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Introduction

Knee Pain

Knee Bursitis

Knee bursitis is inflammation of a small fluid-filled sac (bursa) situated near your knee joint. Bursae reduce friction and cushion pressure points between your bones and the tendons, muscles and skin near your joints.

Any of the bursa in your knee can become inflamed, but knee bursitis most commonly occurs over the kneecap (prepatellar bursitis) or on the inner side of your knee below the joint (pes anserine bursitis).

Bursitis occurs when the bursa becomes irritated and produces too much fluid, which causes it to swell and put pressure on the adjacent parts of the knee. It causes pain and can limit your mobility.

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Causes

Kneeling on hard surfaces: Most cases of knee bursitis result from friction and irritation of the bursa that occurs in jobs that require a lot of kneeling on hard surfaces. Plumbers, roofers, carpet layers, coal miners, and gardeners are at greater risk for developing the condition. Symptoms usually begin gradually and can worsen over time.

Sharp blow to the knee: This could cause symptoms to appear rapidly. Athletes who participate in sports in which direct blows or falls on the knee are common, such as football, wrestling, or basketball, are at greater risk for the condition.

Rheumatoid arthritis / gout: People with these conditions are more susceptible to knee bursitis.

Bacterial infection: If a knee injury — such as an insect bite, scrape, or puncture wound — breaks the skin, bacteria may get inside the bursa sac and cause an infection. This is called infectious bursitis. Infectious bursitis is less common, but more serious and must be treated more urgently, though not always with surgery.

Symptoms
  • Pain with activity

  • Swelling 

  • Tenderness and warmth to the touch

  • Infectious bursitis may produce fluid and redness, as well as fever and chills

Diagnosis

During the physical examination, your doctor will inspect your affected knee and compare it to your healthy knee. They will examine your knee, checking for tenderness, and will also assess the range of motion in your knee and whether pain prevents you from bending it.

 

Your doctor may employ the following tests:

  • X-rays. Your doctor may order X-rays to make sure there is not a fracture or other bony problem that is causing your symptoms.

  • Other imaging tests. The diagnosis of bursitis is usually made on physical examination, but computerized tomography (CT) and magnetic resonance imaging (MRI) scans may be ordered to check for other soft tissue injury.

  • Aspiration. If your doctor is concerned about the possibility of infection, they may aspirate (draw fluid with a needle) from the bursa and send this sample to the lab for analysis.

Non-surgical treatments

Nonsurgical treatment is usually effective as long as the bursa is simply inflamed and not infected:

  • Using the RICE (rest, ice, compression, elevation) method: The RICE method involves resting your knee, icing your knee, wearing an elastic bandage around your knee (compression) and elevating your knee while you’re resting. This helps to reduce pain and swelling.

  • Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee. Acetaminophen can be used as an alternative if you cannot tolerate NSAIDs or are allergic.

  • Aspiration & cortisone injection: If the swelling and pain do not respond to the above measures, your doctor may drain (aspirate) the bursa with a needle, then inject the bursa with a corticosteroid (cortisone injection). The corticosteroid is an anti-inflammatory drug that is stronger than medications that can be taken by mouth.

  • Antibiotics: Infectious bursitis is initially treated with antibiotics. 

  • Surgical drainage: This is required if infectious bursitis does not respond to antibiotics alone.

Surgery