Knee Bursitis

Bursae are small fluid-filled sacs that aid in the smooth gliding of various tissues over one another. There are eleven bursae around the knee joint. Knee bursitis is an inflammation of the bursae surrounding the knee joint. The prepatellar bursae and the infrapatellar bursae are most commonly involved in bursitis.

The prepatellar bursa is located in front of the knee joint. The bursa is present above the kneecap and helps in the smooth gliding of the skin and other soft tissues. The bursa is frequently irritated on activities involving kneeling on hard surfaces.

The infrapatellar bursa is present between the patellar tendon and the upper part of the shinbone. The patellar tendon is present in front of the knee attaching to the shinbone and helps to straighten the leg. The pes anserine bursa is present on the inner side of the knee just below the joint.

Knee bursitis is a common medical condition causing undue pain and swelling. It is commonly associated with certain occupations and activities. The treatment generally involves home remedies or medications/injections prescribed by a doctor.

Causes & Risk Factors

Occupations involving frequent bending and kneeling on hard surfaces such as carpet layers are especially vulnerable to develop prepatellar bursitis. Other professions such as gardeners, mechanics, plumbers who kneel on hard surfaces for extended periods of time may develop knee bursitis. Prepatellar bursitis is also known as housemaids bursitis.

Certain sports involving chronic and repetitive motion about the knee may develop bursitis. Athletes involved in wrestling, volleyball, and football are vulnerable to develop knee bursitis. These sports mostly may involve frequent falls and trauma to the knee. Long-distance runners may develop knee bursitis due to chronic overuse and fluid collection in the bursae.

Obese middle-aged women may develop pes anserine bursitis causing pain and tenderness on the inner aspect of the knee. Infrapatellar bursitis is also known as clergyman’s bursitis is also common among people who kneel on hard surfaces.

A direct blow or trauma to the knee may result in rapidly developing bursitis. The development of bursitis in trauma is secondary due to the collection of blood in the bursa. Rarely, an infection of the bursa may result in acute septic bursitis.

Arthritis of the knee joint such as osteoarthritis, rheumatoid arthritis, gout or pseudogout. Bursitis in inflammatory or degenerative arthritis is due to collection of fluid in the bursae around the knee.

Symptoms

The symptoms of bursitis are variable depending upon the location of the bursa and the underlying cause of bursitis. In general, most patients report knee pain located to the affected area which is increased on activity.

The knee pain may also be present on rest and is associated with swelling. The affected side of the knee may become warm and swollen. There may be a pain in trying to press the swelling. The pain is increased on trying to bend or extend the knee joint.

Diagnosis

The doctor may take a detailed history surrounding the events leading to bursitis and any concomitant medical diseases. The examination may involve testing the range of motion of the knee joint. The doctor may gently press on specific parts of the knee to illustrate tenderness. The doctor will assess the skin overlying the bursa for any redness or signs of infection.

The doctor will also examine the other knee to compare with the involved knee. The examination of the knee is mainly directed to pinpoint the source of the pain and rule out other injuries.

The doctor may request additional blood tests if an infection is suspected. Imaging studies such as x-ray, ultrasound or MRI may be done for additional information. Quite frequently, the physician may aspirate the swelling and send the aspirate for culture and sensitivity to rule out infection. The bursa aspiration may also be used as a part of treatment.

Management

Frequently the knee bursitis is aseptic or uninfected requiring only conservative management. Home remedies may work as well as the majority of bursitis gets better with time. Rest to the affected knee may reduce the discomfort.

Ice packs when applied for a couple of minutes several times a day is quite helpful to reduce inflammation. The use of compression bandages is recommended to reduce swelling. After knee aspiration, compression bandages help to prevent the recurrence of the swelling.

The doctor may prescribe analgesics in the form of anti-inflammatory drugs such as NSAIDS to help reduce pain and inflammation. The doctor may also advise physical therapy to improve range of motion and increase flexibility. Activities require frequent kneeling or overuse may have to be cut down. Patients are advised to wear knee braces are advised if kneeling is unavoidable.

Oral antibiotics are prescribed if infection of the bursa is suspected. The doctor may also inject a corticosteroid into the bursa to relieve inflammation and symptoms. Most patients have excellent recovery after the injection. The aspiration of the bursa is both diagnostic as well as therapeutic for bursitis.

The infected bursa may require an open incision and drainage. The bursa is removed and the overlying skin is closed with stitches. The removal of bursa does not interfere in the normal function of the knee joint, muscle, and tendons. Oral antibiotics are usually prescribed in the case of an infected bursa.

Outcome

he majority of patients experience excellent relief with the conservative management of knee bursitis. Very rarely, some patients require surgical treatment for infected bursitis. Reduction of weight and change of lifestyle to prevent irritation of the bursa may prevent repeat episodes of bursitis.