Knee pain is one of the most common problems seen in clinical practice by both rheumatologists as well as orthopedic surgeons.
While the typical trauma related knee problem is easy to identify- an athlete who suffers a severe injury on the playing field and has to be helped off- non-traumatic knee pain is more difficult to diagnose.
This article will focus on bursitis (B) which is a very common cause of pain in the knee.
B is due to inflammation of bursae, small sacks of fluid which cushion joints. There are multiple bursae that surround the knee joint. When they become irritated or traumatized, they can begin to develop swelling, redness, heat, and pain.
Some of the more common types of B are:
Anserine B. This is a type of B that is relatively common in middle-aged, obese people who also have osteoarthritis of the knee. The pain is felt along the inside part of the knee approximately two inches below the joint line. It is aggravated by walking and climbing stairs. Because it is a frequent accompaniment to osteoarthritis of the knee, it is often missed or ignored.
The treatment involves local measures such as topical anti-inflammatory drugs, ice, physical therapy and occasionally steroid injection. Steroid injection should be administered using ultrasound guidance.
Prepatellar B affects the bursa in front of the patella- the kneecap. It is predominately related to pressure and is seen in people who are on their knees a lot as a result of their occupation. Examples would be plumbers, electricians, and carpet layers. Gardeners are also at increased risk. The key point is that infection needs to be ruled out because it can be medical emergency. An infected bursa needs to be treated with antibiotics.
Infrapatellar B refers to B affecting the bursa located below the knee cap. It also is seen in people who kneel as a result of their work. Traumatic injuries can also be a cause. Infection also needs to be excluded in patients with infrapatellar B.
Suprapatellar B refers to B affecting the bursa located above the knee cap. It is relatively uncommon but can occasionally be seen in patients who have inflammatory forms of arthritis.
Most type of B will respond to conservative measures such as ice, rest, physical therapy, knee pads, and non-steroidal anti-inflammatory drugs. Some patients will require steroid injection administered using ultrasound guidance.
Key points that should be emphasized are that B is a different condition than arthritis and that it is imperative that infection be ruled out before initiating treatment.
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