Bunion of knee joint

Bursitis of the knee joint is an inflammatory process in prednadolennikovyh bags (subcutaneous, subfascial and podsuchislennoy).

Most often the subcutaneous sac is susceptible to the disease, bursitis is manifested by sharp edema of the joint and all clinical signs of the inflammatory process.

[1],

Causes of bursitis of the knee

The causes of bursitis of the knee joint are various:

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

The knee joint is often injured, especially when practicing traumatic sports (football, skiing, hockey, etc.), so the probability of developing inflammatory processes in it is quite high.

[2], [3]

Symptoms of bursitis of the knee joint

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

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

• articular puffiness, initially practically painless;
• The motor amplitude before the onset of pain, as a rule, is not disturbed;
• hyperemia of the skin over the focus of inflammation, palpation shows local hyperthermia;
• the disturbance of the motor activity of the joint is accompanied by the appearance of considerable painful sensations;
• if the inflammatory process is of an infectious nature, there may be signs of general intoxication of the body: weakness, decreased appetite, fever, fever, headache;
• if inflammation of the knee joint is a secondary disease, there may be a surge in symptoms of the underlying pathological process.

Acute bursitis of the knee joint

The acute bursitis of the knee joint is characterized by a sudden onset and a sharp increase in symptoms. In the first place, one should note a strong soreness, up to the rezi in the joint, especially when trying to flex and bend the knee. Palpation above 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 tissues, skin warm to the touch.

Acute bursitis usually occurs within a short time after injury, pathological lesions are manifested as signs of an acute process in the walls of the synovial bag.

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

[4], [5],

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 the disease develops against a background of constant vibration or mechanical impact on the joint.

Chronic bursitis differs latent (latent), or sluggish and slowly progressive currents, which can periodically exacerbate. In such periods of exacerbation, all signs and characteristic symptoms of the acute form of the disease are clinically present.

Prolonged process can provoke a significant increase in the effusion of exudative fluid in the cavity of the synovial bag, which contributes to the development of cystic formations.

Chronic inflammation of the knee joint requires more serious, complex and prolonged treatment, in contrast to the acute process. Sometimes a doctor has to resort to a puncture of the inflammatory focus for aspiration of accumulated fluid and washing the cavity with antibacterial drugs.

[6]

Supratellar bursitis of the knee joint

Supratellar bursitis of the knee joint is an inflammation in one of the synovial knee pouches, namely in the patella bursa. Sometimes it is called the term "nosocomial bursitis", or "monastic knee". The latter name is associated with one of the causes of this disease - a long kneeling.

Suprapatellar bursitis can also form due to excessive loads on the knee joint: statistics state that such a manifestation of bursitis is characteristic of almost all hockey goalkeepers because of increased traumatization of the knee washer and when falling on ice.

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

The patellar connecting bursa is one of the largest articular synovial bags in the knee. It performs the function of joint protection, damping friction and shocks. It is located above the upper pole of the patella.

Prepatellar knee joint bursitis

The prepatellar synovial bag has a subcutaneous location, rather close to the surface, in the anterior part of the patella. Inflammatory phenomena in it develop as a protective reaction due to frequently repeated injuries and mechanical influences.

Inflammatory reaction can be as minimal, and expressed up to formation of abscesses. The causes of prepatellar bursitis can be strokes directly into the patella, accompanied by damage to the integrity of the bag and hemorrhage of varying degrees.

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

This kind of inflammatory process does not allow the patient to lean on the affected knee and even touch the patella.

Infratellar bursitis of the knee joint

Inflammatory process in the synovial bag located in the immediate vicinity of a large tendon under the patella is called infripatellar bursitis of the knee joint. This inflammation is formed as a result of the injury received during the jump: the process is localized specifically in the adjacent tendon, which connects the femoral muscle and the patella muscles to the bones of the ankle joint. For this reason, the name "knee jumper" is often used for infratellular inflammation. This disease is inherent in athletes professionally engaged in various types of athletics, basketball, ski jumping, parachuting.

The infrasatellar bursa is normally filled with a physiological fluid, thanks to which shock and sharp movements of the knee joint are amortized. In case of unsuccessful landing after a jump, and also in the presence of excess weight in a jumping man, the load on the bursa rapidly increases, its walls do not stand up, internal hemorrhages appear that contribute to the rapid development of the inflammatory reaction.

Purulent bursitis of the knee joint

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

Infectious agents are introduced into the bursal cavity during penetrating damage, or are transferred from other foci (furuncles, abscesses, arthritis, phlegmon, pustular skin lesions).

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

Purulent process can spread to nearby tissues, in the presence of a puncture in the cavity of the focus there is an outflow of purulent discharge to the outside.

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

Bunion of knee joint in a child

Bursitis of the knee joint in a child can be extremely rare, children are more likely to manifest bursitis of the foot. This is explained by the fact that the child's weight is not yet so large that, when falling, create the load necessary to damage the wall of the synovial bag.

However, from the age of 12-13 the risk of knee bursitis in children is significantly increased. During this period it becomes possible to develop the so-called "goose bursitis", in which the inflammatory process seizes the bag located on the inner lower part of the knee. Such inflammation is accompanied, as a rule, by severe pain while walking the stairs, as well as when getting up from the stool after a prolonged immobile state.

The appearance of bursitis at a young age is associated with the accelerated development of a young organism, when the fibers of the tendons and the remaining periarticular tissues do not keep up with the rapid growth of the body, so during this period the knee tendons are extremely strained. This condition significantly increases the risk of knee injury.

With mild clinical symptoms of bursitis in children, this disease is prone to self-cure.

[7], [8]

Diagnosis of bursitis of the knee joint

The diagnosis of bursitis of the knee joint is based, first of all, on visual data, on the results of an anamnesis indicating a recent trauma.

Compulsory differential diagnosis with signs of arthritis is carried out. These diseases are not only different, but also able to flow against each other's background.

The infragastular shape of bursitis is diagnosed more easily than other types of inflammation due to its proximity to the surface of the skin.

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

Deep bursitis, not amenable to palpation, is determined by X-ray examination. Less commonly used methods of arthrography, bursography, ultrasound.

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

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

[9], [10]

Treatment of bursitis of the knee joint

Treatment of bursitis of the knee joint in the first place should be aimed at reducing painful sensations and damping of the inflammatory process.

The therapeutic technique depends on the type, location, severity and causes of the inflammatory response. Sometimes for the treatment of bursitis, it is sufficient to apply longi and ensure rest and elevated position of the affected limb, and in some cases it is necessary to connect the method of electropuncture, magnetotherapy, laser treatment, puncture procedures.

The acute course of 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 the intracavitary fluid and by washing the bag with a solution of antibiotics or corticosteroids.

In the three-week period after the start of medication, pain should be completely eliminated, but if this does not happen, we can talk about the inadequacy of the treatment or the complicated course of the disease.

Physiotherapeutic methods of treatment can quickly restore the efficiency of the knee joint and return the knee to previous motor abilities. Perfectly activate the tissue circulation of the sessions of therapeutic massage and exercise therapy.

Surgery

With a variety of surgical methods, it is especially popular to point the synovial bag with the suction of the exudative fluid and the washing of the inner walls. Sometimes this procedure is applied many times before the complete cure. Complete ectomy of the pathological focus is used extremely rarely and only in neglected cases.

Surgery is limited to opening or partial excision 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 by indications, and the internal surface of the cavity is treated with an antiseptic. Sometimes internal tamponing of the bag is used. Two hours after the procedure, in the absence of complications, the patient is released home.

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

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

Treatment with alternative means

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

• fresh cabbage leaf tightly bandaged to the joint area, it is possible for the night; this method has established itself as an effective anti-inflammatory agent;
• fresh leaves of aloe or colanchoe (preferably the most "adult" leaves) are ground or milled and applied to a sore spot as a bandage; this procedure has a pronounced dissolving and stimulating effect;
• the dried and ground root of the burdock is combined with an equal amount of pork, badger or goat fat; such substance is rubbed into the knee area followed by application of a protective dressing;
• The application of fresh lilac leaves promises rapid relief from pain;
• warm coniferous baths have a distracting and anti-inflammatory effect (the concentrated broth is diluted with water, the affected limb is lowered into the bath for 15-20 minutes);
• A good therapeutic effect of grapefruit juice is found (it is advised to take three times a day for half a glass).

Recall that the use of alternative means is desirable only after consulting a doctor.

Treatment with ointments

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

• Voltaren emulgel, an analog of diclofenac sodium, effectively cures soreness and inflammation in the joint;
• gel Dip Relief - a combination of ibuprofen and menthol, quickly enough brings relief from pain;
• Nayz-gel, a drug based on nimesulide, has a local anesthetic and anti-inflammatory effect;
• ointment ortofen 2% reduces the manifestation of pain, relieves swelling and redness;
• fast-gel 2.5% on the basis of ketoprofen, non-steroidal anti-inflammatory agent;
• liniment of methyl salicylate or chloroform liniment is an excellent anti-inflammatory drug (analogue of these medicines is the substance of saliment);
• ointments of warming up action - finalgon, gymnastics, mellyvenon;
• anti-inflammatory and resorptive ointments based on bee or snake venom (apizartron, virapine, viprosal, vipratox);
• pepper ointment capsitrin, camphocin, complex finger linen warm, improve local blood circulation and accelerate posttraumatic recovery.

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

Medication

Treatment of bursitis of the knee joint with medicines presupposes, first of all, the administration of non-steroidal anti-inflammatory drugs, such as diclofenac, indomethacin, ibuprofen, piroxicam, ketoprofen. These are very effective medicines. Their only disadvantage with oral administration is a large number of contraindications and side effects, which are practically absent in external application. Consequences of prolonged or uncontrolled administration of such drugs can be gastritis, enterocolitis, up to a stomach ulcer, a change in the pattern of blood, increased bleeding, allergic reactions. Therefore, take these medications only if prescribed by a doctor.

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

Antibiotic therapy

The administration of antibiotics in bursitis of the knee joint is carried out only in specific cases, when there is a suspicion of the penetration of pathogenic microflora into the synovial bursa. Antibiotics are prescribed in a solution for washing the cavity of an inflamed bag, or injectively. If the inflammation affects several bursis at once, the antibiotic therapy becomes complex and is performed against a background of steroid preparations.

Antibiotics of a wide spectrum of action are more often used for treatment of a bursitis, however at possibility of bacteriological crop of an exudative liquid it is desirable to define sensitivity of a microflora to antibacterial agents. This procedure is used to select the most effective antibiotic for therapy.

For example, in the treatment of brucellosis bursitis, levomycetin is often used, with tuberculous bursitis - streptomycin, with gonorrheic - preparations of the penicillin group. Antibiotics take at least a week and not more than 10 days, at the same time necessarily prescribe antifungal drugs and funds to maintain normal intestinal flora.

[11], [12], [13]

Treatment of pre-patellar bursitis of the knee joint

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

Aseptic uncomplicated bursitis is usually cured with the use of ice packs, elevated position and immobilization of the limb, the appointment of anti-inflammatory and analgesic drugs. Where appropriate, the removal of bag exudate may be required-an aspiration puncture by a syringe, performed in a hospital or ambulatory setting.

The inner side of the bursa during puncture can be treated with corticosteroid and antimicrobial drugs, especially in the infectious nature of prepatellar bursitis.

Oral and injectable administration of drugs is assigned individually according to existing indications. Symptomatic therapy may be prescribed to alleviate the general condition of the patient and to remove signs of general intoxication of the body. Such therapy includes painkillers and restorative medications, stimulants for immunity, complex vitamin preparations, if necessary, antipyretic agents.

Treatment of supratellar bursitis of the knee joint

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

Severe pain with suprapatellar bursitis may require the appointment of analgesic and anti-inflammatory drugs (nonsteroidal drugs, salicylates) that are applied externally in the form of ointments and gels, or orally in the form of tablets.

Antibiotics can be prescribed with the addition of purulent infection, or for the prevention of complications, as well as in the presence of concomitant pathological processes in the body.

Prevention of bursitis of the knee joint

The qualitative prevention of bursitis of the knee joint should include a set of the following measures:

• any inflammatory disease in the body should be fully treated, with an absolute restoration of all functions and normal results of the analyzes;
• the muscular apparatus of the lower extremities should be strengthened by appropriate physical exercises, gymnastics, walking;
• it is recommended to avoid the influence of low temperatures on the knee joint area to prevent disturbances in local blood circulation and eating disorders of synovial bag tissues;
• during work or playing sports, in which there is an increased load on the knee joints or there is a possibility of damage to the knees, it is recommended that you wear a special protective knee. Such a necessary attribute reduces the articular load and has a damping and restraining effect;
• Also, attention should be paid to the position of the knees during physical exertion, avoiding prolonged squatting or focusing on the kneecaps.

Prognosis of bursitis of the knee joint

The prognosis of bursitis of the knee joint is generally favorable, but only if all the necessary medical prescriptions are observed.

To prevent the occurrence of recurrences and complications of this disease of the synovial bursa, one should start the treatment of the inflammatory process up to signs of absolute 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 a full volume.

The prognosis for the chronic form of bursitis can be favorable under conditions of a change in the type of activity or prevention of further traumatization of the knee joint and a constant vibratory effect on it.

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

An easy course of bursitis may not require a doctor, but the question is whether the patient will be able to correctly diagnose bursitis of the knee joint and prescribe the necessary procedures; so sometimes the best solution is to visit a qualified specialist.