Overview of Knee Bursitis

Knee bursitis is a condition characterised by inflammation of the bursae, which are small fluid-filled sacs that act as cushions between bones, tendons, and muscles around the knee joint. The inflammation can result from repetitive movements, direct trauma, or underlying medical conditions.

Anatomy of the Knee Bursae

Bursae are located throughout the body and help cushion and reduce pressure points between your bones and the tendons, muscles and skin around your joints.

There are several bursae around the knee, including the prepatellar bursa (in front of the kneecap) and the pes anserine bursa (on the inner side of the knee). The prepatellar bursa tends to be the most common one to become irritated and inflamed.

Causes of Knee Bursitis

• Overuse: Repetitive movements or activities, such as prolonged kneeling or crawling, can irritate the bursae and lead to inflammation.
• Direct Trauma: A fall or blow to the knee can cause bursitis.
• Infection: Bursitis can occur if bacteria enter the bursa (from a cut or wound), leading to infection and inflammation. This is much less common, but can be more serious and needs urgent medical attention.

Risk Factors of Knee Bursitis

• Occupation – People who do jobs such as Plumbers, roofers, carpet layers, and gardeners are more likely to suffer from bursitis due to spending long periods of their day kneeling.
• Sport and Activity – Those who participate in sports that are high contact, in which falls or a direct impact on the knee are common, such as football, hockey, ice skating wrestling, or basketball, are at greater risk for the condition.
• Medical Conditions – Some medical conditions can make you more susceptible to the condition such as rheumatoid arthritis or gout.

Symptoms of Knee Bursitis

Knee bursitis symptoms can vary depending on the severity and the underlying cause. These are some of the most common symptoms:

• Pain: Pain around the affected bursa, which can worsen with movement or pressure. It can also be painful at night.
• Swelling: Swelling around the front of the knee, this is often accompanied by redness and the knee being warm to touch.
• Limited movement: Difficulty bending or extending the knee fully. It can also be painful to walk in more severe cases.

Diagnosis of Knee Bursitis

Your consultant will be able to diagnose your condition during your first consultation. They will talk with you about your symptoms, such as the severity of your pain, how long you’ve had symptoms, and what things aggravate and ease your pain. They will also carry out a physical examination to confirm their diagnosis.

• Physical Examination – 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 heat, tenderness, and any signs of infection. They will also assess the range of motion in your knee may get you to perform a few activities like walking, and squatting.
• Imaging Tests – X-rays may be ordered to rule out other conditions, while an MRI scan or an ultrasound scan can help visualise the inflammation and fluid of knee bursitis.
• Aspiration – If your doctor is concerned that you have infected bursitis, they may aspirate (draw a small amount of fluid with a needle) from the bursa and send this sample to the lab for analysis.

Treatment Options for Knee Bursitis

Treatment for knee bursitis focuses on reducing pain and inflammation, regaining strength and movement and getting you back to pre-injury activity.

Conservative Management

• Rest and Activity Modification: Avoiding activities that worsen symptoms and allowing the bursa to heal.
• Ice: Applying ice to the affected area to reduce pain and swelling.
• Anti-Inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation.
• Physiotherapy: Stretching and strengthening exercises to address muscle imbalances, improve knee mechanics and prevent recurrences.

More Invasive Treatment

• Aspiration and injection: If these treatment measures don’t resolve your symptoms, your knee consultant may drain the bursa with a needle (knee aspiration), and then also inject the bursa with a corticosteroid (cortisone injection). The corticosteroid is a strong anti-inflammatory drug that is used to reduce pain and inflammation associated with knee bursitis

Surgical Options for Knee Bursitis:

Surgery is rarely necessary for knee bursitis and is usually only considered as a last resort, if all conservative treatments have failed.

• Bursa Removal: Your orthopaedic surgeon may recommend surgical removal of the inflamed bursa. After surgery, the knee should regain its flexibility in a few days,  and you can resume normal activities in a few weeks.

Questions & Answers

Can knee bursitis be prevented?
Yes, by using proper knee protection during activities that involve frequent kneeling or direct impact, and by avoiding overuse.

Is it safe to drain the bursa at home?
It’s recommended to have a healthcare professional perform bursa drainage to avoid infection or injury.

Can knee bursitis become chronic?
Yes, if not properly managed, knee bursitis can become a chronic condition with recurrent episodes of inflammation.

Can I continue my regular activities with knee bursitis?
Depending on the severity of your symptoms, you may need to modify activities that exacerbate your condition. Consult a healthcare provider for guidance.

How long does it take to recover from knee bursitis?
Recovery time varies but often takes a few weeks with proper treatment. Severe cases may require more time.