Prepatellar bursitis: causes, symptoms, treatment

01.12.2020

Bursitis of the knee joint is called inflammation of the synovial bursa (bursa), which is located between the bones and tendon fibers. A healthy bursa reduces friction when walking. An inflamed cavity makes it difficult for the joint to move and causes a feeling of discomfort. The inflammatory process can develop in one or several cavities at the same time.

Causes of the disease

Bursitis is usually infectious in nature. It can be caused by untreated inflammatory pathologies. Viruses and bacteria are often the causative agents, leading to the development of sinusitis, otitis, bronchitis, abscess or the formation of another source of infection.

The cause of the onset of the inflammatory process can also be:

• allergic reaction;
• poor circulation in the joint capsule;
• injuries of the synovial bursa or its vessels.

People at risk include people with low or excessive physical activity. In both cases there is an increased risk of injury. Therefore, inflammation of the joint capsule is more common among housewives, office workers, drivers, miners, and professional athletes.

Bursitis of the shoulder joint - what is it?

Bursitis – the name of the disease comes from the Latin term “bursa”, which means “bursa”. In modern medical science, the term bursitis refers to the occurrence and development of the inflammatory process in the articular capsules of different joints. Inflammation in this case can have a different nature. Bursitis of the shoulder joint is an inflammatory process that affects one or several joint capsules located in this area, and is accompanied by the accumulation of exudate mixed with blood or pus.

Inside the joint capsule there is synovial fluid - the functionality of this tandem for joint health is difficult to overestimate. Thanks to them, when moving, the pressure on all elements of the joint is reduced and all the nutrients necessary for the normal functioning of cartilage are supplied.

Bursitis of the shoulder joint leads to disruption of these functions, as a result of which the patient feels severe pain, and the motor functions of the limb are significantly reduced. If inflammation of the joint capsule is not treated in a timely manner, serious complications may develop (for example, the development of arthritis). This disease most often affects young men (35-40 years old).

ICD-10 code: M75.5 (Bursitis of the shoulder).

Types of bursitis

In medicine, the disease is given several classifications. Types of the disease are distinguished by the location of inflammation, the composition of the exudate and the reasons that led to the development of the pathology. There are 160 bursae in the human body. But the bursae of large joints become inflamed more often:

• elbows;
• shoulder;
• knee;
• hip

Based on the composition of the exudate released into the capsule, serous, purulent, fibrinous and hemorrhagic bursitis are distinguished. In the first case, an almost transparent and quickly absorbable liquid accumulates in the bursa. In the purulent form of the disease, pus is released into it, fibrinous - fibrin, hemorrhagic - blood.

Bursitis can be primary or secondary. In the first case, there are no internal reasons that could cause it. Secondary pathology is usually a consequence of another disease - rheumatoid arthritis, psoriasis, diabetes, etc.

Causes and types of disease

The cause of inflammation of the joint tissue in the knee can be:

• trauma: chronic microtraumas during intense loads in athletes or single injuries from falls or blows are the main culprits of this disease. The cause may be partial or complete rupture of the ligament or damage to the meniscus of the knee joint;
• microcrystalline arthropathy, when microcrystals of salts of different compositions are deposited in the joint;
• inflammatory arthritis of various types: rheumatoid, psoriatic, gouty;
• autoimmune diseases (psoriasis), allergic reactions, and metabolic disorders (obesity);
• bacterial infections caused by pyogenic microorganisms (staphylococci, streptococci, gonococci, pneumococci, brucella). The pathogen can enter the bursa both from the external environment and through tissue.

Depending on the location of the lesion, several types of bursitis are distinguished:

• suprapatellar - an inflammatory disease that occurs in the patellar bursa of the knee joint. Occurs when there is damage (bruises, sprains) or prolonged exposure to the knee;
• infrapatellar is an inflammation of the popliteal bursae of the knee joint, which most often occurs when the ligaments are damaged;
• prepatellar - manifests itself in the form of swelling of the anterior surface of the knee joint. May appear as a result of a direct fall on the kneecap or repeated impacts;
• anserine - affects the crow's foot bursa (between the tibia and three tendons) and is often complicated by tendonitis;
• Baker's cyst is an inflammation of the bursa, which may be a consequence of injury or illness. Located on the posterior surface of the joint (in the popliteal fossa).

Bursitis can be serous (aseptic inflammation), purulent (with penetration of pathogenic microflora into the joint cavity) or hemorrhagic (with injuries and ruptures of blood vessels).

How does the disease manifest itself?

Bursitis can be acute or chronic. Both forms of the disease have a similar clinical picture. For the first time, the disease develops acutely and is manifested by the following symptoms:

• swelling of the joint;
• redness of the skin at the site of the lesion;
• pain that gets worse with exercise;
• stiffness of movements;
• increased weakness;
• increased sweating;
• increased body temperature;
• elastic swelling of a round shape, deflecting when pressed (due to the accumulation of effusion in the bag).

If there is no treatment, symptoms worsen. Body temperature rises to +39…+40 °C, swelling increases, pain does not go away even with rest. Then the disease becomes chronic. It is characterized by alternating periods of remission and exacerbation.

Chronic bursitis of the elbow, knee or other joint is manifested by softening of the swelling. Pain when pressed goes away and mobility returns. Redness and swelling disappear. But the inflammation may worsen. This is facilitated by particles of tissue remaining in the bursa after the end of the acute period.

Symptoms

Normally, a person cannot feel or see the bursa. If inflammation of the olecranon bursa occurs, then thickening of the skin and swelling appears on the back of the elbow. The bursa can also be filled with fluid and then appear as a small, soft ball - a bit like a cyst. In most cases (non-infected bursitis and not associated with arthritis), elbow bursitis is painless or slightly painful. Movement in the elbow joint is not impaired.

If the bursa is infected (“septic” olecranon bursitis), pain, redness, and tenderness in the elbow typically develop.

Bursitis associated with arthritis may not be painful in itself, but there may be joint pain due to arthritis. Patients with olecranon bursitis usually experience pain and swelling at the back of the elbow. The pain is usually worse when leaning on the elbow or when bending or straightening the elbow. In less severe cases, patients may experience only pain and stiffness in the elbow at rest after activities such as carrying a bag. Additionally, activities such as using a hammer or straightening the elbow against resistance can also cause pain in the initial stages.

As it progresses, patients may experience symptoms that increase during sports or physical activity. Patients may notice swelling and a large ridge above the ulnar prominence. Most patients with olecranon bursitis experience pain when the olecranon is touched. Sometimes small lumps can be felt in the area of ​​the olecranon. Patients may also experience weakness in the elbow, especially when trying to straighten the elbow against resistance.

Methods of treating the disease

Bursitis is treated by a surgeon or orthopedic traumatologist. But before his appointment, he conducts a diagnosis. It includes an external examination, palpation of the joint, as well as blood tests and puncture of the bursa to collect synovial fluid. Its research helps to establish the type of pathogen and select drugs effective against it.

During treatment, it is important for the patient to ensure the immobility of the diseased joint. Therefore, most of the time he should be at rest. He is prescribed:

• Injections with glucocorticosteroids into the cavity of the bursa. They reduce inflammation and relieve pain.
• Removal of excess effusion using a sharp needle that is inserted into the capsule.
• Rinsing the bag with antiseptic solutions. They are also introduced into the cavity through a needle.
• Antibacterial therapy for the bacterial form of the disease.
• Compresses with anti-inflammatory and analgesic solutions to reduce pain and external symptoms of inflammation.

The initial stage of the disease can be easily treated without consequences for the patient. Therefore, at the first symptoms of bursitis, contact your doctor. Our surgeons will conduct a series of studies to clarify the diagnosis and prescribe competent treatment.

Diagnostics

To diagnose bursitis, the doctor performs a clinical examination, during which he interviews the patient and collects a detailed history. Based on the results, he may prescribe:

• puncture. It is performed under local anesthesia. Using sterile instruments, the liquid is removed from the bag and laboratory tests are performed;
• ultrasound and magnetic resonance imaging. They help confirm the diagnosis in cases where the synovial bursa is not accessible for direct inspection, palpation and puncture. These studies show the nature of the inflammatory changes, as well as the amount of exudate;
• radiography. This study is carried out to exclude arthrosis and possible pathologies, including complex tumors. It also helps if bursitis persists for a long time and calcification is suspected.

These methods help clarify the diagnosis, as well as prescribe the correct treatment regimen.

Traditional methods of therapy

Treatment for bursitis at home is optional and is recommended to be used in conjunction with medications prescribed by a doctor and physical therapy.

There are a lot of traditional medicine recipes for treating shoulder bursitis. All of them are aimed, first of all, at eliminating pain and inflammation. For chronic bursitis of the shoulder joint, treatment with folk remedies at home gives a good effect. In acute forms of pathology, therapy with folk remedies is used only at the recovery stage after swelling has subsided and redness has disappeared. In any case, before using any folk remedies, you should definitely consult with your doctor.

Diagnostic measures

When visiting a medical facility, an orthopedist diagnoses elbow bursitis by performing:

Visual and palpation examination, as well as questioning the patient.

X-ray examination. Such diagnostics are needed to assess the condition of the olecranon process - in some cases, the formation of osteophytes is found in this place. Using this method, you can choose a treatment method (conservative or surgical).

Puncture of the synovial cavity. It is performed when it is necessary to accurately determine the origin of the disease (infectious or inflammatory etiology). The exudate obtained as a result of the puncture is sent for laboratory testing to identify sensitivity to antibacterial and other drugs and determine the nature of the disease, after which the doctor will decide on a treatment plan.

The use of alternative medicine

It is worth noting that the unauthorized use of folk remedies instead of traditional antibacterial drugs for bursitis is prohibited. First you need to consult with a specialist about the use of alternative medicine. Such drugs can only be used as an auxiliary treatment, and only with the permission of a doctor.

For bursitis, you can resort to help:

Compresses with alcohol tincture of propolis. To prepare the product you will need vodka and a few grams of the substance. It must be infused for 7 days in a sealed container. You can purchase a ready-made product at a pharmacy.

Ointment with aloe juice and honey. One part of aloe and 2-3 parts of honey and vodka need to be mixed. The resulting product should be applied to the affected joint.

Lotion with lilac inflorescences. The flowers need to be lightly squeezed and tied to the bend of the elbow using a bandage. This helps cope with inflammatory manifestations.

Sugar, heated in a frying pan, is poured into a fabric bag and applied to the joint. This way you can eliminate swelling.

In addition to the use of medications and folk remedies, it is recommended to observe preventive measures in the form of proper distribution of things at the place of work, proper rest, and reduction of physical stress on the affected area. It is also recommended to avoid hypothermia.