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What is knee bursitis?
Bursitis is the medical term for inflammation of a bursa.
This is a small, closed sac containing synovial fluid that has the task of promoting the sliding movement of tendons, ligaments and skin. When the bursa is inflamed, the production of sinovial fluid
increases , causing it to increase in volume until a blister a few centimeters in diameter forms.
Sometimes some of the blood vessels in the bursa are injured and leak blood into the sac, creating a bruise; this happens in hemorrhagic bursitis. Bursitis can occur in the right or left knee with equal probability, and children are rarely affected.
The bursae, which are easily inflamed, are located in the knee, shoulder , elbow , and hip. There are five bursae in the knee area :
- The bursa prepatellaris is located between the kneecap and the skin, it is the knee bursa most often affected by inflammation;
- the bursa of the goosefoot (pes anserinus) lies on the inner surface of the knee between the tendons of the slender, sartorial, and semitendon muscles;
- the subcutaneous infrapatellar bursa is in front of the patellar ligament;
- the deep infrapatellar bursa is positioned between the patellar ligament and the fat pad of the knee joint (corpus adiposum infrapatellare);
- the bursa of the semimembranous muscle is located in the medial knee area above the goose foot.
Inflammation-related bursitis is the most common and can be broken down as follows:
- due to overuse or prolonged irritation when it occurs as a result of repetitive, unnatural movements;
- chemical when caused by certain substances;
- septic if caused by infection .
What are the causes of knee bursitis?
A bursitis on the knee can be caused by a constant pressure stimulus, a direct trauma ( bruise ), repetitive minor injuries (microtraumatization) or continuous, monotonous movements.
Inflammation of the bursa at the knee is also known as “housemaid’s knee” because in the past the floor was cleaned lying on the knees, with the weight on the kneecap and thus on the prepatellar bursa.
In general it can be said that certain professional groups such as tilers and carpenters are prone to bursitis due to their kneeling posture.
Another risk group are athletes who play high-impact sports such as rugby, soccer, football, volleyball and martial arts, especially when there is a risk of falling to their knees.
Inflammation of the goosefoot or semimembranous bursa is caused by functional overload. Factors that promote bursitis are rheumatic diseases, such as rheumatoid arthritis and gout , and diabetes .
What Are the Symptoms of Knee Bursitis?
Symptoms of knee bursitis include: pain , limping, disability, and stiffness.
The patient complains of very intense, knife-like pain. External signs: swelling (due to the increase in synovial fluid); if the inflammation is accompanied by an infection, the knee will be red and overheated.
The swelling (intumescence) can be significant and appear like a ball lodged in front of the knee.
Hemorrhagic bursitis is characterized by a clearly visible bruise.
Symptoms worsen when pressure is applied to the bursa or when the knee bends/extends.
Septic bursitis can cause fever , and a wound that caused the infection is usually found.
Which diagnostic methods are useful for bursitis on the knee?
A clinical examination with assessment and palpation of the pain area as well as an anamnesis interview is usually sufficient to make the diagnosis of knee bursitis.
In some cases, the doctor also prescribes an X-ray to rule out changes and injuries to the bone structures.
The definitive confirmation is a musculoskeletal ultrasound , which shows the soft tissues: muscles, tendons, ligaments, bursa, etc.
The doctor may also perform laboratory tests and have the bursal fluid analyzed.
How is knee bursitis diagnosed?
The doctor feels the inflamed area, examines the medical history, performs muscle tests and looks for typical signs of the disease.
If he deems it useful, he will also order imaging procedures (ultrasound, X-ray ) and laboratory tests ( blood test and analysis of bursal fluid).
A bone fracture or contusion with bruising should also be considered in the differential diagnosis, but in the latter case the symptoms are different because the range of motion is not restricted.
The family doctor can refer the patient to an orthopedist who will make the diagnosis and initiate therapy.
Fluid aspiration is done for confirmation or as a therapeutic measure if infection is suspected.
What treatment is suitable for knee bursitis?
The therapy depends on the type of bursitis.
In any case, cold treatment ( ice or cold packs) should be carried out as soon as the disease occurs in order to prevent the inflammation from getting worse. It is sufficient to apply ice/cold packs 3 times a day for 20 minutes each time.
Natural remedies for mild knee bursitis include green clay; Moisten with water and apply to the swollen area (leak time at least 30 minutes). You can also use arnica ointment.
Irrespective of whether the bursitis is hemorrhagic, traumatic or due to overuse, treatment takes the form of rest and cold therapy; it also makes sense to protect the knee area with knee pads to avoid further trauma. Possible forms of therapy:
- anti-inflammatory drugs (NSAIDs);
- local cortisone infiltration after aspiration of the bursa fluid;
- Physiotherapy with laser and shock wave therapy ;
If these treatment methods prove to be insufficient, the last alternative is surgery: the orthopedic surgeon will clean and, if necessary, remove the bursa.
The procedure consists of making an incision in the skin above the bursa and removing it completely.
The operation is performed under local anesthesia ; the patient is hospitalized for one night. Treatment for septic bursitis is treatment of the infection with antibiotics .
How long does the inflammation last? When does the healing take place?
The healing times depend on the cause of the disease. If infected, the patient should have recovered by the end of antibiotic treatment.
If there is a traumatic cause, but the bursitis is neither hemorrhagic nor infected, it can take a long time to heal without proper treatment, and the inflammation can become chronic and last longer than a year.
How can knee bursitis be prevented from recurring?
Preventive measures consist of avoiding situations that can cause bursitis; if you kneel on the floor a lot, you should use a soft support such as a cushion to pad.
Sporting activities and activities that involve performing repetitive movements over a long period of time should be reduced to a minimum. Allowed sports include swimming and cycling (if doing so does not cause pain).
