Pain and swelling in the front of knee: Knee Bursitis?

Knee Bursitis is also referred to as housemaid’s knee or carpenter’s knee.

Knee bursitis is either infectious nature (30%) with a history of fever, chills and is associated with lower immune response, anaemia and most commonly seen in children and geriatric population. (1)

70% of knee bursitis are due to direct fall on patella, acute trauma, repeated blow or friction of the knee. It is associated with occupation which involves prolonged kneeling: mechanics, carpet layers, gardeners, miners. (1,2)

There are 4 main knee bursa:

1. Supra patellar bursa

2. Prepatellar bursa

3. Infra patellar bursa

4. Pes Anserine Bursa

Signs/ Symptoms:

1. Differential warmth around the knee

2. Tenderness

3. Swelling

4. Pain on moving the knee and weight bearing.

5. Reduce range of motion of knee (2)

6. Runners can develop pain and inflammation in the pes anserine bursa, situated on the inner side of your knee below the joint.

7. Obesity and osteoarthritis. Pes anserine bursitis, affecting the inner side of your knee below the joint, often occurs in obese women with osteoarthritis.

Treatment:

1. Acute Phase:

a. Icing the knee has shown to have great therapeutic outcome. It controls in the inflammation and reduces the swelling. Ice for 20min for 2-3 times a day.

b. Knee Compression Sleeve: It helps in compression of the swollen knee and promotes faster recovery.

c. Exercise: Avoid exercise for 2 weeks until full recover in case of non-infective bursitis. In case of infective bursitis consult GP for tests and medications to manage the infection.

d. Medication: Over the counter pain medication like paracetamol or ibuprofen is advisable for pain management. (3)

Physiotherapy management:

A latest study in 2018 showed that a combination of IFT (Interferential Therapy)

and therapeutic ultrasound has greater recovery outcomes in recreational athletes between the age of 16-35. (4)

Chronic Phase:

1. Corticosteroid injection.

If the bursitis is persistent and not responding to basic treatments, your doctor might inject a corticosteroid drug into an affected bursa to reduce inflammation. The inflammation usually subsides rapidly, but you might have pain and swelling from the injection for a couple of days.

2. Aspiration. Your doctor might aspirate a bursa to reduce excess fluid and treat inflammation. He or she will insert a needle into the affected bursa and draw fluid into the syringe. Aspiration might cause short-term pain and swelling, and you might need to wear a knee immobilizer for a short period after the injection to reduce the chance of recurrent swelling.

3. Surgery. If you have severe chronic or recurrent bursitis and don't respond to other treatments, your doctor might recommend surgery to remove the bursa.

Reference:

1. Yu-Chih H, et al. Endoscopic treatment of prepatellar bursitis. Int Orthop 2011; 35(3): 355–358.(2)

2. Mcafee J.H. et al.. Olecranon and prepatellar bursitis: diagnosis and treatment. West Journal Medicine, 1988; 149: 607-610.

3. Baoge L., et al. Treatment of Skeletal Muscle Injury: A Review. ISRN Orthop. 2012.

4. B. Veerakumar Reddy, M.V. Srinivasan, Department of Physical Education and Sports Sciences, Sri Krishnadevaraya University, “Effects of Ultrasound Therapy, Interferential Therapy and Combination of Ultrasound Therapy with Interferential Therapy on Bursitis of Knee in Sports”. International Journal of Research in Advent Technology, Vol.6, No.5, May 2018.