Bursitis is a painful medical condition of the knee bursa.Source: Getty Images
Things to know about knee bursitis
- 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.
- Localized swelling, warmth, and tenderness, as well as knee pain, often accompany bursitis 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.
Knee Bursitis Treatment
Cortisone injections can be used to treat the inflammation of small areas of the body (local injections), or they can be used to treat inflammation that is widespread throughout the body (systemic injections). Examples of conditions for which local cortisone injections are used include inflammation of a bursa (bursitis of the hip, knee, elbow, or shoulder), a tendon (tendinitis such as tennis elbow), and a joint (arthritis).
A medical image of where the knee bursae are located around the knee joint.Source: iStock
What is bursitis?
A bursa is a closed, fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. Bursae is plural for bursa. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.
When a bursa becomes inflamed, the condition is known as bursitis. This can cause swelling, warmth, and tenderness in the affected area. Most commonly, bursitis is caused by local soft-tissue trauma or strain injury, and there is no infection (aseptic bursitis).
On rare occasions, particularly when the immune system is suppressed, the bursa can become infected with bacteria. This condition is called septic bursitis.
A knee bursa can become inflamed due to prolonged kneeling, causing knee pain.Source: iStock
What is knee bursitis?
The knee joint is surrounded by three major bursae. At the tip of the knee, over the kneecap bone (patella), is the prepatellar bursa. This bursa can become inflamed (prepatellar bursitis) from direct trauma to the front of the knee. This commonly occurs when maintaining a prolonged kneeling position, thereby causing irritation of the prepatellar area. It has been referred to as "housemaid's knee," "roofer's knee," and "carpet layer's knee," based on the patient's associated occupational histories.
The strain of the large tendon below the kneecap can cause both tendonitis and infrapatellar bursitis. This 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."
Inflammation of the bursa at the inner side of the knee (anserine area) can cause pes anserine bursitis. Pes anserine bursitis causes local tenderness of the inner knee.
This bursa of the knee is located on the lower inner side of the knee and is called the "anserine bursa." 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.
Bursitis symptoms occur when a bursa is injured, infected, or filled with fluid.Source: iStock
What are causes of knee bursitis?
Bursitis of the knee can occur when the bursa fills with blood from injury and overuse, such as from athletic competition. Bursitis can also occur from rheumatoid arthritis and from deposits of crystals, as seen in patients with gouty arthritis and pseudogout.
The prepatellar bursa can also become infected with bacteria (septic bursitis). When this happens, fever may be present. This type of infection usually occurs from breaks in the overlying skin or puncture wounds. The bacterium involved in septic bursitis of the knee is usually Staphylococcus, which is normally present on the skin. Rarely, a chronically inflamed bursa can become infected by bacteria spreading through the blood.
See an illustration of the knee joint plus our entire medical gallery of human anatomy and physiology
Bursa inflammation contributes to joint pain, knee pain, stiffness, and knee swelling.Source: Getty Images
What are knee bursitis symptoms and signs?
Bursitis can lead to varying degrees of swelling, warmth, tenderness, and redness in the overlying area of the knee.
As compared with knee joint inflammation (arthritis), it is usually only mildly painful. It is frequently associated with increased pain when kneeling and can cause stiffness and pain with walking. Also, in contrast to problems within the knee joint, the range of motion of the knee is frequently preserved and the swelling is outside of the joint.
How do health care professionals diagnose knee bursitis?
Bursitis of the knee is diagnosed based on the typical location of a bursa displaying signs of inflammation including
- knee pain,
- stiffness, and
- sometimes redness and warmth.
Typically, there is point tenderness at the site of the inflamed bursa.
Fluid can be drained from an inflamed knee bursa to alleviate bursitis symptoms.Source: Getty Images
What is the treatment for prepatellar bursitis of the knee? Are there home remedies for knee bursitis?
The treatment of any bursitis depends on whether or not it involves infection. Non-infectious (aseptic) prepatellar bursitis can be treated with ice compresses, rest, and anti-inflammatory and pain medications.
When ice packs and anti-inflammatory drugs are not effective, knee bursitis can require aspiration of the bursa fluid and/or a local cortisone injection. This procedure involves the 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. Cortisone injections are 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.
Pain Management: Surprising Causes of Pain
The prepatellar bursa, infrapatellar bursa, or anserine bursa can all become affected by painful forms of knee bursitis.Source: iStock
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 anti-inflammatory 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 anti-inflammatory and/or pain medicines, although cortisone injections are also given.
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Bursitis treatments vary and medical health care professionals may recommend reducing inflammation of the bursa with medication or knee fluid drainage.Source: iStock
What is the prognosis (outlook) of knee bursitis?
The outlook for knee bursitis is generally very good. Mild bursitis resolves spontaneously with rest. More significant bursitis can require medications (either taken by mouth or locally injected) to reduce inflammation. Infectious bursitis requires drainage, possibly surgical resection, and antibiotics.
Can knee bursitis be prevented?
To the extent that the bursitis is caused by injury or athletic activity, it can be prevented by avoiding reinjury to the bursa and adjacent tissues.
Medically Reviewed on 4/27/2022
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.