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Bursitis of the knee
What is bursitis?
Bursitis is inflammation and swelling of a bursa. A bursa is a fluid-filled sac which forms under the skin, usually over the joints, and acts as a cushion between the tendons and bones. There are a number of different bursae around the knee joint. "Housemaid's knee" is inflammation of the bursa located in between the kneecap and the skin.
The main symptoms of bursitis are pain, swelling and tenderness.
Any of the bursae around the knee can become inflamed.
How do we treat bursitis at the Mansfield Clinic?
The first step in treatment of any bursitis is to use simple measures such as ice packs, painkillers and anti-inflammatory medication.
If the swelling caused by bursitis is particularly severe, you may need to consider having the fluid drained out. This procedure, known as aspiration, can relieve the pain in your joint. During aspiration, Dr Allfree will use a needle to draw out the fluid before covering the area with a dressing. You will need to avoid strenuous activity for about two days afterwards.
If your bursitis symptoms are very severe or they do not respond to simple treatment, steroid injections introduced into the inflamed bursa are another possible treatment option.
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What causes bursitis?
A bursa around the knee can become inflamed through injury, pressure or repetitive movement. Your risk of developing bursitis is increased if you regularly take part in physical activities that involve a lot of repetitive movement, for example running. People who spend a lot of time kneeling, such as carpet fitters and miners, also have an increased risk of developing bursitis in front of the kneecap - this is known commonly as "housemaid's knee".
Less commonly, bursitis can develop as a result of an infection or as a complication of certain conditions, such as gout or rheumatoid arthritis.
The severity of bursitis depends on how inflamed the bursa is. It can cause swelling and stiffness and the affected area may also be warm and red.
The pain of bursitis usually feels like a dull ache aggravated by movement or direct pressure. Bursitis in the knee is usually aggravated by kneeling down.
Septic bursitis
Septic bursitis is caused by infection. This can cause other symptoms, such as:
- a high temperature of 38ºC or above
- feeling shivery
- an infection of the deeper layers of the skin - this is called cellulitis
- broken skin over the affected area
Treating bursitis
Resting the affected area, using an ice pack to reduce inflammation, and taking painkillers such as paracetamol and ibuprofen will help relieve the symptoms and speed up your recovery. The pain usually improves within a few weeks, but the swelling may take longer to resolve. Purpose-made ice packs are available from the Mansfield Clinic.
Self-care
There are a number of other things you can do to reduce the swelling. Rest the knee until your symptoms improve and avoid strenuous activities that are likely to cause additional pain, such as running.
Wearing padding may help protect the joint from further injury. For example, knee pads may help.
Aspiration
If the swelling caused by bursitis is particularly severe, you may need to to have the fluid drained out. This procedure, known as aspiration, can relieve the pain and improve the range of movement in your joint. During aspiration, Dr Allfree will use a needle to draw out the fluid before covering the area with a dressing. You'll need to avoid strenuous activity for about two days afterwards.
Corticosteroids
If your bursitis symptoms are very severe or they do not respond to treatment, steroid injections into the bursa are another possible treatment option. Steroid injections are used to reduce inflammation.
Possible side effects include the wasting of the surrounding tissue under the skin and discolouration of the skin around the injection site.
You will not be able to have a steroid injection if you have septic bursitis, and you cannot have more than three steroid injections a year in the same area.
Antibiotics
If you have septic bursitis, you will need a course of antibiotics. If you are prescribed antibiotics, it is important that you finish the entire course, even if your symptoms improve. This will help to prevent the infection returning.
Referral
If your symptoms do not improve with treatment after a couple of months, you may need referral to an orthopaedic surgeon, and Dr Allfree will be able to arrange a referral for you. You may also be referred if you have infected bursitis that does not get better or reoccurs. Surgery may be recommended to remove the affected bursa, particularly where septic bursitis does not respond to antibiotics. Surgery either involves removing the bursa completely, or making an incision in your skin and draining the fluid out of the bursa.