinitis. He did stretches for months - nothing changed. Then he saw a physical therapist who used ultrasound and found the bursa was swollen. He got one cortisone shot, stopped overhead lifting for six weeks, and used ice packs daily. His pain dropped from 8/10 to 1/10 in three weeks.

Another person with Achilles tendinitis tried rest and NSAIDs. It didn’t help. Then he started Alfredson’s eccentric heel drops. He did them every day, even when it hurt. After 27 weeks, he could run again. He tracked his progress using a simple questionnaire - and saw real improvement each month.

Workplace changes matter too. One office worker with elbow pain realized she was resting her forearm on the desk while typing. She switched to a vertical mouse and adjusted her chair height. Her pain vanished in three weeks.

When to See a Doctor

You don’t need to rush to the ER. But call your doctor if:

• The pain lasts more than two weeks despite rest and ice
• You notice redness, warmth, or fever - that could mean infection
• You can’t move the joint at all
• You’ve had two or more episodes in the same spot

Most primary care doctors can handle the basics. For stubborn cases, look for a sports medicine specialist or a physical therapist certified in orthopedics. They know the difference between inflammation and degeneration - and they won’t push you into a shot or surgery too soon.

The Future: Better Tools, Smarter Care

New tech is making diagnosis and treatment more precise. Ultrasound-guided injections are now standard - they’re accurate 95% of the time, compared to 70% with the old "feel it out" method.

Platelet-rich plasma (PRP) injections are showing promise for chronic tendinitis. One 2023 study found PRP worked better than cortisone after six months - though it costs more ($850 vs. $120). It’s not covered by all insurance yet.

Wearable tech like the Apple Watch is starting to help too. Stanford’s pilot study showed it can detect risky movement patterns before pain even starts. Imagine getting a notification: "You’ve been leaning on your elbow 120 times today. Take a break."

And research is moving away from the term "tendinitis." Many experts now say "tendinopathy" - because often, there’s no active inflammation. Just worn-out tissue. That changes how we treat it. Instead of fighting inflammation, we rebuild strength.

Bottom Line

Bursitis and tendinitis aren’t just "joint pain." They’re specific conditions with different causes, symptoms, and treatments. Mixing them up wastes time and makes recovery slower. If you’ve had pain for more than a couple of weeks, get it checked. Don’t rely on Google. Use the right tools - ice, rest, movement modification, and targeted rehab. And remember: the goal isn’t to push through pain. It’s to heal properly so it doesn’t come back.