Knee Bursitis
Knee pain is common, but when it becomes severe enough to disrupt your daily activities or is accompanied by swelling, tenderness, or inflammation, seeking medical attention is essential. One potential cause of knee pain is knee bursitis, an inflammation of the bursa, small fluid-filled sacs that cushion the knee joint. Knee bursitis can be caused by overuse, trauma, or other underlying conditions and can be quite debilitating if not addressed promptly. At Complete Orthopedics, our expert team specializes in diagnosing and treating knee bursitis, offering both non-surgical and surgical interventions when necessary.
How Common It Is and Who Gets It? (Epidemiology)
Knee bursitis is a common condition, particularly among individuals who engage in physical activities that involve repetitive movements of the knee, such as running, cycling, or kneeling. It can affect people of all ages but is more prevalent in those over 40, particularly athletes or people with occupations that involve frequent knee use. Bursitis can also be more common in individuals with certain risk factors, such as those with arthritis, obesity, or a history of knee trauma.
Why It Happens – Causes (Etiology and Pathophysiology)
Knee bursitis is caused by inflammation of one or more of the bursae around the knee. The primary causes include:
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Overuse: Repetitive movements, such as running or cycling, can irritate the bursa, leading to inflammation.
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Trauma: A direct blow or injury to the knee can cause swelling and irritation of the bursa.
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Underlying Conditions: Conditions such as osteoarthritis, rheumatoid arthritis, or gout can increase the risk of bursitis by affecting the knee joint.
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Infection: In rare cases, the bursa can become infected, leading to septic bursitis.
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Poor Biomechanics: Improper movement patterns or muscle imbalances can place excessive pressure on the bursa.
How the Body Part Normally Works? (Relevant Anatomy)
The knee is a hinge joint that consists of three main bones: the femur (thigh bone), tibia (shin bone), and patella (kneecap). The bones are covered with articular cartilage to ensure smooth movement. Around the knee joint, there are several bursae—small, fluid-filled sacs that reduce friction and cushion the knee during movement. The most commonly affected bursae in knee bursitis are:
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Prepatellar Bursa: Located in front of the kneecap.
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Infrapatellar Bursa: Below the kneecap.
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Pes Anserine Bursa: On the inner side of the knee, near the shinbone.
What You Might Feel – Symptoms (Clinical Presentation)
The primary symptom of knee bursitis is localized pain around the affected bursa. Other symptoms may include:
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Swelling: The knee may appear enlarged, and the skin over the knee may feel warm to the touch.
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Tenderness: Pain is typically worse when pressure is applied directly over the affected bursa.
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Pain during movement: Activities such as bending or straightening the knee may worsen the pain. Certain movements, like going up or down stairs, may exacerbate the symptoms.
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Snapping or Popping: Some individuals report a snapping or popping sensation over the affected area as they move the knee.
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Difficulty with Knee Movements: The pain and swelling can lead to stiffness and difficulty performing daily activities, such as walking or standing for extended periods.
How Doctors Find the Problem? (Diagnosis and Imaging)
To diagnose knee bursitis, a doctor will:
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Physical Examination: The physician will assess the knee for swelling, tenderness, and warmth, and test the knee’s range of motion.
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Clinical Tests: Specific tests, such as the Ober Test and Noble Compression Test, may be performed to identify tightness in the iliotibial band and inflammation in the bursa.
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Imaging: X-rays can help rule out bone fractures or arthritis. MRI and ultrasound are useful for visualizing soft tissue inflammation in the bursa and assessing the severity of the condition.
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Aspiration: If the bursa is filled with fluid, a needle may be used to withdraw the fluid for analysis, especially if infection is suspected.
Classification
Knee bursitis can be classified based on its severity:
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Mild: Occasional pain and slight swelling, often alleviated with rest and over-the-counter medications.
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Moderate: Pain and swelling that persists and may affect mobility, requiring physical therapy or steroid injections.
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Severe: Persistent, disabling pain and swelling, potentially accompanied by infection, requiring surgical intervention.
Other Problems That Can Feel Similar (Differential Diagnosis)
Several conditions can mimic the symptoms of knee bursitis, including:
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Osteoarthritis: Generalized knee pain and stiffness due to cartilage degeneration.
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Patellofemoral Pain Syndrome: Pain around the kneecap, often exacerbated by activity.
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Meniscal Tears: Tears in the knee cartilage may cause pain, clicking, and swelling.
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Tendonitis: Inflammation of the tendons around the knee can cause pain and swelling, similar to bursitis.
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Infections: Septic bursitis or other knee infections may present with similar symptoms but require different treatments.
Treatment Options
Non-Surgical Care
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Rest and Activity Modification: Avoiding activities that aggravate the knee, such as running or kneeling, can help reduce inflammation and promote healing.
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Ice Therapy: Applying ice to the knee for 15-20 minutes several times a day helps reduce swelling and pain.
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NSAIDs: Non-steroidal anti-inflammatory drugs like ibuprofen or naproxen can reduce pain and inflammation.
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Physical Therapy: Exercises to strengthen the muscles around the knee and improve flexibility can help prevent future flare-ups of bursitis.
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Corticosteroid Injections: In cases of severe pain, an injection of corticosteroids directly into the bursa may provide significant relief.
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Aspiration: Fluid removal from the bursa using a needle can alleviate swelling and pain if there is excess fluid buildup.
Surgical Care
In rare cases, if conservative treatments fail to relieve symptoms, surgical intervention may be necessary:
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Bursectomy: Surgical removal of the inflamed bursa is typically reserved for chronic cases that don’t respond to other treatments.
Recovery and What to Expect After Treatment
Recovery from knee bursitis depends on the severity of the condition and the treatment provided:
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Initial Phase (0-2 Weeks): Rest, ice therapy, and medications to reduce pain and swelling.
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Rehabilitation (2-6 Weeks): Physical therapy exercises to strengthen the knee and improve flexibility.
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Gradual Return to Activity: Once symptoms subside, activities can be slowly reintroduced, starting with low-impact exercises.
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Full Recovery: Most patients recover fully within 4-6 weeks, though chronic cases may require longer treatment and follow-up.
Possible Risks or Side Effects (Complications)
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Infection: If bursitis is caused by an infection (septic bursitis), it can spread and cause more serious issues.
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Chronic Pain: In rare cases, bursitis can become chronic, requiring ongoing management.
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Recurrent Inflammation: Without proper management, bursitis may recur, especially in individuals with underlying risk factors like arthritis or overuse.
Long-Term Outlook (Prognosis)
The prognosis for knee bursitis is generally good, with most cases resolving with conservative treatments. Surgical intervention, though rare, is typically successful in providing relief for persistent or severe cases. With proper rehabilitation and activity modification, most individuals can return to their regular activities without significant long-term limitations.
Out-of-Pocket Costs
Medicare
CPT Code 20610 – Aspiration/Injection of Knee Bursa: $15.12
CPT Code 29870 – Arthroscopic Bursectomy (Knee): $131.77
CPT Code 27340 – Open Bursectomy (Prepatellar/Other Knee Bursa): $90.62
CPT Code 27345 – Open Bursectomy (Other Knee Bursa): $117.56
Under Medicare, 80% of the approved amount for these procedures is covered once your annual deductible has been met. The remaining 20% is typically the patient’s responsibility. Supplemental insurance plans—such as Medigap, AARP, or Blue Cross Blue Shield—typically cover this 20%, leaving most patients with little to no out-of-pocket expenses for Medicare-approved knee procedures. These supplemental plans coordinate directly with Medicare to provide full coverage for the procedure.
If you have secondary insurance—such as Employer-Based coverage, TRICARE, or Veterans Health Administration (VHA)—it functions as a secondary payer once Medicare processes the claim. After your deductible is satisfied, these secondary plans may cover any remaining balance, including coinsurance or small residual charges. Secondary plans typically have a modest deductible, usually between $100 and $300, depending on the specific policy and network status.
Workers’ Compensation
If your knee bursa procedure is work-related, Workers’ Compensation will fully cover all treatment-related costs, including surgery, hospitalization, and rehabilitation. You will have no out-of-pocket expenses under an accepted Workers’ Compensation claim.
No-Fault Insurance
If your knee injury resulting in these procedures is caused by a motor vehicle accident, No-Fault Insurance will cover all medical and surgical expenses, including aspiration/injection, arthroscopic bursectomy, and open bursectomy. The only possible out-of-pocket cost may be a small deductible depending on your individual policy terms.
Example
John, a 60-year-old patient with prepatellar bursitis, underwent aspiration/injection of the knee bursa (CPT 20610) and later required arthroscopic bursectomy (CPT 29870). His estimated Medicare out-of-pocket cost was $15.12 for the aspiration and $131.77 for the arthroscopic surgery. Since John had supplemental insurance through Blue Cross Blue Shield, the 20% that Medicare did not cover was fully paid, leaving him with no out-of-pocket expenses for the procedures.
Frequently Asked Questions (FAQ)
Q. What causes knee bursitis?
A. Knee bursitis is caused by inflammation of the bursa, typically due to overuse, trauma, or underlying conditions like arthritis.
Q. How is knee bursitis treated?
A. Treatment includes rest, ice therapy, anti-inflammatory medications, physical therapy, and in some cases, corticosteroid injections or surgery.
Q. Can knee bursitis be prevented?
A. Preventative measures include avoiding repetitive knee movements, using proper footwear, and maintaining a healthy weight.
Summary and Takeaway
Knee bursitis is a treatable condition that typically responds well to conservative care, including rest, ice, and physical therapy. Early intervention can prevent it from becoming a chronic issue. If you’re experiencing persistent knee pain, seeking professional medical advice is crucial to determine the most appropriate treatment.
Clinical Insight & Recent Findings
A recent study examined the effectiveness of both conservative and surgical treatments for prepatellar bursitis, a common knee condition, particularly in individuals with occupations or hobbies involving repetitive kneeling.
The review highlighted the multifactorial causes of the condition, including trauma, infection, and underlying conditions such as gout or rheumatoid arthritis. Conservative treatments, including rest, ice, physical therapy, and anti-inflammatory medications, were found to be effective in most cases.
However, in more severe or persistent instances, surgical options such as bursectomy or endoscopic excision may be necessary. The study emphasizes the importance of an interprofessional approach, including physical therapists and orthopedic specialists, to optimize patient care. (“Study of prepatellar bursitis management – See PubMed.“)
Who Performs This Treatment? (Specialists and Team Involved)
Orthopedic surgeons, physical therapists, and sports medicine specialists are involved in diagnosing and treating knee bursitis.
When to See a Specialist?
If your knee pain persists despite rest or worsens with activity, it is important to consult with an orthopedic specialist for evaluation and treatment options.
When to Go to the Emergency Room?
Seek emergency care if you notice signs of infection, such as fever or increased redness and warmth around the knee joint.
What Recovery Really Looks Like?
Recovery typically takes 4-6 weeks with proper treatment, including physical therapy and activity modification.
What Happens If You Ignore It?
Ignoring knee bursitis can lead to chronic pain, swelling, and possibly the need for surgical intervention.
How to Prevent It?
Prevent ITBS by gradually increasing activity intensity, using proper techniques, and maintaining strong muscles around the knee to reduce the risk of strain and injury.
Nutrition and Bone or Joint Health
A balanced diet rich in calcium and vitamin D supports joint health and reduces the risk of bursitis and other joint issues.
Activity and Lifestyle Modifications
Incorporate stretching and strengthening exercises into your routine to improve knee function and flexibility.
Do you have more questions?
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).
How many bursas are there in the knee?
There are multiple bursas around the knee. The most important of them are the prepatellar bursa, infrapatellar bursa and pes anserine bursa. These are most commonly involved in the inflammation and the swelling. They can be caused due to daily activities like kneeling or may be caused due to pathology in the knee leading to bad biomechanics around the knee.
They can be treated usually with RICE that is rest, ice, compression and elevation along with anti-inflammatory medications. They can also be treated with cortisone shot if not improved. The patient should see a physician if the pain is not relieved with over-the-counter medications.
Can you get gout in the knee?
Gout can affect multiple joints of the body and knee and ankle are among the common ones that can be involved. Gout is usually treated with medications which is provided by the primary care physician. If the knee is severely involved and is not relieved with medications, then the patient should seek treatment with a sports physician.
What is pes bursitis of the knee?
Pes bursitis or pes anserine bursitis or goose foot bursitis of the knee is an inflammation of the bursa around the three tendons on the inner side of the knee. This happens usually due to bad biomechanics of the knee particularly in osteoarthritis of the knee. It can be treated with medications along with rest, ice, compression and elevation.
If the pain is not relieved with over-the-counter medications and conservative measures, then the patient should seek physician attention. They can get cortisone injection also in the knee. Occasionally pes bursitis may be caused due to pathology inside the knee which may need attention and management.
Can knee bursitis be cured?
Knee bursitis can usually be cured with conservative means including medication and cortisone injection. Mostly patients with bursitis get good relief with these measures.
What is bursitis of the knee feel like?
Bursitis of the knee usually presents with localized pain along with swelling which may or may not be worsen with activity. It may affect the gait of the patient.
Is knee brace good for bursitis?
Knee brace can be used in patients with bursitis as it gives compression and thereby decreases the swelling and the pain due to bursitis. It can prevent recurrence of bursitits.
Is heat or cold better for bursitis?
In acute onset cases ice is better for the first two to three days to relieve pain. If the bursitis is longstanding, then heat usually gives better results than ice. In some cases, patients may have preferential benefit with ice and heat and should try using that.
How do you treat bursitis of the knee?
Bursitis of the knee is usually treated with anti-inflammatory medications along with compression with sleeve. The patient can also use physical modality like ice or heat to relieve pain. If the pain is not improved with these measures, then prescription medication as well as cortisone injection with or without aspiration can help in decreasing the pain and swelling.
What is patellar bursitis?
Patellar bursitis is the inflammation of the bursa in the front of the knee cap. It is usually found in people who are involved in kneeling activities like housemaids, technicians, plumbers. It presents with pain and swelling in the front of the knee cap. It is usually treated with compression and anti-inflammatory along with ice or heat. If the patient is not relieved, then the fluid from the bursa can be aspirated and the cortisone injection can be given which may help in early healing of the bursitis. The patients are also asked to avoid activities lie kneeling that may cause recurrence of the bursa.
Is bursitis a form of arthritis?
Bursitis is not a form of arthritis but may be caused as a secondary presentation of arthritis. Most of the times when arthritis is controlled, bursitis usually resolves itself.
What is septic bursitis?
Septic bursitis means inflammation of the bursa caused due to micro-organisms like bacteria. It presents with pain, swelling, redness, and may also have fever and chills. These patients should seek urgent attention for management. The patient may need antibiotic according to the sensitivity. The patient may need surgical treatment to clean up the bursa and eradicate the infection.
What is the function of bursa?
Bursa is usually present between the skin and the bone to allow easy gliding of the skin over the bone due to the fluid filled in the bursa. This fluid is in minimal quantity and allows proper gliding of the skin or the bone. It is present in all places where the bone is directly underneath the skin.
Can the bursal sac be removed surgically?
The bursal sac can be removed surgically in patients who have recurrent bursitis or have septic arthritis and are not improved with medication. This procedure is called bursectomy and has a good success rate.
Is there risk in removing the bursa?
The risks for removing a bursa are usually the same as of any minor surgery. Occasionally the patient may have recurrence of the bursa and may need prolonged treatment for the management.
What is the bump below my knee?
A bony bump just below the knee usually is a tibial tuberosity where the patellar tendon from the knee cap inserts. It acts as a point of stress because all the forces from quadriceps are passed through the patellar tendon on to the leg. It may be enlarged in patients of Osgood-Schlatter disease in which there is hypertrophy of the tibial tuberosity which is usually found in teenagers.
What is the Housewives knee?
Housewives knee or Housemaid’s knee is usually the inflammation of the prepatellar bursa. These patients are involved in kneeling activities due to their profession or work and have caused inflammation and irritation of the prepatellar bursa causing it to be inflamed.
What is the Baker’s cyst on the back of the knee?
Baker’s cyst is outpouching of the synovial lining of the knee joint. Occasionally when the patient has fluid in the knee, the fluid may track outside into this outpouching causing it to collect the fluid and swell up that can be felt as a soft swelling of the back of the knee. It is usually treated by the management of the pathology that causes the formation of the fluid as well as aspiration of the fluid from the knee joint. Rarely the Baker’s cyst just needs a surgery to remove it.
What is infrapatellar bursitis?
Infrapatellar bursitis is inflammation of the bursa that is present below the knee joint. This bursitis is also called clergyman bursitis and is usually found in clergies due to the way that they stand on their knees.
Can I work out while having knee bursitis?
Knee bursitis if under control or being managed actively by physician can allow the patient to gentle workouts. The patient can involve in exercises which are not worsening the pain and swelling of the knee. If any specific exercise worsens the pain, then it should be avoided.
How effective are cortisone shots for pes anserine bursitis of the knee?
Cortisone shots do help in decreasing the pain and swelling of the pes anserine bursitis of the knee. Most of the time the bursitis is secondary to pathology inside the knee which may also need to be taken care so as to prevent the recurrence of the bursitis.
Dr. Mo Athar
