Bursitis Knee

Bursitis Knee

Article by J.Miller, S.Armfield

What is Knee Bursitis?

Knee Bursitis

Knee bursitis can cause pain above, on or below your patella (kneecap). The knee consists of up to 11 bursae. Your knee bursae most commonly subjected to inflammation are your: prepatellar bursa, infrapatellar bursa, pes anserinus bursa and suprapatellar bursa.

Swelling on your kneecap

The prepatellar bursa lies just above the kneecap between the skin and the kneecap. Prepatellar bursitis, “housemaid’s knee”, is derived from being a condition commonly associated with individuals whose work necessitated kneeling for extended periods. Prepatellar bursitis is common in professions such as carpet layers, gardeners, roofers and plumbers.

bursitis knee

Swelling below your kneecap

The infrapatellar bursa primarily consists of two bursae. One bursa sits superficially between the patella tendon (below the kneecap) and the skin. The second is the deep infrapatellar bursa 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 near the shin bone’s upper aspect (tibia). It usually affects middle-aged women and overweight individuals.

Swelling above your kneecap

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. Severe injuries are from direct trauma to the bursa via falls directly onto the knee and 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 Bursitis?

A bursa is a thin sack filled with synovial fluid, the body’s natural lubricating fluid. Your bursa substantially reduces the friction between structures. They allow different tissues such as muscle, tendon, and skin to slide over bony surfaces without catching.

A bursa usually is very thin, but it can become inflamed and irritated. This inflammation 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:

  • Direct trauma or a knee blow.
  • Frequent falls on the knee.
  • Repeated pressure upon the knee (e.g. from activities that entail prolonged periods of kneeling) or repetitive minor trauma to the knee.
  • Knee Arthritis, thus bursitis, can be associated with such conditions as gout, rheumatoid arthritis, and osteoarthritis.

What are the Symptoms of Knee Bursitis?

The symptoms of knee bursitis include:

  • A swelling over, above or below the kneecap.
  • Limited motion of the knee.
  • Redness and warmth at the site of the bursa.
  • Painful movement of the knee.

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 essential difference between fluid accumulation within the bursa and the knee joint.

Symptoms of knee bursitis are 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. A diagnosis is confirmed if there is localised swelling and you feel tenderness over the bursa when pressure is applied.

Concerning scans, an MRI or Ultrasound is the most effective for a definitive diagnosis of knee bursitis.

What is the Treatment of Knee Bursitis?

The diagnosis is relatively simple. Your physiotherapist will also undertake a biomechanical analysis to determine the cause of your bursitis. Factors may include muscle weakness, tightness, pain inhibition, leg length discrepancy, training techniques and more.

More info: Bursitis Treatment

Physiotherapy

Many patients with knee bursitis start to feel better within a few weeks of the injury. Your physiotherapy treatment will aim to:

  • Reduce pain and inflammation. The application of electrical modalities, ice, therapeutic taping and education regarding activity modification
  • Normalise your knee joint range of motion.
  • Strengthen your knee muscles: quadriceps and hamstrings.
  • Strengthen your lower limb: calves, hip and pelvis muscles.
  • Normalise your muscle lengths.
  • Improve your proprioception, agility and balance.
  • Improve your technique and function, e.g. walking, running, squatting, hopping and landing.
  • Minimise your chance of re-aggravation.

Anti-inflammatories or NSAIDs are also used in combination with physiotherapy to help alleviate the pain and swelling. If the bursa becomes infected or your symptoms persist for a prolonged period, your doctor may recommend aspirating the bursa. Alternatively, your doctor may also recommend an injection of a glucocorticoid steroid mixed with a local anaesthetic. If an infection occurs, you may require antibiotics.

Knee Bursa Surgery?

In particularly stubborn cases, surgical removal of the bursa is an option.

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-Surgical Rehabilitation

Post-operative knee rehabilitation is one of the most important, yet too often neglected, knee surgery aspects. 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 your time in a kneeling position. Ice after excessive kneeling can avoid an inflammatory response, which is the first stage of bursitis.

Pacing yourself during activities that entail repeated bending or squatting is also paramount. It is vital to ensure that you take regular rest breaks between bending or kneeling and alternating them with other less aggravating activities. Mainly, you aim for an appropriate balance between rest and exercise. Weight management can play a role in the pressure exerted on lower limb joints and should be considered a long-term preventative measure.

Common Causes - Knee Pain

Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.

Knee Ligament Injuries

Knee Meniscus Injuries

Kneecap Pain

Knee Arthritis

Knee Tendon Injuries

Muscle Injuries

Knee Bursitis

Children’s Knee Conditions

Other Knee-Related Conditions

Knee Surgery

Knee FAQs

For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your knee physiotherapist.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.