Knee bursitis: how to avoid disability

The knee is a large joint with a large and constant load. It is not surprising that injuries often occur here and the risk of knee joint diseases is high. Periodic knee pain bothers almost 50% of people at the age of 40, and by the age of 70 it becomes a constant companion. One of the common pathologies of this joint is bursitis of the knee joint. In this case, the periarticular sac becomes inflamed and fluid accumulates in it. Movement becomes limited and painful. Doctors at the Kuntsevo Medical and Rehabilitation Center know how to recognize and treat bursitis. The clinic’s specialists are ready to help with acute and chronic forms of the disease using the most modern, safe and effective methods.

Knee bursitis and its types

The term “bursitis” is applied to the inflammatory process that occurs in the anatomical structure of the joint – the bursa.

This is a kind of hydraulic airbag - a cavity made of dense connective tissue that protects the joint from external damage. On the outside, it consists of dense tendons and ligaments that provide a durable outer covering. Inside is a layer of cells that produce synovial fluid. This is a special joint lubricant that facilitates the sliding of bone heads in it, protects tendons from friction, nourishes and moisturizes joint tissues. When moving, cartilage, like a sponge, absorbs this liquid along with nutrients.

The knee is a complex joint, in which there are several synovial bursae: above, below and in front of the kneecap, on the lateral ligaments, tendons, heads of the gastrocnemius and popliteus muscles. Inflammation can appear in each of them or in several at the same time.

Bursitis occurs at the site of inflammation:

• Anterior kneecap - prepatellar - inflammation and swelling occur as a result of diseases such as rheumatism, gout and from constant injury. For example, when working specifically with frequent support on the knee. Maid's or priest's bursitis is what they call this type of pathology, in which the front of the knee swells.
• Popliteal – the tendon bursa in the lower part of the kneecap becomes inflamed. A typical cause for this type of pathology is falls and strong impacts to the knee, injuries and tears of the meniscus. Traumatic bursitis of the knee joint is common in people with arthritis or excess weight.
• Goose - or Baker's cyst. Inflammation occurs in the inside or back of the joint. It manifests itself as pain in the knee when moving, walking up stairs, and more often affects overweight women.

Knee bursitis is classified according to its course:

• Acute – occurring suddenly, with noticeable and intense symptoms and lasting up to a month.
• Subacute.
• Chronic – lasts up to a year.
• Recurrent - periodically worsens.

According to the type of cause, bursitis occurs:

• Aseptic is a non-infectious pathology caused by injuries (post-traumatic bursitis of the knee joint), gout, and autoimmune diseases.
• Septic – caused by bacteria or infections (tuberculosis, syphilis and others).

According to the type of accumulated synovial fluid: serous, purulent and others.

An accurate classification of bursitis is needed to understand its cause and which treatment methods will be effective.

Traditional methods of therapy

Treatment with folk remedies is part of complex measures to cure the infrapatellar form of bursitis. Medicines prepared at home can be taken orally, and ointments can be prepared for external use. Baths with anti-inflammatory decoctions have an excellent effect on the inflammatory process. For purulent bursitis, sometimes folk remedies work even better than medications. But you shouldn’t get carried away with them, because traditional treatment also has some contraindications and side effects.

To make the pus come out faster, you can use cabbage leaves and honey. The cabbage leaf is heated so that it is warm, smeared with honey and applied to the sore knee. After some time, the procedure is repeated until the pus begins to come out. Usually this method begins to work within 24 hours. To relieve inflammation, use lotions, soak a cloth in an anti-inflammatory solution and apply to the sore spot. Decoctions are prepared from chamomile, string, and linden flowers. Decoctions can be taken orally; they will also restore metabolic processes. Remember to consult your doctor before using any home remedies.

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Symptoms

General signs of bursitis of the knee joint (they will appear when different joint capsules are affected) include:

• Pain – bothers you at rest or when moving: running or walking up the stairs. Pain with bursitis of the knee joint most often occurs in the morning and gradually increases with increasing strength or intensity of exercise.
• Swelling – of the knee as a whole or of a specific joint capsule.
• A rise in temperature – both local (a feeling of heating appears in the knee) and in body temperature as a whole.
• Limitation of the possibility of movement - from slight stiffness and pain (the leg bends and unbends worse) to the complete inability to transfer body weight to the leg and walk normally.
• Signs of general intoxication during infections and purulent inflammation.
• Local symptoms of bursitis of the knee joint: swelling and pain in the area of ​​the inflamed bursa.

How does the procedure work?

If fluid accumulates in a joint, it can only be pumped out in an operating room. If local anesthesia is intended, no preliminary preparation is required. During general anesthesia, the patient should not eat the night before and on the day of surgery. You should also not drink alcohol or smoke. The day before, you need to shave the hair on the entire limb.

The doctor tells the patient in detail before the operation how fluid is pumped out of the knee joint. There are two ways:

Scheme of arthroscopy with pumping out exudate

1. Arthroscopy is a type of endoscopy in which optical equipment is placed inside the knee and allows the doctor to see on the monitor the accumulation of fluid in the knee joint and all other abnormalities. The doctor eliminates the identified pathology using tools built into the equipment. During arthroscopy, he can treat synovitis and perform the following manipulations:
   pump out exudate;
2. rinse the cavity with an antiseptic solution (lavage);
3. inject the required medication into the cavity; if it is a purulent process, antibiotics; for severe inflammation without pus and a large amount of exudate, glucocorticoid hormones; sometimes water-attracting hyaluronic acid is injected into the cavity; this facilitates the sliding of articular surfaces;
4. remove pathological elements from the cavity: necrotic tissue, fragments of bones and cartilage, etc.;
5. if there is a significant increase in the volume of the synovial membrane, the fluid is first pumped out, and then its complete or partial excision is performed - synovectomy.

The procedure begins by making three small incisions in the skin of the knee. Endoscopic instruments are inserted into them, which allows the doctor to first carry out diagnostics, and then pumping and all other therapeutic manipulations. After arthroscopy, a pressure bandage is applied to the knee: effusion may re-accumulate in the knee joint after the procedure.

Arthrocentesis - pumping out effusion from the knee joint can be done using a syringe under local anesthesia. The doctor treats the skin in the knee area with a disinfectant solution. Then, with a needle placed on an empty syringe, the skin and soft tissues are pierced and the needle is inserted into the joint cavity. By pulling the plunger of the syringe, he tries to remove the liquid, rinses the cavity with an antiseptic solution and injects the medicinal solution. After the procedure, a pressure bandage is applied using an elastic bandage.

Scheme of knee arthrocentesis

How painful is pumping?

Since anesthesia is performed before arthroscopy and arthrocentesis, the patient does not feel pain in the joint during the operation. After the operation of pumping out the effusion, the inflammatory process and associated pain may increase. They are easily eliminated by prescribing non-steroidal anti-inflammatory drugs (NSAIDs - Nise, Diclofenac, etc.) several times a day. To prevent inflammation, the leg requires rest for 1 to 3 days. The underlying disease that caused the synovitis is also treated.

Causes

The main causes of knee bursitis:

• Knee injuries range from severe (from falls, impacts) to microtraumas due to regular physical activity on the knees.
• Excessive physical activity due to obesity, carrying heavy objects, and playing strength sports.
• Diseases in which salts are deposited in the joint in the form of microcrystals.
• Arthritis of various natures (rheumatic, psoriatic and others).
• Spread of bacterial infections.
• Autoimmune diseases.
• Arthrosis of the knee joint (gonarthrosis).
• Malfunctions of the endocrine system.

What is this?

This is an inflammation of the periarticular bursae (from the Latin bursa - bag). Near some joints there are small cavities called bags that allow tissue to glide over the bones. Strictly speaking, the bursae are not directly related to the joints, are not connected to them, but are simply located nearby. From the inside, they are lined with a synovial membrane, which normally secretes a small amount of fluid, which is enough to lubricate and slide the tissues. When such a bursa becomes inflamed, the joint itself is not involved in the process.

Diagnostics

Consulting a doctor will help confirm bursitis. Inspection of the joint, palpation and a series of tests will be required. Moreover, with bursitis of the right knee joint, you need to pay attention to the left knee (and vice versa). An orthopedic traumatologist evaluates pain, swelling and other signs, asks you to make some movements to understand what exactly causes the most pain and where the inflammation occurs.

Instrumental diagnosis of bursitis:

• Ultrasound – for visualization of periarticular tissues, the meniscus, the amount and nature of intra-articular fluid, the location and boundaries of inflammation.
• MRI is the most informative method for diagnosing soft tissues.
• X-ray (an alternative to computed tomography) - assessment of bone structures - the presence and foci of their degeneration and destruction.
• Diagnostic puncture - collection and laboratory examination of fluid.

Laboratory diagnostic methods:

• Tests to look for diseases that could cause bursitis.
• A blood test for general and specific indicators that will indicate the autoimmune nature of bursitis.
• Analysis of joint fluid.

Clinically Relevant Anatomy

The patella is a triangular bone located in the anterior part of the knee joint. When you bend or straighten your knee, it slides into the intercondylar groove of the femur. The patellar tendon is a tough structure that connects the underside of the patella to the tibia. The top of the patella is connected to the quadriceps muscle, which extends the knee and moves the patella upward. The bursae around the knee can be divided into two groups - those that lie around the patella (the suprapatellar bursa, the superficial and deep infrapatellar bursa, and the prepatellar bursa) and those that lie elsewhere (the pes anserine bursa and the iliotibial bursa).

Treatment of knee bursitis

Both conservative methods and surgical interventions are used.

Conservative treatment:

• Medicines – for the treatment of bursitis of the knee joint, taking into account its cause, the following can be used: anti-inflammatory drugs, painkillers, antibiotics (in tablets, gels and ointments or injections). The course of taking prescribed medications is 5-7 days. If the clinical picture remains without positive changes, the drugs are changed.
• Puncture - a puncture is done to remove accumulated intra-articular fluid and rinse the cavity of the bursa with anti-inflammatory drugs. In case of purulent inflammation, drainage is installed for the internal cavity of the joint in order to remove the accumulating pus out.
• Physiotherapeutic procedures - techniques such as laser, ultrasound, magnetic, electro-, shock wave therapy activate blood circulation and lymphatic drainage, reduce inflammation, swelling and pain, accelerate healing processes, and “break up” salt deposits. One effective way to relieve swelling and pain is to apply a cold compress.
• Therapeutic physical education - classes using an individual set of exercises (and preferably under the supervision of a doctor or exercise therapy instructor) speed up recovery.

The operation is the opening and even removal of the inflamed bursa if conservative procedures are unsuccessful and an abscess or phlegmon develops (spill of purulent contents beyond the bursa and “melting” of its walls).

Exactly how to treat knee bursitis will differ depending on the type of pathology. So, in case of acute bursitis, which has developed for the first time, it is necessary to ensure temporary immobility in the joint (at least reduce the load). This will be helped by supporting bandages, wearing an orthosis, taping, temporary refusal or reduction of physical activity.

With chronic inflammation, joint immobility is less important. In this case, more attention is paid to an individually selected set of physical therapy exercises and the prescription of anti-inflammatory drugs.

In case of septic inflammation, it is necessary to act on the causative agent of inflammation. You cannot do without antibiotics and (in many cases) without drainage of the joint cavity.

Complications

Any form of bursitis leads to severe complications. Untreated acute bursitis can provoke the development of an acute purulent process when the surrounding tissues are affected by pathogenic bacteria. Arthritis develops, which limits a person’s movements and does not allow him to fully engage in sports. When the acute phase becomes chronic, further discomfort and constant pain force a person to leave sports and stop engaging in his favorite profession.

If you start self-medicating and do not consult a doctor in time, you can bring the process to a sad state.

Where to treat bursitis in Moscow

A quick and accurate diagnosis of diseases of the musculoskeletal system (including joints) will be carried out at the Kuntsevo Treatment and Rehabilitation Center. For this we have all the necessary equipment and doctors with extensive experience.

We are ready to offer the safest and most effective treatment methods. The clinic has a specially equipped day hospital for minimally invasive procedures and a physical therapy room with all the necessary exercise equipment. Classes are held in small groups or individually.

Book a consultation by phone.

What physical therapy methods are available?

Most cases of infrapatellar bursitis are treated with physical therapy. Doctors often prescribe ultrasound and laser treatment. The following procedures may also be prescribed:

• in acute cases of bursitis, ultrasound treatment with the use of non-steroidal or hormonal drugs is prescribed;
• Electrophoresis is effective for this form of pathology;
• UHF therapy.

Physiotherapy is carried out by an experienced specialist. It improves joint mobility and stops the inflammatory process. Physiotherapy must be carried out in several courses. Physiotherapists recommend at least 2-3 courses of treatment per year. Only the attending doctor can tell which method is necessary. All cases are individual, sometimes only 1 method is required, and in other situations 2-3 procedures are performed simultaneously. It all depends on the course of the disease and the well-being of the victim.

Epidemiology

Prepatellar bursitis occurs more often in men than women and can occur at any age. 80% of people with prepatellar bursitis are men aged 40 to 60 years. In 1/3 of cases, prepatellar bursitis is septic in nature and in 2/3 it is non-septic. Infectious prepatellar bursitis occurs more often in children than in adults. Prepatellar bursitis is quite common, with an annual incidence of at least 10/100,000. The incidence of prepatellar bursitis is probably underestimated because most cases are not septic and only patients with the most severe conditions require hospitalization.