Knee Bursitis FAQ’s
What is Bursitis of the Knee?
Bursitis of the knee is inflammation of small collections of fluid in and around the knee joint known as bursae. These are normal anatomical findings and their purpose is to help facilitate fluid and smooth movement of tendons, muscles and fascia between one another and the knee joint. When these small pockets of fluid become inflamed, they will typically get larger and become tender. They may also cause pain with ambulation, weight bearing or even certain specific movements depending on the bursa affected.
What causes Bursitis in the Knee?
There are a great many different causes of knee bursitis that can range from the less serious such as idiopathic causes, underlying osteoarthritis, repetitive straining of the muscle or joint around which the bursa is located and simple muscle fatigue to the more serious such as infection, rhabdomyolysis, local trauma and potentially even undiagnosed malignancy. Fortunately, the most serious causes are exceptionally rare and the vast majority of bursitis cases are caused by less serious diagnoses.
What are the symptoms of Bursitis of the Knee?
Bursitis tends to present typically as pain in and around the knee. The pain is usually a burning sensation in nature, although it can be felt sharply in certain areas. The best way to differentiate bursitis pain from generalized muscle or joint pain such as from osteoarthritis is try and localize the pain to a specific area around the joint.
Pain that localizes to a specific area is much more likely to appear as a result of bursitis, especially if the area that is localized is known to have a bursa directly underneath the point of maximal tenderness (e.g. the pes anserine bursa, the prepatellar bursa). Osteoarthritis pain is much more generalized and far more difficult to localize with the patients typically describing this as more of a global sensation around the whole joint itself rather than pinpointing it to a specific spot.
Activity and weight bearing will typically worsen the pain experienced from bursitis, especially activity of the muscles that directly interact with or are directly adjacent to the culpable bursa. For example, a prepatellar bursitis will worsen with extension and flexion of the knee joint and activation of the quadriceps/hamstring mechanism whereas pes anserine bursitis will be specific to flexion of the knee, in particular the hamstrings, and be localized to the anteromedial aspect of the joint.
How to treat Bursitis of the Knee?
First line treatment for any kind of bursitis should be cessation of the offending activity for a short period of time. If the bursitis does not self-resolve when returning to said activity, then over-the-counter nonsteroidal antiinflammatory drugs should be trialed if the patient is able to tolerate them. These will fight against the inflammation that is present in the bursa and will reduce it, thereby reducing the patient’s pain.
If this is not effective or only effective for a short period of time, the next line of treatment would be to trial a corticosteroid injection directly into the bursa itself. This is typically not necessary in the majority of patients and is reserved only for those who have symptoms refractory to activity modification and oral or topical antiinflammatory drugs.
For patients with persistent bursitis that is refractory to all of the aforementioned, there is a surgical option to undergo a bursectomy, although this is rarely performed and is typically not necessary due to the very small number of patients who do not respond to any of the aforementioned interventions.
How long does Knee Bursitis take to heal?
Most patients should notice that the bursitis settles down within several weeks, whether this is due to the activity modification or whether this is due to the commencement of a course of antiinflammatory medication. If neither of these are effective after 3 or 4 weeks then consideration of an injection should be given.
If the patient does wish to proceed with injection as an intervention then typically these injections will take several days to become effective and should provide significant pain relief that will hopefully be semi-permanent in nature (i.e. may very well relieve the pain in its entirety, although there is a small risk that the bursitis will return with repeated activity in the future).
Knee bursitis is an exceptionally common complaint around the knee joint and is typically not due to any serious cause and mostly self-limiting. Cases that do not self-resolve should be treated first with activity modification and then with an anti inflammatory medication trial. More refractory cases may require one or more injections directly into the bursa itself and on very rare occasions, some patients require surgical excision of the bursa if the symptoms have been completely refractory to all of the aforementioned nonsurgical treatments.
If you think you may be suffering from knee bursitis, call and arrange an appointment with one of our specialist orthopedic surgeons who will be happy to confirm the diagnosis and discuss your treatment options with you.