Knee Bursitis: What You Need to Know
Bursitis occurs when the bursal sac becomes inflamed and is accompanied by pain and swelling. A bursa is a closed fluid filled sac lined with a synovial membrane. If bursitis is unresolved, then it could progress into a chronic condition resulting in thickening of the bursal walls.
Types of Bursitis In and Around the Knee:
- Prepatellar bursitis (washerwoman’s knee, coal miner’s knee, carpet layer’s knee)
- Baker’s cyst
- Pes anserine bursitis
- Gastrocs bursitis
- Infrapatellar bursitis
Some predisposing factors that can result in bursitis in the knee are occupations involving kneeling, obesity, osteoarthritis of the knee, running sports and direct trauma. Bursitis can also be secondary to rheumatoid arthritis, history of ACL injury or meniscus injuries.
Overuse which could cause acute and chronic conditions, trauma, sepsis, gout, vascular rupture and idiopathic.
Don’t confuse bursitis in the knee with other conditions that mimic the same signs and symptoms such as joint effusion (swelling/fluid in the joint), Baker’s cyst, myofascial pain syndrome, foreign bodies, patellar maltracking, patellar tendonitis and rheumatoid arthritis.
Some of the clinical findings which can help to narrow your diagnosis is that there needs to be familiarity with the anatomy and the exact positions of the commonly affected bursae. Range of motion may be painful or painless except on maximum flexion. If there is history of trauma that can be easier to identify, however often the exact inciting incident is unknown. The area may be red and warm and swelling is essential to diagnosis. There can be an antalgic gait (limping during walking) and quadriceps atrophy can be seen for more chronic types. There is no muscle spasm either.
How do we treat bursitis in the knee? The first thing you need to do is follow the RICE principle which is rest, ice, compression, and elevation to reduce the swelling and inflammation in the knee and bursae. Also protect the area and once the diagnosis is identified, seek physical therapy. Modalities such as ultrasound, myofascial release of surrounding tight musculature and gentle ROM exercises may also be indicated. Additionally, stretching tight adjacent muscles and correcting any possible biomechanical faults which may be contributing to pathology is imperative. If you see your orthopedic doctor he or she may prescribe NSAID’s (Nonsteroidal anti-inflammatory drugs) which could help to reduce the swelling and inflammation.
In some chronic cases it may be necessary to undergo surgical excision or a bursectomy. What’s most important is to make sure your bursitis is addressed immediately so it does not become a chronic condition.
Author: Avi Bregman, PT, MPT