Knee Bursitis, medically termed as Prepatellar Bursitis is an inflammation of the bursa situated in front of the knee cap. Bursae are small, slippery, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. Their primary function is to reduce friction and serve both as a cushion and lubricant on the pressure points, between the bones and the tendons, muscles and the skin near the joints.

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This painful inflammatory condition mainly occurs when the bursa becomes irritated and produces excessive fluid, which causes it to swell and put additional pressure on the adjacent parts of the knee. Although any of the bursa in the knee can become inflamed, but knee bursitis most commonly  occurs on the bursa over the kneecap or on the inner side of the knee below the joint.

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Causes

The inflammation of the bursa of the knee mainly occurs due to the following:

• Continuous pressure, such as from kneeling, especially on hard surfaces
• Strenuous activities or overuse of the knees
• A direct blow to the front of the knee
• Bacterial infection of the knee bursa
• Complications from conditions like osteoarthritis, rheumatoid arthritis or gout

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Risk factors

Although this inflammatory condition is quite common, but certain causative factors that aggravate the risk of developing knee bursitis include:

Prolonged Kneeling: People whose work involve putting pressure on their knees for long periods like carpet layers, roofers, coal miners, plumbers and gardeners — are at an increased risk of knee bursitis.

Participation in Sports: Certain sports that result in direct blows or frequent falls on the knee — such as wrestling, football, basketball and volleyball — can make a person more prone to knee bursitis. Even runners can develop pain and inflammation in the pes anserine bursa, (bursae that is situated on the inner side of the knee below the joint).

Health Conditions: Pes anserine bursitis is more commonly noticed in  people suffering from obesity, osteoarthritis or gout.

Symptoms

The common signs and symptoms of knee bursitis depend upon the specific bursae that is inflamed.

• Pain on carrying out any activity, but not usually at night
• Rapid swelling on the front of the kneecap
• Tenderness and warmth to the touch

Complications

In case the condition gets unnoticed for a long time period, it often leads to Septic bursitis characterizing signs like:

• Oozing fluid-like puss
• Red in appearance
• Warmer to touch than other areas
• Looks patchy or has a rash, bumps, or sores
• Fever
• Chills
• Fatigue

Diagnosis And Treatment

On noticing the above mentioned signs and symptoms, do consult a doctor at the earliest to avoid complications. The doctor usually acknowledges the patient’s past medical history, occupation and does a thorough physical check-up including:

• Comparing the condition of both knees, especially if only one is painful
• Gently putting a slight pressure on and around the knee to detect warmth, swelling and the source of pain
• Inspecting the skin over the tender area for redness, or other signs of infection which might indicate septic bursitis
• Carefully move your legs and knees to assess the knee’s range of motion and whether it hurts or pains to bend or flex it independently.

The doctor may also perform some diagnostic procedures like:

• X-rays to make sure there is not a fracture, arthritis or other bone related issue that is causing the swelling and pain
• Imaging techniques like computerized tomography (CT) and magnetic resonance imaging (MRI) scans may be conducted to check for other soft tissue injury.
• Ultrasound to visualise swelling in the affected bursa.
• Aspiration to detect any infections.

Treatment

Although bursitis may gradually improve with time, the doctor mainly aims at mitigating the painful symptoms of the condition. Depending upon the cause and specific bursae that is inflamed, the doctor may suggest the following treatment options.

Medications: If the knee bursitis has occurred due to an infection , the doctor prescribes for a course of antibiotics to subdue to the infection.

Therapy: In case knee bursitis has occurred due to a sports injury, the doctor may recommend physiotherapy as it not only improves flexibility and strengthens muscles but also alleviates pain and reduces the risk of recurring episodes of knee bursitis. If you are a sports person or athlete or in an occupation where you can’t  avoid kneeling the doctor may suggest protective knee braces and compressive knee sleeves to help reduce swelling.

In the case, the knee bursitis is chronic, the doctor might have the following approach:

Corticosteroid injection: If the inflammatory condition does not respond to the above mentioned treatments, the doctor may inject corticosteroid medications directly to reduce inflammation.

Aspiration: The doctor might use a syringe to draw out the accumulated fluid from the bursa to provide short-term relief from pain and swelling.

Surgery: In the case, where the bursitis does not respond to any treatment and are recurrent in nature, the doctor may surgically remove the bursae.

Lifestyle and Home remedies

If the knee  bursitis is acute, to ease pain and discomfort, the doctor may recommend the following lifestyle modifications:

• Rest your knee to avoid movements that may worsen the pain.
• Prescribe over-the-counter pain relievers to help relieve pain temporarily.
• Apply ice until the pain goes away and the knee no longer feels warm and tender to the touch.
• Apply compression by using compressive wraps or knee sleeves to help reduce swelling.
• Elevate the affected knee to help reduce pressure and swelling in the knee.