Bursitis of the knee joint - types, alternative treatment, symptoms.

The reasons why bursitis of the knee joint occurs are very diverse, and in order for the treatment of the problem to be effective, it is first of all important to find out what factor triggered the progression of the pathology. Ultrasound, MRI, CT or radiography will help diagnose the problem. In the early stages, treatment is prescribed with medication; in advanced cases, bursitis will have to be treated surgically.

Main causes

Knee bursitis is a pathology in which inflammation of the joint capsule develops due to damage to soft tissue. If the disease is not treated promptly, dangerous consequences develop. The disease can be triggered by the following factors:

excessive physical stress on the lower limbs;
knee injury;
penetration through a wound or bloodstream from another source of an infectious pathogen;
allergic reaction;
intoxication;
endocrine and hormonal disorders.

Other causes of knee bursitis may include:

The development of pathology can be provoked by the presence of a gonococcal infection in the body.

rheumatoid polyarthritis;
specific arthritis of the knee joint;
gout;
tuberculosis;
gonorrhea;
syphilis.

Causes of bursitis

Damage! Character:

traumatic;
infectious.

The first, caused by overload, can be acute and lead to the development of acute inflammation. Or become a consequence of prolonged traumatic exposure and develop into chronic inflammation. Athletes are the first at risk of developing severe or chronic bursitis. It is not for nothing that this nosological form belongs to the so-called. occupational illnesses. Chronic bursitis is often the fate of people with large weights due to the constant increased load on the joints.

Infectious lesions of the bursa are usually secondary to the development of an inflammatory process in nearby or distant tissues. The primary source of infection is often:

boils and carbuncles;
felon;
erysipelas of soft tissues;
osteomyelitis;
bedsores.

Pathogens enter the bursa through the blood or lymph flow.

Primary infection of the bursa is possible in the event of direct entry of the pathogen into the cavity of the bursa, for example, due to injury.

Other factors of damage to the joint capsule may include:

autoimmune processes;
allergies;
intoxication;
endocrine pathologies.

Varieties

Considering the symptoms and nature of the course, bursitis of the right or left knee occurs:

spicy;
subacute;
chronic.

Depending on the type of pathogen, there are:

specific or infectious bursitis;
nonspecific or non-infectious.

Pathology is also classified according to the nature of the exudate, which can be:

hemorrhagic;
serous;
purulent;
fibrous;
calcareous bursitis.

Considering the location of inflammation, there are:

Based on the localization of the inflammatory process, the pathology can be identified posteriorly in the popliteal region.

Suprapatellar or popliteal bursitis. In this case, the bursae become inflamed in the popliteal fossa, where the medial ligamentous apparatus is located. The development of this pathology is often influenced by a traumatic factor, which damages the soft structures of the popliteal muscle.
Prepatellar. The inflammation is localized in the area of the patellar bursa. The main cause of development is injury to the right or left knee joint and patella.
Baker's cyst. The formation often occurs on the inside of the knee and develops as a result of increased physical stress on the lower extremities.
Subtendinous or tendobursitis. It affects the tendons, ligaments and bursae of the knee joint. Occurs after injury and infection in the wound.
Cyst of the external meniscus. Inflammation occurs when the lateral meniscus is damaged and its cystic degeneration occurs.

Types, forms, degrees and symptoms of bursitis

The types of knee bursitis are:

suprapatellar (infrapatellar) or popliteal. Develops in the synovial bursa under the knee due to tendon injuries. The knee joint is not involved in the pathological process due to the lack of connection between its cavity and the synovial bursa;
prepatellar with development above the knee due to injury to the patella;
Baker's cyst on the inner side of the lower knee joint due to large body weight. The bursa under the knee is divided into 2 parts and completely occupies the popliteal fossa and is often connected to the joint cavity. Therefore, bursitis can occur against the background of arthritis and complicate the diagnosis and differentiation of the disease.

The figure shows the dislocation of Baker's cyst

According to its form, bursitis is divided into superficial (for example, prepatellar) with localization between the skin and bone tissue. And also deep, which occurs between the rubbing bones of the joint and muscles. Depending on the course and activity, inflammation can be acute or chronic.

Depending on the severity of bursitis, it can be:

serous with moderate redness of elastic skin, slight fever and pain;
infectious (purulent) with tense and hot formation, hyperemic skin, acute pain, high fever, fibrous changes and dense salt formations in the synovial bursa.

Bursitis can develop in connection with systemic diseases: tuberculosis, gonorrhea, metabolic uremia, hyperparathyroidism and inflammation of soft tissues of another nature. Patients complain of general muscle weakness, malaise, and inability to move their legs. They have difficulty sitting down, standing up and walking due to knee pain.

If the synovial bursa and the tendon that comes into contact with it become inflamed, then the disease is called tendobursitis. It is associated with a type of Baker's cyst - a pathology without affecting the knee joint, which is called anserine or crow's foot bursitis.

It is observed in women after 40 years of age due to obesity, knee arthritis, flat feet or diabetes. This pathology occurs in athletes after long periods of running, with a meniscus tear, and in people with long walking, sudden heavy load on the legs, frequent turning of the foot inward, and with sensitive hamstrings.

Subcutaneous prepatellar bursa with localization of anserine bursitis on the inner surface of the knee

Inflammation affects the semimembranous and semitendinosus muscles and the internal collateral ligament at the attachment points. In this case, swelling, hyperemia and pain occur when bending the knee, walking, especially on steps, or standing on one place for a long time.

Which doctor treats knee bursitis? Initially, the patient is examined by a therapist, then by a surgeon and an orthopedic traumatologist. Each doctor can prescribe a specific individual treatment regimen.

Diagnosis is carried out, including differential diagnosis in the presence of signs of arthritis, since it is necessary to treat bursitis of the knee joint depending on its type, shape and severity. The characteristics of the microflora and the degree of sensitivity to drugs are established. Superficial bursitis is confirmed by palpation, deep bursitis is confirmed by X-ray examination.

If necessary, the bursa is punctured to determine the composition of the exudate, as well as cultured on a special medium to identify the specific infectious agent and its sensitivity to the antibacterial treatment.

A detailed blood test confirms the inflammatory reaction in the body. Based on the diagnostic results, the doctor will know how to treat knee bursitis, what medications and physical therapy methods to use.

What are the symptoms of knee bursitis?

At the very beginning of progression, the pathology is accompanied by moderate pain and slight swelling. But over time, the symptoms become more intense, the patient complains of the following manifestations:

A feature of the pathology may be pain in the joint while walking.

impaired functionality of the joint due to the formation of extensive edema;
acute pain symptom on palpation;
pain while walking and at rest;
redness and local increase in skin temperature.

Acute bursitis of the knee joint is characterized by the following symptoms:

the joint swells and constantly hurts;
due to swelling, the functioning of the limb is sharply impaired;
general body temperature rises;
a purulent abscess forms.

Chronic bursitis of the knee joint is accompanied by less severe symptoms:

the mobility of the joint is not impaired, only occasionally there is discomfort when walking;
the resulting soft swelling does not go away, but there is no redness, swelling or increase in temperature;
when protective functions decrease, relapses occur.

Treatment of bursitis of the shoulder, elbow, knee joints

Main vectors of therapy:

Reducing the load on the joint (immobilization, pain relief).
Reducing pain.
Relief of inflammation (compresses, anti-inflammatory and antibacterial therapy; physiotherapeutic procedures).
Creating conditions for the restoration of affected tissues (nutrition, water regime, physiotherapy, therapeutic exercises).

Surgical intervention (puncture, cryotherapy, laser therapy, bursectomy, etc.) may be required in case of significant damage, prolonged course, or development of complications.

How is diagnosis carried out?

The doctor can make a preliminary diagnosis based on the results of examining the joint.
To cure post-traumatic infectious bursitis and avoid negative consequences, if characteristic symptoms occur, you should immediately consult a doctor. Diagnostics begins in the office of a traumatologist, who will conduct an initial examination and collect important information to prescribe a further course of action. To confirm the diagnosis, the doctor will give a referral for the following instrumental procedures:

radiography;
MRI or CT;
Ultrasound of the knee;
puncture of synovial fluid to assess the nature of the exudate.

Diagnostics

Before making a diagnosis, the doctor carefully interviews the patient. Particular attention is paid to the presence of injuries, past illnesses, professional responsibilities and sports activities.

Then the doctor examines the knee, determining the presence of swelling, redness, pain, and limitation of movement.

During an exacerbation of the process, a small amount of fluid is taken from the synovial cavity by puncture to determine its composition, the presence of microbes and their sensitivity to antibiotics.

To resolve controversial issues, the patient is prescribed:

radiography of the joint;
MRI;
Ultrasound.

The x-ray clearly shows the inflammatory process in the bursa above the kneecap

What treatment is prescribed?

Medication

Treatment with medications is prescribed primarily to relieve pain, inflammation and swelling. The doctor prescribes complex therapy, which includes the use of groups of drugs presented in the table:

Group	Action	Medicines
Nonsteroidal anti-inflammatory drugs	Reduce swelling, help reduce inflammation and pain	"Ketoprofen"
		"Diclofenac"
		"Revmoxicam"
		"Ibuprofen"
Hormonal	For severe pain that cannot be treated with NSAIDs	"Hydrocortisone"
		"Diprospan"
		"Triamcinolone"
Muscle relaxants	Relieves muscle tension, thereby reducing swelling and pain	"Baclofen"
		"Structum"
		"Sirdalud"
Antibiotics	Prescribed for the development of infectious purulent bursitis of the knee joint	"Cefazolin"
		"Cefix"
		"Fromilid"

Dimexide can be used externally.
In the acute stage, to make the medicine work better, injections are prescribed; when the symptoms subside, you can switch to tablets. Ointment for bursitis of the knee joint is recommended for external use. Most often, Dimexide and Vishnevsky ointment are prescribed. If the disease was diagnosed at the very beginning of its development, it is successfully treated conservatively, and the course of therapy takes 5-7 days. Otherwise, you cannot do without surgery.

In what situations do they operate?

If conservative therapy is powerless, the knee joint is inflamed, and a deep synovial fistula has formed, which is extremely dangerous, an operation is prescribed, when puncture, drainage or excision of the bursa is performed. Depending on the severity of the pathology, the procedure chosen by the doctor is prescribed:

Puncture. Using a puncture needle, the doctor removes the pathological fluid from the joint, then painkillers and antibacterial drugs are injected into the joint cavity. After the puncture, the patient does not need to be in the hospital, so he can return to everyday activities.
Drainage. An operation in which the bursa cavity is opened, cleaned and drainage is installed.
Bursectomy. Bursitis is removed by excision of the joint capsule. Orthopedic knee pads or orthoses are used to immobilize the joint. After a while, a new one appears in place of the removed bursa.

Exercise and physical therapy

Physiotherapeutic procedures are not prescribed if a relapse occurs. When the condition returns to normal, you can use the following methods:

After the acute condition is relieved, the patient can be prescribed ozokerite applications.

electrophoresis;
phonophoresis;
laser treatment;
restorative therapy, which uses a magnet and its properties;
ozokerite compresses;
UHF.

Regenerative gymnastics and daily training exercises are selected by the doctor. It is not recommended to change the complex of exercise therapy training on your own initiative, because it can cause negative consequences.

While performing exercises, you need to wear a knee brace on the affected joint. You can do this charging:

strain the quadriceps muscle;
bend and straighten the limb at the knee;
make rotational movements with your shin, concentrating the load on the knee.

Alternative medicine

Treatment of knee bursitis at home with folk remedies is carried out only with the consent of the doctor. Using products at your own discretion is unsafe and can cause complications. If your doctor doesn’t mind, you can use the following recipes:

For compresses you need potato juice, which is squeezed from grated root vegetables.

Grate the potatoes and squeeze out the juice. Soak gauze in the liquid and apply to the sore spot overnight.
Heat salt and sand in equal proportions. Place in a bag and apply to your knee.
Moisten gauze with propolis tincture, wrap a compress around the knee, and insulate it with a woolen scarf on top.

Folk remedies

Along with medication, folk remedies are also often used. In combination with other conservative methods, they can produce positive results.

There are quite a lot of folk recipes, but the most often recommended are:

Cabbage leaf , it is advisable to leave it in the refrigerator for a couple of hours first. Next, the sheet is applied to the sore knee and bandaged. Cabbage will help reduce the appearance of swelling and reduce inflammation.
Aloe. The leaf is crushed to a mushy state and applied to the knee joint overnight, after which the leg should be bandaged. This ointment helps well against bursitis and relieves swelling.
Fresh adult burdock root is ground in a meat grinder and mixed with goat fat, at the rate of 3 tablespoons of ground burdock and 2 tablespoons of fat. Afterwards, let it brew for several hours and rub it into the area of inflammation 2 times a day.
Warm baths with the addition of essential oils . They have a calming and relaxing effect. It is recommended to add oils: fir, eucalyptus, tea tree.
Also, with bursitis, it is important to pay attention to nutrition . It should be balanced, contain a minimum of salty, sour, and spicy foods.

NSAIDs and antibiotics for BCS are the main therapy; traditional methods can be used to enhance the therapeutic effect.

Symptoms

There are several symptoms of knee bursitis:

severe inflammation and pain of the knee joint, especially when pressing on it with your hand,
increase in body temperature,
manifestation of frequent pain at night,
development of muscle weakness, difficulty walking,
swelling of the knee compared to a healthy one by 8-10 centimeters,
redness of the skin above the knee,
difficulty moving in the joint, which also begins to hurt,
weakness, fatigue, malaise.

If you have at least one or two symptoms, you need to consult a surgeon to clarify the diagnosis and begin adequate treatment.

What is chronic bursitis and how to treat it?

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Causes

Classic factors in the initial stage of the disease are divided into several categories:

Mechanical damage to periarticular tissues - bruises, sprains, injuries, including degenerative changes in bone.
Infectious penetrations - entry of aggressive bacteria through external cuts or abrasions, or internal infection through lymph.
Pathological changes are due to metabolic disorders, including the deposition of calcium salts.

Despite the theoretical possibility of inflammation of any joint capsule, the most active joints are usually at risk:

brachial;
subscapular;
elbow;
knee;
hip;
ankle;
big toe.

This is due to the daily activity and intense loads of any person on these areas, especially when playing sports or fitness. Mechanical damage takes the lion's share in the appearance of the disease. Of these, the largest number of recorded inflammations is caused by chronic bursitis of the knee joint.

The cause of the development of a long-term illness is usually incompletely cured primary inflammation, or regular repetition of increased load on the joint. This is not only physical activity on a specific muscle group, but also professional routine actions associated with certain professions. There are even common expressions like “tiler's knee” or “seamstress's elbow” for patients whose work involves constant routine pressure on one of the joints. Repeating the same manipulations gradually accumulates micro injuries and provokes the transition of frequent bursitis to a chronic condition.

Symptoms

If acute inflammation has clear visual signs in the form of redness, swelling or the formation of a spherical tumor, then chronic bursitis will behave less aggressively. Redness and swelling may not cause a rise in body temperature. The lump of the tumor may be the same color as the rest of the skin and may simply look like a strange deformity, for example on the elbow.

The same picture will be observed with pain. If in the initial acute form the pain is acute and in some positions unbearable, then with the chronic development of the disease, the unpleasant sensations can be reduced to discomfort, habitual and aching.

However, you should not hope that the discomfort will “get used to” and not get worse. One of the unpleasant characteristics of advanced bursitis may be a decrease in the amplitude of action of the joint, which will slowly but surely progress. Infectious bursitis is unlikely to become chronic, since sepsis will quickly occur if infected without medical care. But inflammation of the joint capsule due to metabolic disorders or salt deposition can last for several years, without giving clear signals to its owner.

Diagnosis of the causes of chronic bursitis is usually difficult, since over time the symptoms will blur and the cause may simply be forgotten by the patient. If a mechanical shock occurred several years ago and was not associated with a fracture, then it is quite difficult to recall the injury when interviewed by a doctor.

Complications

The most unpleasant side of an advanced disease is the possibility of complications and the spread of the problem to nearby tissues. In addition to the most common long-term inflammations associated with the loss of calcium particles and classifying chronic bursitis as “stone”, in some cases more serious diseases may develop:

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arthritis;
passive contracture (impossibility of movement);
fistulas (in combination with bone tuberculosis);
osteomyelitis (actual inflammation of the bone and its destruction);
phlegmon (inflammation of soft tissue tissue, purulent);
sepsis (infectious agents entering the blood, commonly called “blood poisoning”);
lymphadenitis (inflammation of the lymphatic system in the area of the problem joint);
cicatricial adhesions (can occur as a consequence of trauma due to ruptures of the mucous membrane).

Treatment

Bursitis is given a separate code in the international classification of diseases and is considered a fairly common occurrence. Getting rid of it is a long process and requires a lot of time and patience. If there are subtle signs that were indicative at the onset of the disease and have ceased to be visible over time, the doctor will be forced to conduct a full examination of the joint to determine treatment tactics.

After a detailed interview to identify old injury or previous diseases, test movements of the joint will be performed. For example, abduction and adduction of the hips for the hip joint, circular and multilateral rotations for the shoulder, flexion and extension for the knee or elbow. Based on the amplitude and nature of the pain symptoms that occur at different turns of the diseased area, a first idea of the severity of the inflammation will be drawn. Also, during palpation, the presence of a “signature” sign of bursitis will be examined - an increase in the inflamed synovial bursa in the form of spherical edema. You'll probably have to be prepared for hardware research:

ultrasound to determine the level of fluid in the bursitis pocket;
computer or magnetic resonance imaging for a complete picture of the condition of bone and soft tissues;
radiography - if there is a suspicion of a change in bone structure or significant calcareous deposits. To determine the biological composition of the fluid, puncture of the mucous pocket and taking a puncture are practiced.

The injection is performed under local anesthesia and does not cause damage. The analysis provides a complete description of the presence of purulent, serous, blood or salt components. Quite often, the fight against chronic bursitis can be carried out in a conservative way.

The main condition for outpatient recovery will be the absence of infection and pathology of nearby tissues and bones. A striking example would be chronic bursitis of the elbow joint, which can be present in a person for several years, as a result of constant emphasis on the elbows and numerous damage to the bursa. If this does not cause severe pain or block the elbow, then the doctor may first prescribe cold compresses to the sensitive area. For swelling, a regular tight bandage may be recommended to block the internal fluid. If daily work requires support on the elbows, then elbow pads will be recommended to absorb regular pressure on the joint capsule.

Non-infectious heel bursitis (the famous abrasion of the Achilles tendon by the back of ill-fitting shoes) can be treated in a similar simple way.

Drug treatment

The use of drugs for chronic bursitis may be necessary in the following cases:

exacerbation of chronic bursitis;
calcification of articular tissues and loss of motor activity of joint joints;
metabolic disease;
the occurrence of pathology that destroys periarticular soft tissues and the bone base.

For painful episodes of a non-infectious nature, corticosteroids can be prescribed, which significantly facilitate motor activity and relieve aching pain at night. The course of hormonal drugs is usually not long and gives a quick effect. In case of calcification and metabolic disorders, medications that remove excess salts, examination by an endocrinologist and an individual diet will be prescribed. If a pathology is detected, the doctor’s prescriptions will include a set of medications that may include antibiotics to combat chronic inflammation.

Physiotherapy

One of the most effective ways to treat chronic inflammation. Today, there are many options for physiotherapeutic procedures, and the attending physician can always choose the most useful ones for each specific problem. This can be ultrasound, thermal procedures, as well as radiation therapy, which has an additional analgesic effect.

The procedures are prescribed in courses of 10 days, with breaks to check the results achieved. Although these methods are considered auxiliary, they are the most comfortable and psychologically beneficial for patients.

Traditional methods of treatment

Traditional medicine recipes are very diverse and can always help if you have an accurate diagnosis and symptoms. You can always consult with a doctor who controls the treatment plan for additional support with non-drug medications.

For example, if you need to remove excess salts, you can discuss with your doctor taking infusions of coltsfoot, horsetail and cinquefoil. For swelling, a cold compress with ice cubes and chamomile will relieve inflammation. Traditional Vishnevsky ointment will help you hold on for some time before visiting the doctor. It is important to remember the basic rules - for home treatment, a doctor’s permission is required. The purchase of folk remedies can only be done in pharmacies, in compliance with the recommended preparation methods.

It is also necessary to remember that if there is an infection, self-medication is strictly prohibited.

Operation

Surgical intervention for chronic inflammation of the joint capsule is carried out in extreme cases, when all possible methods of conservative treatment have been exhausted. Usually they try to use a laparoscopic method that does not leave large scars.

The most common operations are to excise the bursa and remove excess fluid, or remove excess hardened calcium deposits that physically impede the functioning of the joint. Surgery as the last stage is usually performed to relieve severe pain, restore functionality, or eliminate emerging pathologies.

Prevention

The best tactic to prevent the transition of bursitis to the chronic stage should be timely contact with a medical specialist - a traumatologist, rheumatologist or surgeon - at the initial stage of the disease, especially if the cause of bursitis is an injury.

A full course of treatment and subsequent regular checks of the joint at least once a year are the key to reducing the risk of chronic disease. Paying attention to physical activity and limiting sudden or numerous monotonous movements for any joints will mean real care for your own body.