Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The treatment of any bursitis depends
on whether or not it involves infection. Aseptic prepatellar bursitis
can be treated with ice compresses, rest, and antiinflammatory
and pain medications. Occasionally, it requires aspiration
of the bursa fluid. This procedure involves removal of the fluid with a needle
and syringe under sterile conditions and can be performed in the doctor's office. Sometimes the fluid is
sent to the laboratory for further analysis. Noninfectious knee bursitis
can also be treated with an injection of cortisone medication
into the swollen bursa. This is sometimes done at the same time
as the aspiration procedure.
Septic bursitis requires even further evaluation and treatment. The bursal fluid can be
examined in the laboratory to identify the microbes causing the infection. It requires
antibiotic therapy, often
intravenously.
Repeated aspiration of the inflamed fluid may be required. Surgical
drainage and removal of the infected bursa sac (bursectomy) may
also be necessary.
What about the other knee bursae?
A second bursa of the knee is located just under the kneecap beneath the large
tendon that attaches the muscles in front of the thigh and the kneecap to the
prominent bone in front of the lower leg. This bursa is called the infrapatellar bursa, and when
inflamed, the condition is called infrapatellar bursitis. It is commonly seen
with inflammation of the adjacent tendon as a result of a jumping injury, hence
the name "jumper's knee." This condition is generally treated with ice, rest,
and oral antiinflammatory and/or pain medicines.
A third bursa of the knee is called the "anserine bursa."
It is located on the lower inner side of the knee. This bursa
most commonly becomes inflamed in middle-aged women. This condition is referred to as anserine bursitis. Anserine bursitis is particularly
common in those who are obese. These patients can notice pain in the inner
knee while climbing or descending stairs. Anserine bursitis is generally
treated with ice, rest, and oral antiinflammatory and/or pain
medicines, although cortisone injections are also given.
A bursa is a fluid-filled sac that functions as a gliding surface to reduce friction between moving tissues
of the body.
There are three major bursae of the knee.
Bursitis is usually not infectious, but the bursa
can become infected.
Treatment of noninfectious bursitis includes rest, ice,
and medications for inflammation and pain. Infectious bursitis is treated with
antibiotics, aspiration, and surgery.
References:
Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.
Kelley's Textbook of Rheumatology, W B Saunders Co, edited by Shaun Ruddy, et al., 2000.
Gout is a condition that results from crystals of uric acid depositing in tissues of the body. Gout is a condition that can lead to abnormally elevated levels of uric acid in the
blood, recurring attacks of joint inflammation (arthritis), deposits of
hard lumps of uric acid in and around the joints, and decreased kidney
function and kidney stones.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
Bursitis is inflammation of a bursa. A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. There are 160 bursae in the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
Osgood-Schlatter disease, a painful inflammation just below the knee but above the shin, typically affects adolescent boys. Symptoms include localized pain, inflammation, swelling, and calcification. Osgood-Schlatter disease typically goes away over time, however, symptoms can be helped with antiinflammatory and pain-relieving medications, ice, and rest.
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