Anatomy & Background

The knee is the largest joint in the body. It was designed for stability, mobility and for bearing weight. The knee is made up of four bones and three different bone-to-bone joints. These is the patella-femoral joint, tibio-femoral joint, and the tibio-fibular joint. The knee joint itself is surrounded by eleven separate bursae. A bursa is a fluid filled sack that is used to help reduce friction between tendons, and also between tendons and bones. The following are the four major bursae in the knee:

  • Suprapatella bursa is found between the distal femur and the quadriceps tendon. It allows the quadriceps tendon to move freely over the distal femur. It allows for full flexion and extension in  the knee and can be aggravated by a direct impact or from repetitive stressful and strenuos motions.
  • Prepatella bursa is found at the top of the knee covering the kneecap. Bursitis of the prepatella bursa is also known as “carpet layer’s knee,” “housemaid’s knee” or “roofer’s knee.” It can be caused by an acute blow to the knee or from being in a prolonged kneeling position.
  • Infrapatella Bursa is located underneath the kneecap, under the large patella tendon. It is commonly associated with patella tendonitis or from a jumping injury called “jumper’s knee,” which involves repetitive impacts on the knee.
  • Anserine Bursa is located on the inside of the knee. It is found in the area where the hamstring muscle inserts into the lower leg connecting the two. When this bursa becomes inflamed it can produce pain in the inside of the knee, especially when descending stairs.

Causes

  • An impact to the bursa that may cause pain, inflammation, or irritation.
  • A fall, directly onto the knee or the bursa.
  • Continuous pressure on the bursa from activities that involve prolonged kneeling.
  • Repetitive injury to the bursa and tendon from jumping, which can cause tendonitis and bursitis.
  • Bursitis can be a complication caused by a previous condition such as rheumatoid arthritis, osteoarthritis or gout.
  • Infection of the bursa or knee.
  • Bursa can become swollen in response to other knee conditions occurring simultaneously.

Symptoms of Bursitis

  • Pain and tenderness over the location of the bursa.
  • Swelling
  • Loss of range motion of the knee.
  • Pain with activities that stress the bursa such as kneeling, jumping, running or any activities that may cause stress on the tendons lubricated by the injured bursa.

Treating Bursitis

  • You should avoid activities that produce pain or stress on the bursa and the associated tendons.
  • Use ice to reduce inflammation of the bursa and to help alleviate pain.
  • NSAIDS (non-steroidal, anti-inflammatory drugs)
  • Physical Therapy
  • Drainage of the fluid in the bursa may be required in the most severe of cases. Bursa fluids may also need to  be checked for any potential infection.
  • Antibiotics if infections do occur in the bursa.
  • Surgery may be needed, but only in the most severe of cases. If the problem becomes chronic, surgery might also be used.

Medicine Intervenes

First begin by avoiding the activities that produce any pain in the injured area. Then try the following suggestions:

  • RICE: (Rest, Ice, Compression, Elevation) should be used to help alleviate the stress on the bursa.
  • NSAIDS (non-steroidal, anti-inflammatory drugs) to help reduce any pain and swelling.
  • Needle drainage to remove excessive fluid from the bursa.
  • Injection of steroids to reduce swelling in bursa.
  • If infection occurs, antibiotics may be prescribed.
  • In severe cases, surgery may be required to completely remove the bursa.

Prognosis

Normally, patients respond well to conservative treatment of knee bursitis. PLEASE NOTE: that once the pain and swelling has been reduced and motion and strength are restored, the patient should gradually return to full mobility and function. In general, full return to all activity will take anywhere from two to six weeks depending on the severity of the injury. As a preventive measure individuals should:

  • Make modifications in work or daily activities (like kneeling, squatting or possibly wearing protective equipment). Any preventive measures to avoid prolonged pressure or unexpected blows on the bursa will help reduce the chance of the bursitis returning.
  • Maintain strength and flexibility to alleviate stress on the bursa and tendons located in the knee.
  • Avoid highly repetitive activities that stress the previously affected bursa whenever possible.