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Knee bursitis

What is it?

Bursitis (ber-SEYE-tis) is swelling and pain of a bursa. A bursa is a fluid-filled sac that acts as a cushion or shock absorber between a tendon and a bone. A tendon is a cord of tough tissue that connects muscles to bones. Normally a bursa has a small amount of fluid in it. When injured, the bursa becomes inflamed (red and sore) and may fill with too much fluid. When you have an inflamed bursa in your patellar (pah-TEL-er) or kneecap area, you have knee bursitis. You may have inflammation (in-flah-MAY-shun) in front of or behind the kneecap. You may also have it on the inner sides of your knees (where they may knock together).

Causes

  • Constant pressure on your knees. This is often caused by kneeling for long periods of time to garden, tile or scrub floors, or lay carpet.
  • Direct, hard hit to your knee. This may happen if you fall hard on bent knees, such as during sports like football or wrestling.
  • Infection (in-FEK-shun).
  • Medical problems such as rheumatoid (ROO-ma-toid) arthritis (ahr-THREYE-tis) or gout.
  • Overusing your knees. This is caused by doing activities or sports that use the same motions (movements) over and over again. Examples of repeating motions are running or jumping.
  • Sometimes people do not know how they developed knee bursitis.

Signs and Symptoms:

Your bursitis may be a problem that you have only once. More commonly, it is a long-term problem that comes and goes over time. Your bursitis may happen suddenly if it is caused by things like infection or a hard hit to the knee. You may have one or more of the following:

  • Decreased movement. Your knee may feel stiff or unable to move as well as it usually does.
  • Pain or tenderness in your knee. You may have pain or tenderness while walking, kneeling, or when your knees touch together. The pain may be worse when you do an exercise that uses repeated movements, or when climbing stairs.
  • Redness and warmth. If the bursa is infected, the skin over the knee may be red and warm. You may also have a fever.
  • Swelling on top of the kneecap or the inside area of your knees.

Wellness Recommendations:

  • The most important part of treating bursitis is resting your knee while it heals. Resting your knee decreases swelling and keeps the bursitis from getting worse. When the pain decreases, begin normal, slow movements.
  • Use ice for two to three days. Ice causes blood vessels to constrict (get small) which helps decrease inflammation (swelling, pain, and redness). Put crushed ice in a plastic bag or use a bag of frozen corn or peas. Cover it with a towel. Put this on your knee for 15 to 20 minutes, three to four times each day. Do not sleep on the ice pack because you can get frostbite. Your caregiver may also tell you to use an ice cube to massage your knee. To do this, rub the ice cube in gentle circles over the inflamed area.
  • Lie down and elevate (raise) your knee by propping it on pillows. Raising it to a level above your heart may help decrease the swelling.
  • After two or three days, you may try using heat to decrease knee pain and stiffness. Use a hot water bottle, heating pad, whirlpool or warm, moist compress. To make a compress, dip a clean washcloth in warm water. Wring out the extra water and put it on your knee for 15 to 20 minutes, three to four times each day. Your caregiver may tell you to switch between treating your knee with ice packs and heat treatments. Repeat ice and heat treatments as directed by your caregiver.

Medical Care:

  • Caregivers may wrap your knee with tape or an elastic bandage to keep your knee from swelling. Loosen the elastic bandage if your toes begin to tingle or turn blue.
  • You may be given antibiotics (an-ti-bi-OT-iks) to fight infection if needed. Take them as ordered until they are all gone, even if your knee begins to feel better.
  • You may use nonsteroidal (non-ster-OID-al) anti-inflammatory (an-tee-in-FLAM-ah-tohr-ee) medicine (NSAIDs) to help decrease pain and inflammation (swelling). Some NSAIDs may also be used to decrease a high body temperature (fever). This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
  • You may be given shots of medicine called steroids (STER-oids) to decrease inflammation. Caregivers may also give you local anesthesia (an-es-THEE-zah). This medicine helps decrease bursitis pain. Because these shots decrease swelling and pain, you may feel like your knee is healed and that you can return to heavy exercise. It is important not to exercise your knee until your caregiver says it is OK. You could make the bursitis worse if you exercise your knee too soon.
  • Your caregiver may want you to go to physical (FIZ-i-kal) therapy. A physical therapist (THER-ah-pist) can do treatments to help your knees. Exercises to make the muscles and tendons of your knee, thigh, and calf stronger will be started after the bursitis has healed. Caregivers may use ultrasound to increase blood flow to the injured area. Caregivers may use massage to stretch the tissue and bring heat to the injury, which increases blood flow. This can help your knee heal faster and better. You may slowly increase the amount of weight you put on your leg when caregivers say it is OK. You will be told to stop doing any activity or exercise if you feel any pain.
  • Caregivers may use a needle to drain fluid from your knee. Removing the extra fluid may help the bursitis heal faster. The fluid may be sent to a lab and checked for infection.
  • You may need surgery to drain or remove the bursa. Surgery is usually not needed unless the bursitis is very bad, and does not heal with other treatments..

Following are things you can do to help prevent bursitis from returning:

  • Keep pressure off your knees. Use a soft foam pad or wear kneepads. Use them whenever you must kneel on a hard surface. This includes gardening and doing floor work such as scrubbing, tiling, or laying carpet. If you sit or kneel a lot, take pressure off your knees by standing up and walking around every 20 to 30 minutes.
  • Protect your knees from bumps and hits. Use kneepads if you play sports that may cause hits to the knee. These sports include wrestling, football, and basketball. Use kneepads to protect your knees if you fall often when riding a snowboard.
  • Start exercising when caregivers say it is OK. Slowly start exercise, such as bicycling, when caregivers say that it is OK. Do not begin running or other heavy exercise until you no longer feel any pain, and your caregiver says it is OK. Elevate your legs and put ice packs on your knees after you finish exercising.
  • Stretch before exercising. Always warm up your muscles and stretch gently before exercising. Do cool-down exercises when you are finished. This will loosen the muscles and tendons in your thigh and calf which will decrease stress on your knees.
  • Start treatment right away if you feel bursitis swelling, warmth and pain. Follow the R.I.C.E. plan (rest, ice, compress, elevate) and use NSAIDs as directed by your caregiver.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

    Supplements:

      Complementary Therapies:

      • Acupuncture decreases bursitis inflammation.

      Other ways of treating your symptoms :

      Talk to your caregiver if:

      • You would like medicine to treat bursitis.
      • Your symptoms have not gone away or improved by these self-help measures.
      • Your pain and swelling increase.
      • You have pain in other joints.
      • You have new symptoms.
      • You have a fever.
      • You have questions about what you have read in this document.

      Care Agreement:

      You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

      References:

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      2. American Academy of Orthopaedic Surgeons. Kneecap (prepatellar) bursitis. October 2000. Available at: http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=210&topcategory=knee (cited 3/4/04).

      3. American Academy of Orthopaedic Surgeons. What are NSAIDs? December 2002. Available at: http://orthoinfo.aaos.org (cited 3/1/04).

      4. Arthritis Foundation. Bursitis, tendinitis and other soft tissue rheumatic syndromes (online brochure). September 26, 2003. Available at: http://www.arthritis.org/AFStore/singleproduct.asp?idproduct=3320&idcat=8 (cited 3/4/04).

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      8. Mayo Foundation for Medical Education and Research. Injections. November 19, 2002. Available at: http://www.mayoclinic.com/invoke.cfm?id=PN00046 (cited 3/1/04).

      9. Pinter E & Szolcsanyi J. Systemic anti-inflammatory effect induced by antidromic stimulation of the dorsal roots in the rat. Neurosci Lett 1996; 212(1):33-36.

      10. Richards CF, Koutouzis TK. Tendonitis and bursitis. In: Marx JA, Hockberger RS, Walls RM, Adams J, Barkin RM, Barsan WG et al (eds). Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed. St. Louis, MO; 2002:1599-1607.

      11. Schoen AM. Acupuncture for musculoskeletal disorders. Probl Vet Med 1992; 4(1):88-97.

      12. Schoen RT. Bursitis, tendonitis, myofascial pain, and fibromyalgia. In: Rakel RE, Bope ET (eds). Conn's Current Therapy 2004. Saunders, Philadelphia, PA; 2004:1040-1042.

      13. Taunton JE, Wilkinson M. Rheumatology: 14. Diagnosis and management of anterior knee pain. CMAJ. May 29, 2001; 164(11):1595-1601.

      14. University of Miami School of Medicine. Bursitis of the knee. 2002. Available at: http://www.med.miami.edu/patients/glossary/art.asp?print=yes&articlekey=305 (cited 3/4/04).

      15. Zhang WY & Li Wan Po A: The effectiveness of topically applied capsaicin: a meta-analysis. Eur J Clin Pharmacol 1994; 46(6):517-522.


      Last Updated: 4/4/2014

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