Suprapatellar bursitis of the knee joint - symptoms and treatment methods

Suprapatellar bursitis affects the knee joint approximately 3-4 days after injury or increased physical activity. Clinically, it manifests itself as pain, aggravated by walking, swelling, and limited mobility. Treatment of suprapatellar bursitis is predominantly conservative. But when purulent exudate accumulates in the cavity of the knee joint, surgical intervention is required.

General information about the disease

Suprapatellar bursitis is an inflammatory lesion of the suprapatellar bursa, which is located at the junction of the knee cartilages. This joint structure plays the role of a kind of shock absorber. The suprapetellar bursa protects the tendon from excessive mechanical stress, such as friction or compression. Normally, there is always a small amount of liquid in it. With bursitis, its production increases so much that a tumor-like compaction forms in the knee area. The liquid presses on the inner walls of the bag, which leads to the development of an acute inflammatory process.

Moderate and severe bursitis of the suprapatellar bursa of the knee joint

Bursitis of the suprapatellar bursa develops 3–4 days after the injury. It is not uncommon for the first signs to appear after a week. This is due to the fact that at the initial stage there is a gradual accumulation of serous fluid in the bursa cavity. Then it begins to put pressure on the inner walls and an inflammatory reaction occurs. Sometimes, during an injury, blood will enter the cavity of the synovial joint capsule. In this case, a hemorrhagic form of suprapatellar bursitis develops, accompanied by severe pain, severe swelling of the soft tissues and difficulty in mobility of the lower limb.

Moderate suprapatellar bursitis often becomes chronic, since the pain in this form of the disease is not pronounced, and the person does not lose the ability to move independently in space. Accordingly, in most cases, patients with such symptoms do not seek medical help.

The danger of a moderate form of bursitis of the suprapatellar bursa of the knee joint is the risk of developing the following complications:

• spread of the process of inflammation and scarring to the quadriceps femoris muscle with damage to its structural tissues, fascia and tendons;
• a secondary form of deformation and dystrophy of the cartilage tissue of the joints against the background of a decrease in the shock-absorbing capacity of the suprapatellar bursa;
• deposition of fibrin in the cavity of the bag and the formation of a thickened wall with gradual tissue proliferation;
• formation of cystic neoplasms;
• displacement of the kneecap and destruction of the articular plate in the knee.

Severe suprapatellar bursitis often occurs in an acute form with severe general intoxication. The patient experiences severe swelling of the entire area around the knee. The suprapatellar bursa is easily palpable through the skin. It is significantly increased in size, dense, and stiff. On palpation, acute pain occurs. Without treatment, the inflammatory process may spread to surrounding tissues.

Why does pathology appear?

Another name for suprapatellar bursitis is “nun’s knee.” Church workers often suffer from this inflammatory pathology due to prolonged kneeling during the day. Bursitis develops as a result of repeated microtraumas and overloads of the joint. Since the suprapatellar bursa is located close to the surface of the skin, even a minor single household or sports injury can provoke its inflammation. Factors predisposing to the appearance of bursitis include the following pathologies:

• rheumatoid arthritis, scleroderma;
• gouty, infectious, reactive arthritis;
• endocrine diseases, including diabetes mellitus, hypothyroidism;
• some renal pathologies;
• metabolic disorders;
• deforming osteoarthritis (gonarthrosis);
• stagnation of lymph in the knee joint;
• varicose veins, atherosclerosis, obliterating endarteritis.

Allergic reactions and the use of glucocorticosteroids can provoke inflammation. Infectious suprapatellar bursitis, which develops against the background of sepsis, osteomyelitis, phlegmon, and furunculosis, is also diagnosed.

Prevention

By observing the following preventive measures, you can forget about knee diseases:

• use means of protecting the knee joints during traumatic sports (put on knee pads, tightly bandage the joint);
• avoid injury;
• after a blow or fall on your knee, you need to go to the emergency room;
• disinfect skin lesions;
• avoid excessive weight gain;
• do not overload your knees, alternate loads with rest;
• treat infectious diseases in a timely manner;
• do exercises every day, gymnastics and walking are useful;
• do not overcool the joints;
• do not squat or kneel.

The prognosis for bursitis is favorable if the patient follows all the doctor’s recommendations and adheres to the treatment regimen. In the chronic course of the disease, it is important to avoid exposure to predisposing factors, otherwise complications are possible.

Author: Oksana Belokur, doctor, especially for Ortopediya.pro

Symptoms of pathology

In orthopedics and traumatology, acute and chronic suprapatellar bursitis are distinguished. The reason for the development of the latter is the patient’s ignorance of the symptoms characteristic of the initial stage of inflammatory pathology.

For acute bursitis

This form of the disease can manifest itself with moderate or severe symptoms. A round elastic seal is formed in the knee area. When you press it, you feel movement inside the liquid (fluctuation). The skin turns red, swells, smoothes, and becomes hot to the touch. The damaged knee increases in size compared to the healthy joint. The following symptoms also occur:

• pain increases when walking, going up or down stairs, flexing and straightening the joint;
• range of motion decreases.

Infectious suprapatellar bursitis is especially severe. Pathogenic microorganisms that penetrate the joint cavity release toxic products of their vital activity into the surrounding space. As a result, signs of general intoxication of the body appear. These are elevated body temperature, chills, excessive sweating, and in weakened patients - gastrointestinal disorders.

For chronic bursitis

The pathology that has taken a chronic form manifests itself with significantly less severe symptoms. An elastic formation is felt in the knee area, slightly painful when pressed. There is a feeling of stiffness when walking. The pain is mild, intensifying after a sudden change in weather, increased physical activity, hypothermia, or exacerbation of other chronic pathologies. Sometimes, usually in the evening, the knee swells, the local temperature rises, and hyperemia is observed.

What is suprapatellar bursitis?

Location of the suprapatellar bursa in the knee joint

Bursitis is an inflammatory process in the bursa or joint capsule. The pathology is associated with increased production and accumulation of exudate in the bursa, which is manifested by the formation of severe edema.

Suprapatellar bursitis is an inflammation of the popliteal region. This form of bursitis is accompanied by an accumulation of exudate in the lower pocket of the knee joint, that is, directly under the kneecap.

Due to the specific development and characteristic symptoms, this type of bursitis is often called “nun’s knee”, as it can develop due to prolonged kneeling.

Strong pressure on the joint leads to increased production of synovial fluid, which accumulates in the bursa due to lack of movement and causes discomfort. As a result of the accumulation of fluid, the pressure in the bag increases even more, severe pain appears and normal movement in the joint is limited.

Suprapatellar bursitis is considered one of the most common pathologies of the knee joint. Most often it develops due to blows, injuries and bruises to the lower part of the knee joint. The disease is equally common in children and adults, regardless of gender, but most often athletes and people whose professional activities involve constant stress on the lower limbs experience inflammation.

Diagnostics

The diagnosis is made on the basis of specific external signs, medical history, and patient complaints. A series of functional tests are performed to assess range of motion and sensation. A puncture of the joint is performed to collect fluid and examine it further. This allows you to determine the nature of the inflammation and exclude infection of the joint capsule. The following instrumental studies can confirm the diagnosis:

• MRI to assess the condition of soft tissue structures of the knee, blood vessels, nerve trunks;
• arthroscopy to examine the inner surface of the knee joint;
• Ultrasound to determine the localization of the inflammatory process.

If an autoimmune disease is suspected, serological and biochemical studies are performed. The level of antinuclear antibodies, C-reactive proteins, and rheumatoid factor is determined.

Surgery

Surgical treatment is practiced in two cases - severe swelling and infectious inflammation. In the first case, it is necessary to reduce the fluid pressure inside the joint for a speedy recovery; in the second case, you need to install drainage and cleanse the cavity of purulent contents.

To reduce fluid pressure, a puncture is sometimes sufficient. For infectious inflammation, the doctor makes an incision about 3 cm long and then inserts a catheter into the bursa. Purulent contents are pumped out through it, and then the cavity is treated with an antibacterial solution. Additionally, the patient is prescribed antibiotic tablets to treat bursitis and prevent the recurrence of pus in the joint capsule.

Read also: How to take Allopurinol for gout

How to treat suprapatellar bursitis of the knee joint

Treatment methods for acute and chronic disease differ. In the latter case, medications and physiotherapy are used mainly. In the acute course of the pathology, patients are advised to use a gentle motor regimen that eliminates stress on the knee. While walking, it is recommended to wear knee pads with hard metal or plastic inserts. Cold compresses are required. Every hour, an ice pack wrapped in thick cloth is applied to the joint for 10 minutes. This helps prevent inflammation from spreading to healthy tissue.

Conservative therapy

An integrated approach to conservative treatment is practiced using local and systemic medications and physiotherapeutic procedures. The main goals of therapy are the complete elimination of symptoms and the causes of their occurrence.

Drug treatment

Non-steroidal anti-inflammatory drugs are always the first choice. NSAIDs relieve acute and chronic inflammation, reduce the severity of pain, and promote the resorption of edema. Depending on the form of suprapatellar bursitis, therapeutic regimens include drugs in various dosage forms:

• solutions for parenteral administration - Movalis, Lornoxicam, Ortofen, Ketorolac;
• tablets - Diclofenac, Ketoprofen, Nimesulide, Ketorol, Ibuprofen;
• ointments and gels - Indomethacin, Fastum, Voltaren, Artrosilene, Finalgel.

External agents with a cooling effect are also used to relieve pain. This is Bom-Benge ointment, Ben-Gay with menthol. Antibiotic therapy is carried out when pathogenic bacteria are detected in the exudate. Patients are prescribed a course of cephalosporins (Cefazolin, Ceftriaxone), macrolides (Clarithromycin, Azithromycin), semisynthetic penicillins (Amoxiclav, Panclave) for 2-3 weeks.

Physiotherapeutic methods

Carrying out physical procedures helps to increase the body's susceptibility to drug treatment. The impact of physical factors on the inflamed suprapatellar bursa helps to quickly relieve inflammation, eliminate pain and limited mobility. The following physiotherapy procedures are most often used in the treatment of pathology:

• magnetic therapy;
• diadynamic currents;
• applications with ozokerite and paraffin;
• ultraviolet irradiation;
• UHF therapy;
• ultrasound;
• mud therapy.

In the acute and subacute period, to eliminate severe pain, patients are prescribed electrophoresis with glucocorticosteroids, anesthetics, and analgesics. For chronic bursitis, this procedure is carried out with B vitamins, chondroprotectors, and solutions of calcium salts.

Surgery

Despite their high therapeutic efficacy, systemic NSAIDs act nonselectively. Only a certain dose of drugs penetrates into the cavity of the knee joint. Therefore, in some cases, such drug treatment does not give a positive result. The patient is indicated for surgical intervention. The doctor inserts a thin needle into the cavity of the suprapatellar bursa and removes the accumulated exudate. He then rinses it with antiseptic solutions and then treats it with glucocorticosteroids. The post-traumatic wound is drained, and the knee is fixed with an elastic bandage. Patients are prescribed bed rest for 2 days.

The ineffectiveness of conservative therapy for sluggish chronic bursitis over several months becomes an indication for excision of the suprapatellar bursa. During the rehabilitation period, which lasts 2-3 weeks, physiotherapy and physical therapy classes are carried out to restore the functions of the joint.

Therapeutic diet

Following a therapeutic diet can significantly speed up recovery by improving metabolism and accelerating recovery processes in the knee joint. It is necessary to limit foods high in fat and simple (“empty”) carbohydrates in your diet. These include semi-finished meat and fish products, fast food, confectionery and sausages, and baked goods made from wheat flour. Instead, you should include the following products in your daily menu:

• low-fat cheeses, cottage cheese, Varenets, kefir, fermented baked milk, containing a lot of calcium;
• fatty sea fish (salmon, herring, smelt) - a valuable source of polyunsaturated fatty acids and fat-soluble vitamins;
• fresh vegetables, fruits, berries, herbs, which contain a lot of vitamins, microelements, pectins.

Nutritionists recommend that patients with bursitis, in the absence of contraindications, drink at least 2.5 liters of fluid daily. This is clean water, lightly salted mineral waters (Slavyanovskaya, Nagutskaya, Essentuki No. 2), fruit compotes, berry fruit drinks, vegetable juices. Drinking plenty of fluids helps remove toxic products of the inflammatory process from the body.

Folk remedies

Remedies prepared at home according to traditional medicine recipes are used after conservative therapy or surgical treatment. They are used primarily for chronic bursitis during the recovery period. The ingredients of ointments, oil tinctures, herbal teas, infusions and decoctions can eliminate mild discomfort that occurs during increased physical activity. But you cannot use folk remedies with a warming effect, as this can cause inflammation to spread to healthy joint structures.

Treatment

Suprapatellar bursitis of the knee joint is treated using a comprehensive approach. The greatest effectiveness can be obtained with a combination of medications and physiotherapeutic procedures.

The type of treatment is determined by the doctor based on the severity of the disease. In some cases, surgery cannot be avoided.

Medicines

Drug treatment will be effective at an early stage and only if a large volume of serous or purulent exudate has not accumulated in the bursa cavity.

The doctor prescribes medications based on examination data. If bursitis is not complicated by infection, then non-steroidal anti-inflammatory drugs are sufficient. They will not only reduce inflammation, but also relieve pain. You can take tablets and use ointments or gels at the same time. Local agents with an anti-inflammatory effect - Nise or DeepRelief, as well as systemic drugs - Ketoprofen and Diclofenac are suitable.

In case of suppuration and severe symptoms of infection of the bursa, antibiotics cannot be avoided. Broad-spectrum drugs that are used by injection or for washing the joint capsule are effective. The most commonly used are Levomycetin, Streptomycin and Penicillin.

During the treatment period, you need to limit movements in the knee joint as much as possible. To do this, you can use tight bandaging. It is better to move with the help of a cane or crutches.

Physiotherapy

Physiotherapeutic procedures are mainly used for chronic bursitis. In case of calcium salt deposits, laser therapy, magnetic therapy and ultrasound are effective.

Operation

An important role in the treatment of chronic bursitis is played by puncturing the bursa, followed by pumping out the exudate, rinsing with antibiotics and antiseptics. During the first three days, the pain becomes moderate, and later disappears completely. The severity of symptoms gradually decreases.

More complex surgical intervention is required for patients with purulent suprapatellar bursitis. In this case, during the operation the bursa is opened, the purulent contents are removed, and partial removal of the inflamed tissue is possible. Then the bag is treated with antiseptics, and drainage is installed if necessary.

The operation is most effective for chronic and infectious purulent bursitis.

The surgical intervention is low-traumatic and is therefore performed under local anesthesia. The duration of the procedure is about 30 minutes. After surgery, the patient must undergo a rehabilitation course to restore normal joint mobility and improve blood circulation. A complex of exercise therapy is developed for the patient, a tight bandage or fixing splint is applied to the knee.

Immediately after the intervention, the operated knee needs rest. During the recovery period, the load on the knee joint should be minimal.

Consequences of lack of treatment

The chronic form of suprapatellar bursitis is especially dangerous. A person gets used to a certain limitation of mobility and rare mild pain, so he does not consult a doctor. Meanwhile, the inflammatory process in his knee joint slowly progresses, in which nearby connective tissue structures are gradually involved. What are the consequences of lack of medical intervention:

• scarring of the quadriceps femoris muscle, damage to its fascia and tendons;
• destruction of the cartilage layer of the knee with the subsequent development of deforming osteoarthritis;
• formation of cysts in the articular cavity;
• displacement of the kneecap, instability of the joint.

The inflammatory process is accompanied by the deposition of fibrin, which causes thickening of the walls of the suprapatellar bursa, proliferation of its tissues and a decrease in functional activity.

Symptoms

Different bursae become inflamed under different conditions. The bursa directly above the kneecap can be damaged by a fall on the knee. In this case, there is a high probability of wound infection, resulting in the development of suprapatellar bursitis of the knee joint.

Inflammation of the synovial bursa under the kneecap occurs after injury to nearby tendons - for example, as a result of an unsuccessful jump from a height with straight legs. Inflammation on the lower inner side of the knee is typical for women over 40 years of age who are overweight. Bursitis can also occur as a complication of gout, osteoarthritis, and infectious diseases.

Symptoms appear gradually, as follows:

• An increase in the volume of the knee joint without the appearance of severe pain and while maintaining the normal range of motion.
• Local increase in temperature and redness at the site of inflammation.
• Joint pain and limited mobility.
• In the case of bursitis development, a complication is an exacerbation of the symptoms of the underlying diseases.

Experts' forecast

When a patient seeks medical help with complaints about the appearance of the first signs of bursitis, the prognosis is favorable. Timely conservative treatment allows you to fully restore all functions of the knee. If complications develop, the prognosis is less favorable, especially if surgical intervention is necessary. Despite the proper execution of the operation, areas with rough fibrous tissues form in the joint cavity, so in the future there may be a disruption in the functioning of the knee.

Disease prevention

The main prevention of pathology is to exclude traumatic situations. During sports training or increased physical activity, it is necessary to wear elastic knee pads or bandages. They reliably fix all structures of the knee and soften impacts when falling. Orthopedists and traumatologists recommend prompt treatment of respiratory, intestinal, and urogenital infections, the pathogens of which can provoke inflammation of the suprapatellar bursa. You need to take balanced complexes of vitamins and microelements daily to strengthen bone and cartilage tissue, ligaments, tendons and muscles.

Folk remedies

Compresses will help relieve swelling and reduce pain

Suprapatellar bursitis is a complex disease that requires urgent drug therapy. Treating the disease with folk remedies is unsafe. In the case of purulent inflammation, traditional medicine methods can only do harm.

You can use the recipes below only if the inflammation is non-infectious. It is recommended to first agree on the possibility of self-treatment with your doctor.

1. To reduce swelling, take a few pieces of ice, wrap them in a towel, and apply a compress to your knee for 15-20 minutes. The manipulations should be repeated 2-3 times a day.
2. Soak a towel in alcohol tincture of propolis and rub the sore knee. Movements should be soft and smooth.
3. Dissolve a tablespoon of sea salt in a glass of warm water. Moisten a gauze compress in the resulting solution and apply to the sore knee for half an hour.
4. Grate the onion, mix the resulting gruel with two tablespoons of honey and apply to the sore knee, securing with a bandage. You need to keep the compress for half an hour.

To speed up recovery, it is recommended to combine folk remedies with drug therapy. If you have infectious bursitis, you should never use local irritants, as this can lead to the spread of infection.