Knee bursitis

Bursitis of the knee joint is an inflammatory process in the prepatellar bursae (subcutaneous, subfascial and subtendinous).

The subcutaneous bursa is most often affected by the disease; bursitis is manifested by severe swelling of the joint and all the clinical signs of an inflammatory process.

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Causes of knee bursitis

The causes of bursitis of the knee joint are varied:

• various injuries, including soft tissue bruises, hematomas, sprains, microcracks, external knee injuries from various impacts, falls, active sports, as well as the lack of protective knee pads and other necessary equipment;
• the addition of a secondary infection from other nearby foci of the spread of purulent infection through the blood or lymph flow;
• long-term and constant vibration or mechanical impact on the joint, increased loads;
• as a complication of inflammatory processes in the knee joint (arthritis, gout);
• allergic manifestations of joint localization;
• disorders of the basic metabolism in the body;
• as a consequence of autoimmune diseases (systemic lupus erythematosus, rheumatism).

The knee joint is often subject to injury, especially when engaging in traumatic sports (football, skiing, hockey, etc.), so the likelihood of developing inflammatory processes in it is quite high.

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Symptoms of bursitis of the knee joint

Knee joint bursitis can have an acute, subacute, chronic and recurrent course. There is also a classification of inflammation depending on the type of pathogen: brucellosis, gonorrhea, syphilis, tuberculosis, streptococcal, etc.

The main symptoms of bursitis of the knee joint are a classic clinical picture of the inflammatory process, which includes:

• joint swelling, at first practically painless;
• the range of motion before the onset of pain is usually not impaired;
• hyperemia of the skin over the site of inflammation; local hyperthermia is noticeable upon palpation;
• disorder of joint motor activity is accompanied by the appearance of significant painful sensations;
• if the inflammatory process is of an infectious nature, signs of general intoxication of the body may be present: weakness, loss of appetite, fever, headache;
• If inflammation of the knee joint is a secondary disease, then an increase in symptoms of the underlying pathological process may be observed.

Acute bursitis of the knee joint

Acute bursitis of the knee joint is characterized by a sudden onset and a sharp increase in symptoms. First of all, it is necessary to note severe pain up to a burning sensation in the joint, especially when trying to bend and straighten the knee. Palpation over the lesion is especially painful, the pain radiates to the ankle and hip joint. Above the inflammation zone there is visible swelling up to 12 cm in diameter, pronounced hyperemia of the tissues, the skin is hot to the touch.

Acute bursitis usually occurs a short period of time after injury, and pathological damage is manifested by signs of an acute process in the walls of the synovial bursa.

In the initial stages, there is an accumulation of exudative fluid in the joint cavity, as well as serous impregnation of the surrounding tissues. The addition of bacterial microflora can contribute to suppuration of the lesion up to the formation of inflammatory fistulas, therefore, it is extremely important to start treatment of the acute form of the disease in time to prevent purulent complications.

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Chronic bursitis of the knee joint

Chronic bursitis of the knee joint is often a logical result of an ignored or insufficiently treated acute inflammatory process, or this disease develops against the background of constant vibration or mechanical impact on the joint.

Chronic bursitis is characterized by a latent (hidden) or sluggish and slowly progressive course, which can periodically worsen. During such periods of exacerbation, all the signs and characteristic symptoms of the acute form of the disease are clinically present.

A protracted process can provoke a significant increase in the effusion of exudative fluid into the cavity of the synovial bursa, which contributes to the development of cystic formations.

Chronic inflammation of the knee joint requires more serious, complex and long-term treatment, unlike the acute process. Sometimes the doctor has to resort to puncture of the inflammatory focus to aspirate the accumulated fluid and wash the cavity with antibacterial drugs.

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Suprapatellar bursitis of the knee joint

Suprapatellar bursitis of the knee joint is an inflammation in one of the synovial bags of the knee, namely in the suprapatellar bursa. It is sometimes called "patellar bursitis" or "monk's knee". The latter name is associated with one of the causes of this disease - prolonged kneeling.

Suprapatellar bursitis can also develop as a result of excessive strain on the knee joint: statistics claim that this type of bursitis is typical for almost all hockey goalies due to increased trauma to the knees from the puck and when falling on the ice.

A characteristic symptom of suprapatellar localization of the inflammatory process is a soft elastic swelling in the periarticular zone up to 12 cm in diameter, with a strict dislocation in the upper region of the knee.

The patellar bursa is one of the largest joint synovial bags in the knee. It serves as a joint protector, cushioning friction and impact. It is located above the upper pole of the patella.

Prepatellar bursitis of the knee joint

The prepatellar bursa is located subcutaneously, quite close to the surface, in the anterior part of the patellar region. Inflammatory phenomena in it develop as a type of protective reaction due to frequently repeated injuries and mechanical effects.

The inflammatory reaction can be either minimal or pronounced, up to the formation of abscesses. Causes of prepatellar bursitis can be blows directly to the kneecap area, accompanied by damage to the integrity of the corresponding bag and hemorrhage of varying degrees.

Due to the superficial location of the prepatellar bursa, sometimes during palpation one can feel a small, rather painful formation with liquid contents. In some cases, a certain roughness can be felt in this formation, which is the formation of wrinkled folds on the walls of the bursa.

This type of inflammatory process prevents the patient from leaning on the affected knee or even touching the patella.

Infrapatellar bursitis of the knee joint

The inflammatory process in the synovial bursa located in close proximity to the large tendon under the kneecap is called infrapatellar bursitis of the knee joint. Such inflammation is formed as a result of an injury sustained during a jump: the process is localized specifically in the adjacent tendon, which connects the femoral muscles and the muscles of the patella to the bones of the ankle joint. For this reason, the name "jumper's knee" is often used for infrapatellar inflammation. This disease is common in athletes professionally involved in various types of athletics, basketball, ski jumping, and parachuting.

The infrapatellar bursa is normally filled with physiological fluid, which cushions impacts and sudden movements of the knee joint. If the landing after a jump is unsuccessful, or if the jumper is overweight, the load on the bursa increases rapidly, its walls cannot withstand it, internal hemorrhages appear, which contribute to the rapid development of an inflammatory reaction.

Purulent bursitis of the knee joint

Purulent bursitis of the knee joint is an inflammatory process of one or more synovial sacs, complicated by the addition of a purulent infection.

Infectious agents enter the bursa cavity during penetrating injury, or are transferred from other foci (boils, abscesses, arthritis, phlegmon, pustular skin lesions).

Staphylococcal and streptococcal infections can act as a causative agent of purulent inflammation. This disease is rarely independent, it usually occurs as a result of complications of poorly treated common serous inflammation.

The purulent process can spread to nearby tissues; if there is a puncture in the cavity of the lesion, purulent discharge is observed to exit.

The difficulty in diagnosing purulent bursitis of the knee joint is the similarity of clinical symptoms with the manifestations of purulent arthritis, therefore, only a specialist in this field should differentiate these diseases.

Bursitis of the knee joint in a child

Knee bursitis in children can be extremely rare, children are more likely to have foot bursitis. This is explained by the fact that the child's weight is not yet so great that when falling it would create the load necessary to damage the wall of the synovial bursa.

However, from the age of 12-13, the risk of knee bursitis in children increases significantly. During this period, the development of so-called "goose bursitis" becomes possible, in which the inflammatory process affects the bursa located on the inner lower part of the knee. Such inflammation is usually accompanied by severe pain when walking up the stairs, as well as when getting up from a chair after a long period of immobility.

The occurrence of bursitis at a young age is associated with the accelerated development of a young organism, when tendon fibers and other periarticular tissues do not keep up with the rapid growth of the body, so during this period the knee tendons are extremely tense. This condition significantly increases the risk of damage to the knee components.

With mild clinical symptoms of bursitis in children, this disease tends to heal on its own.

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Diagnosis of bursitis of the knee joint

Diagnosis of bursitis of the knee joint is based primarily on visual data, on the results of the anamnesis indicating a recent injury.

Mandatory differential diagnostics with arthritis signs are carried out. These diseases are not only different, but can also occur against the background of each other.

The infrapatellar form of bursitis is easier to diagnose than other types of inflammation due to its close location to the surface of the skin.

Chronic bursitis is palpated as dense formations, which is based on the formation of fibrosis on the walls of the bursa due to a long inflammatory process.

Deep bursitis that cannot be palpated is determined by X-ray examination. Arthrography, bursography, and ultrasound examination are used less frequently.

With diagnostic puncturing of the bursa, it is possible to determine the composition of the exudative fluid, as well as to culture it on special media to identify a specific infectious agent and its sensitivity to antibacterial drugs.

General signs of an inflammatory reaction in the body should be confirmed by a general and detailed blood test.

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Treatment of bursitis of the knee joint

Treatment of bursitis of the knee joint should primarily be aimed at reducing pain and attenuating the inflammatory process.

The therapeutic method depends on the type, location, severity and causes of the inflammatory reaction. Sometimes, to treat bursitis, it is enough to apply a splint and ensure rest and an elevated position of the affected limb, and in some cases, it is necessary to use the method of electropuncture, magnetic therapy, laser treatment, and puncture procedures.

Acute bursitis requires mandatory rest for the inflamed joint; it is recommended to apply a pressure bandage; it is possible to use cold compresses.

Chronic bursitis is often cured by puncture with aspiration of intracavitary fluid and rinsing the bursa with an antibiotic or corticosteroid solution.

Within three weeks after starting to take medications, the pain should be completely eliminated; if this does not happen, we can talk about the inadequacy of the treatment or the complicated course of the disease.

Physiotherapeutic treatment methods allow you to quickly restore the functionality of the knee joint and return the knee to its previous motor capabilities. Sessions of therapeutic massage and exercise therapy are excellent for activating tissue blood circulation.

Surgical treatment

Among the variety of surgical methods, puncture of the synovial sac with suction of exudative fluid and washing of the internal walls is especially popular. Sometimes this procedure is used repeatedly until complete healing. Complete ectomy of the pathological focus is used extremely rarely and only in advanced cases.

Surgical intervention is limited to opening or partial excision of the tissues of the inflamed bursa, which are then treated with bactericidal solutions. The procedure takes about half an hour and is usually performed under local anesthesia. During the operation, the upper wall of the bursa can be removed according to indications, and the inner surface of the cavity is treated with an antiseptic. Sometimes internal tamponade of the bursa is used. Two hours after the procedure, if there are no complications, the patient is sent home.

Chronic bursitis of the knee joint may require removal of calcified deposits when they interfere with the free movement of the joint.

Purulent bursitis, in addition to opening and bactericidal treatment of the bursa, usually requires the installation of surgical drainage.

Treatment with folk remedies

Traditional medicine offers many ways to treat the inflammatory process in the knee joint. The most popular methods are:

• a fresh cabbage leaf is tightly bandaged to the joint area, possibly overnight; this method has proven itself as an effective anti-inflammatory agent;
• fresh aloe or kalanchoe leaves (preferably the most “mature” leaves) are crushed or ground and applied to the sore spot as a bandage; this procedure has a pronounced resorptive and stimulating effect;
• dried and ground burdock root is combined with an equal amount of pork, badger or goat fat; this substance is rubbed into the knee area, followed by the application of a protective bandage;
• applying fresh lilac leaves promises quick relief from pain;
• warm pine baths have a distracting and anti-inflammatory effect (the concentrated decoction is diluted with water, the affected limb is placed in the bath for 15-20 minutes);
• Grapefruit juice has been found to have a good healing effect (it is recommended to take half a glass three times a day).

Let us remind you that the use of folk remedies is advisable only after consulting a doctor.

Treatment with ointments

Treatment of knee bursitis with ointments involves the prescription of a whole range of medical preparations consisting of a wide variety of medicinal components. Often, a group of non-steroidal agents and hormonal creams are used to relieve the inflammatory process. The following preparations are the most common:

• Voltaren emulgel, an analogue of sodium diclofenac, effectively cures pain and inflammation in the joint;
• Deep Relief gel - a combination of ibuprofen and menthol, brings relief from pain quite quickly;
• Nise-gel, a drug based on nimesulide, has a local anesthetic and anti-inflammatory effect;
• Ortofen 2% ointment reduces pain, relieves swelling and redness;
• Fastum gel 2.5% based on ketoprofen, a non-steroidal anti-inflammatory drug;
• methyl salicylate liniment or chloroform liniment is an excellent anti-inflammatory drug (an analogue of these drugs is the substance saliment);
• warming ointments - finalgon, gymnogal, mellivenon;
• anti-inflammatory and absorbent ointments based on bee or snake venom (apizartron, virapin, viprosal, vipratox);
• Pepper ointments capsitrin, camphocin, complex pepper liniment warm, improve local blood circulation and accelerate post-traumatic recovery.

Any of these ointments is applied or rubbed into the area of the affected joint, onto intact skin, several times a day.

Drug treatment

Treatment of knee bursitis with medications involves, first of all, the prescription of non-steroidal anti-inflammatory drugs, such as diclofenac, indomethacin, ibuprofen, piroxicam, ketoprofen. These are very effective drugs. Their only drawback when taken orally is a large number of contraindications and side effects, which are practically absent when used externally. The consequences of long-term or uncontrolled use of such drugs can be gastritis, enterocolitis, up to stomach ulcers, changes in the blood picture, increased bleeding, allergic reactions. Therefore, these drugs should be taken only as prescribed by a doctor.

In addition to non-steroidal agents, it is possible to use corticosteroid hormones, which support the body's basic functions and reduce inflammatory manifestations, as well as antirheumatic drugs based on gold salts. Such drugs not only affect the suppression of the inflammatory reaction, but also reduce the risk of disease progression in the future.

Antibiotic therapy

Antibiotics are prescribed for knee bursitis only in specific cases where there is a suspicion of pathogenic microflora penetrating the synovial bursa. Antibiotics are prescribed in a solution for washing the cavity of the inflamed bursa, or by injection. If the inflammation affects several bursae at once, antibiotic therapy becomes complex and is carried out against the background of steroid drugs.

Broad-spectrum antibiotics are most often used to treat bursitis, but if bacteriological culture of exudative fluid is possible, it is advisable to determine the sensitivity of microflora to antibacterial agents. This procedure is carried out to select the most effective antibiotic for therapy.

For example, chloramphenicol is often used to treat brucellosis bursitis, streptomycin is used for tuberculous bursitis, and penicillin group drugs are used for gonorrheal bursitis. Antibiotics are taken for at least a week and no more than 10 days, and antifungal drugs and agents for maintaining normal intestinal flora are prescribed at the same time.

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Treatment of prepatellar bursitis of the knee joint

Treatment of prepatellar bursitis of the knee joint is carried out individually and depends, first of all, on the nature and character of the inflammatory process.

Aseptic uncomplicated bursitis is usually treated with ice packs, elevation and immobilization of the limb, and administration of anti-inflammatory and analgesic drugs. In appropriate cases, removal of the bursal exudate may be required - this is aspiration puncture with a syringe, performed in a hospital or outpatient setting.

The inner side of the bursa may be treated with corticosteroids and antimicrobials during puncture, especially in cases of infectious prepatellar bursitis.

Oral and injection administration of drugs is prescribed individually according to existing indications. Symptomatic therapy may be prescribed to alleviate the general condition of the patient and relieve signs of general intoxication of the body. Such therapy includes painkillers and general tonics, immune stimulants, complex vitamin preparations, and, if necessary, antipyretics.

Treatment of suprapatellar bursitis of the knee joint

Treatment of suprapatellar bursitis of the knee joint is carried out by a specialist based on clinical symptoms and the severity of the patient's condition; both conservative methods and surgical intervention are standardly used. The doctor must first assess the degree of development of the inflammatory process: mild inflammation can be cured with minimal therapeutic impact on the lesion. Such therapy includes immobilization of the limb, application of ice for 15-20 minutes, tight bandaging of the affected joint.

Severe pain associated with suprapatellar bursitis may require the use of analgesics and anti-inflammatory drugs (non-steroidal drugs, salicylates), which are applied externally in the form of ointments and gels, or orally in the form of tablets.

Antibiotics may be prescribed when a purulent infection occurs, or to prevent complications, as well as in the presence of concomitant pathological processes in the body.

Prevention of bursitis of the knee joint

High-quality prevention of knee bursitis should include a set of the following measures:

• any inflammatory disease in the body must be completely treated, with absolute restoration of all functions and normal test results;
• the muscular system of the lower limbs should be strengthened with appropriate physical exercises, gymnastics, walking;
• It is recommended to avoid exposure of the knee joint area to low temperatures to prevent local blood circulation disorders and disruption of the nutrition of the synovial sac tissues;
• during work or sports activities that involve increased load on the knee joints or the risk of knee damage, it is recommended to constantly and obligatorily wear special protective knee pads. Such a necessary attribute reduces the joint load and has a shock-absorbing and holding effect;
• You should also pay attention to the position of your knees during physical activity, avoiding prolonged squatting or sitting with your kneecaps in the air.

Prognosis of knee bursitis

The prognosis for knee bursitis is generally favorable, but only if all necessary medical instructions are followed.

To prevent relapses and complications of this disease of the synovial bursa, it is necessary to carry out the treatment of the inflammatory process until signs of complete recovery. Such signs are not only the disappearance of pain and the main clinical manifestations of the disease, but also the restoration of the original motor functions of the knee joint in full.

The prognosis for chronic bursitis can be favorable provided that the type of activity is changed or further trauma to the knee joint and constant vibration exposure to it is prevented.

In essence, the nature of the prognosis largely depends on the severity of the disease and the stage at which treatment was started. An advanced form of the inflammatory process, even its treated version, significantly worsens the prognosis of bursitis.

Mild cases of bursitis may not require medical attention, but the question is whether the patient can correctly diagnose knee bursitis and prescribe the necessary treatments; therefore, sometimes the best solution is to visit a qualified specialist.