What is Knee Bursitis?
Knee bursitis can cause pain above, on or below your patella (kneecap). The knee consists of up to 11 bursae. The bursae most commonly subjected to inflammation are the prepatellar bursa, infrapatellar bursa, pes anserinus bursa and suprapatellar bursa.
The prepatellar bursa lies just above the kneecap between the skin and the kneecap. Prepatellar bursitis has historically been referred to as “housemaid’s knee”, which is derived from being a condition that was commonly associated with individuals whose work necessitated kneeling for extended periods of time. Prepatellar bursitis is common in professions such as carpet layers, gardeners, roofers and plumbers.
The infrapatellar bursa essentially consists of two bursae, one of which sits superficially between the patella tendon (below the kneecap) and the skin and the second referred to as the deep infrapatellar bursa is sandwiched between the patella tendon and tibia bone (shin). It can occur conjunctively with a condition called “Jumper’s Knee”, which involves repetitive strain and irritation to the patella tendon, often from jumping activities.
The third most common knee bursitis, pes anserinus, occurs in the lower, inside part of the knee in close proximity to the upper aspect of the shin bone (tibia). It usually affects middle-aged women and overweight individuals.
Suprapatellar bursitis occurs above the kneecap. The suprapatellar bursa extends superiorly from beneath the patella under the quadriceps muscle. It is vulnerable to injury from both acute trauma and repeated microtrauma. Acute injuries are from direct trauma to the bursa via falls directly onto the knee, as well as from overuse injuries, including running on soft or uneven surfaces, or from jobs that require crawling on the knees, such as carpet laying.
What is a Bursa?
A bursa is a thin sack filled with synovial fluid, the body's own natural lubricating fluid. This slippery sack allows different tissues such as muscle, tendon, and skin slide over bony surfaces without catching. Your bursa essentially reduces the friction between structures.
A bursa is normally very thin, but they can become inflamed and irritated. This is what is known as bursitis.
What Causes Knee Bursitis?
There is a myriad of factors that can contribute to knee bursitis. The most common ones include:
What are the Symptoms of Knee Bursitis?
The symptoms of knee bursitis include:
Knee bursitis swelling is within the bursa, not the knee joint. People often call any swelling of the knee joint "water on the knee," but there is an important difference between fluid accumulation within the bursa and within the knee joint.
Symptoms of knee bursitis are usually aggravated by kneeling, crouching, repetitive bending or squatting and symptoms can be relieved when sitting still.
How is Knee Bursitis Diagnosed?
Your physiotherapist will provide you with a thorough quiz of your medical history and a physical examination of your knee to determine if you have knee bursitis. If there is localised swelling and you feel tenderness over the bursa when pressure is applied, a diagnosis is confirmed.
With respect to scans, an MRI or Ultrasound are the most effective for a definitive diagnosis of knee bursitis.
What is the Treatment of Knee Bursitis?
The diagnosis is the easy part. Your physiotherapist will also undertake a biomechanical analysis to determine what the cause of your bursitis actually is. Factors may include muscle weakness, tightness, pain inhibition, leg length discrepancy, training techniques and more.
Many patients with knee bursitis start to feel better within a few weeks of the injury. Your physiotherapy treatment will aim to:
Anti-inflammatories or NSAIDs are also used in combination with physiotherapy to help alleviate the pain and swelling. If the bursa becomes infected or if your symptoms persist for a prolonged period your doctor may recommend that the bursa is aspirated. Alternatively, your doctor may also recommend an injection of a glucocorticoid steroid that is mixed with a local anaesthetic. If infection occurs, you may require antibiotics.
Knee Bursa Surgery?
In particularly stubborn cases, surgical removal of the bursa may be recommended.
Risks of surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity. The good news is that more than 90% of patients have no complications post-surgery.
Post-operative knee rehabilitation is one of the most important, yet too often neglected, aspects of knee surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced physiotherapist.
How Can You Prevent Knee Bursitis?
Knee bursitis is best prevented by maintaining flexible thigh muscles and reducing the amount of time you are in a kneeling position. Ice after excessive kneeling is recommended to avoid an inflammatory response, which is the first stage of bursitis.
Pacing yourself during activities which entail repeated bending or squatting is also paramount. Ensuring that you take regular rest breaks between periods of bending or kneeling and alternating them with other less aggravating activities is key. Essentially, an appropriate balance between rest and activity is recommended. Weight-management can play a role in the pressure exerted on lower limb joints, and thus should be something considered as a long-term preventative measure.
For more advice, please consult your physiotherapist.
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