Knee bursitis
The content of the article:
- Forms of the disease
- Knee bursitis causes and risk factors
- Knee bursitis symptoms
- Knee bursitis in children
- Diagnostics
- Knee bursitis treatment
- Potential consequences and complications
- Forecast
- Prevention
Knee bursitis is an acute, subacute or chronic inflammation of one of the bursae (bursa) located in the knee area. It can be aseptic (non-infectious) and infectious, that is, caused by pathogenic microflora.
Knee bursitis - inflammation of the joint capsule
The bursa, or periarticular bag, is a small sac located between the tendons, muscles, protruding areas of the bones. The cells of the inner lining of the bursa synthesize fluid that facilitates the sliding of anatomical structures. In fact, the bursa is a kind of shock absorber that protects the tendons from significant friction or pressure. The amount of fluid in the bursa cavity is normally small, but with the development of the inflammatory process, the cells begin to synthesize fluid in a larger volume, which leads to an increase in the bursa cavity and is clinically manifested as a tumor-like formation. There are about ten burs in the knee joint, but in clinical practice, inflammation of the goose, infrapatellar and prepatellar bursa is most often observed.
Most often, bursitis of the knee joint is observed in people whose professional activities are associated with increased loads on the lower extremities, for example, among roofers, athletes. In men, this pathology is diagnosed several times more often than in women.
Forms of the disease
Depending on which articular capsule was involved in the inflammatory process, there are:
- patellar (suprapatellar, prepatellar) bursitis - inflammation of the joint capsule located on the surface of the patella, directly under the skin. This form usually develops as a result of prolonged standing of the patient on his knees or injury (blow to the front of the knee, fall);
- popliteal (infrapatellar) bursitis - inflammation covers the bursa located under the patella. The cause of this form of the disease is trauma to the ligamentous apparatus of the knee joint;
- Becker's cyst (goose bursitis) - inflammation affects the bursa located in the popliteal fossa on the back of the joint. The reason for its development lies in excessive stress on the knee joint (obesity, excessive exercise).
Varieties of knee bursitis
By the nature of the inflammatory process, the following forms of bursitis of the knee joint are distinguished:
- serous (aseptic inflammation);
- purulent (inflammation is caused by pyogenic bacteria).
By the nature of the activity of the inflammatory process, bursitis of the knee joint are acute, subacute and chronic.
Knee bursitis causes and risk factors
The most common causes of knee bursitis are:
- overload of the knee joint (usually occurs in athletes);
- repeated microtrauma of the knee joint (typical for people who, while performing their professional duties, have to kneel for a long time);
- single significant trauma (observed in people doing manual labor and / or leading an active lifestyle).
Gout, arthritis, scleroderma can lead to the development of aseptic chronic bursitis of the knee joint. In this case, the inflammatory process is provoked by damage to the inner lining of the cavity of the periarticular bag by salt crystals, i.e., in essence, it is secondary.
Overloading the knee joint often leads to bursitis
Knee injuries, both penetrating and non-penetrating, can cause an infectious form of bursitis, since they contribute to the infection of tissues with pyogenic microbial flora. In addition, the infection can enter the knee joint by hematogenous (with blood flow) or lymphogenous (with lymph flow) through any primary source of inflammation in the body (phlegmon, osteomyelitis, abscess, boil, purulent wounds, sepsis).
In some cases, it is not possible to establish the cause of the knee bursitis.
Factors that increase the risk of developing pathology are:
- metabolic disorders;
- long-term therapy with steroid drugs;
- some kidney disease;
- intoxication;
- autoimmune diseases;
- allergy.
Knee bursitis symptoms
The clinical picture of knee bursitis is determined by the form of the disease.
With patellar bursitis, patients experience severe pain, localized in the region of the anterior surface of the knee joint. Stiffness is felt when walking. On palpation of the patella, a slightly painful, soft-elastic tumor-like formation is determined. In some cases, mild edema of soft tissues develops, their redness and a slight increase in local temperature. Movement in the area of the affected joint is preserved in full or slightly limited.
Popliteal aseptic bursitis proceeds with scant symptoms. Patients complain of not too intense pain in the knee area that occurs during prolonged standing or walking long distances. The affected joint increases slightly in volume.
It looks like a bursitis of the knee
The main symptom of goose bursitis is mild pain that occurs at the time of flexion-extension of the knee joint, for example, when going up or down stairs. With a significant accumulation of inflammatory exudate in the bursa in the popliteal fossa, it is possible to palpate a soft elastic elastic formation.
Infection of the contents of the periarticular bag leads to its suppuration, i.e. the development of purulent bursitis of the knee joint, the symptoms of which are:
- twitching, sharp pain;
- a feeling of fullness in the knee joint;
- sharply painful, tense tumor-like formation;
- swelling of the surrounding soft tissues;
- hyperemia and increased skin temperature in the knee area;
- an increase in regional lymph nodes;
- limitation of mobility in the joint.
With purulent bursitis of the knee joint, the patient's symptoms of general intoxication rapidly increase (an increase in body temperature up to 38-39 ° C, accompanied by chills, headache, lethargy, weakness, weakness).
Chronic bursitis of the knee joint is usually the outcome of an untreated acute form of pathology, but sometimes a sluggish inflammation develops primarily as a result of numerous microtraumas of the knee joint caused by mechanical or vibration effects.
Chronic bursitis of the knee joint is characterized by a sluggish course, with periods of remission and exacerbations. An exacerbation is characterized by a clinical picture corresponding to an acute form of inflammation of the periarticular bag.
Long-term chronic bursitis of the knee joint is often accompanied by the formation of cystic formations.
Knee bursitis in children
Knee bursitis in children is extremely rare. This is due to the fact that the weight of the child is small, and therefore, during physical exertion, falls, the structures of the knee joint are not exposed to excessive impact that could cause their damage.
Children are more likely to have Becker's cyst (goose bursitis)
The risk of knee bursitis increases after children reach 12-13 years of age. Most often at this age, Becker's cyst (goose bursitis) is observed. Clinically, it manifests itself as severe pain in the knee area that occurs when walking up stairs or when the child gets up from a chair after a long sitting position.
Diagnostics
Diagnosis of bursitis of the goose and prepatellar bursa is usually straightforward and is carried out on the basis of data from the clinical picture of the disease. If indicated, the doctor can perform a puncture of the periarticular bag, followed by laboratory examination (clinical and bacteriological) of the resulting fluid. In some cases, especially with bursitis of a goosebone, there is a need for magnetic resonance imaging of the knee joint.
It is somewhat more difficult to diagnose bursitis of the intrapatellar bursa. This is due to the fact that it is located under the patella, as a result of which palpation and examination of it are impossible. In this case, they resort to radiography of the affected knee joint, magnetic resonance imaging and / or computed tomography, arthrography.
X-ray examination of the knee joint allows to confirm the diagnosis of bursitis
A general blood test in this case is not very informative. Changes characteristic of any inflammatory process (acceleration of ESR, an increase in the number of leukocytes, a shift in the leukocyte formula to the left) can be detected.
In order to identify the cause of knee bursitis, consultations of an endocrinologist, allergist, rheumatologist and other narrow specialists are prescribed. If a purulent bursitis is suspected, the patient should immediately be consulted by a surgeon.
Knee bursitis treatment
Treatment of bursitis of the knee joint is carried out by an orthopedist or traumatologist, more often on an outpatient basis, but, if necessary, in a hospital setting.
With the aseptic form of the disease, the patient is temporarily immobilized the affected joint, cold compresses are prescribed. In order to arrest the inflammatory process and reduce pain, non-steroidal anti-inflammatory drugs are used in high dosages. Physiotherapy has a good effect. In the acute period, electrophoresis or ultrasound with corticosteroid ointments is shown, after the inflammation subsides, UHF, paraffin applications are used.
With a prolonged inflammatory process in the periarticular bag, it is punctured with aspiration of the contents and the subsequent introduction of glucocorticoids of prolonged action in combination with local anesthetic drugs.
The severe course of the disease requires systemic administration of glucocorticoids in a short course (no more than three days).
Puncture of the bursa of the knee joint - one of the methods of treating bursitis
In acute infectious bursitis of the knee joint, treatment begins with draining and washing the cavity of the periarticular sac with antiseptic solutions. If it is impossible to establish drainage, frequent punctures of the bursa are performed. Antibiotics of a wide spectrum of action are prescribed, and after receiving the results of the antibioticogram, the drug is replaced taking into account the sensitivity of the microflora. The introduction of antibiotics into the bursa cavity is not indicated.
Treatment for chronic knee bursitis includes:
- taking non-steroidal anti-inflammatory drugs;
- regular exercise therapy, which prevents the risk of developing muscle tissue atrophy;
- performing bursectomy (removal of the affected periarticular bursa) in case of frequent relapses.
Potential consequences and complications
Knee bursitis, especially its purulent form, can lead to serious complications:
- phlegmon;
- lymphadenitis;
- purulent arthritis;
- osteomyelitis;
- calcification;
- soft tissue necrosis.
Forecast
With timely diagnosis and adequate treatment of knee bursitis, the prognosis is favorable. Untimely initiation of therapy or its complete absence contributes to the transition of the disease into a chronic sluggish form.
Prevention
Prevention of knee bursitis is aimed at eliminating risk factors that can cause the development of the inflammatory process in the periarticular bursa. For this purpose, it is recommended:
- normalization of body weight;
- preventing knee injury;
- treatment of foci of purulent infection.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
