Knee Bursitis
Knee bursitis usually causes varying levels of pain and may reduce your mobility.

The symptoms of knee bursitis may vary depending on which bursa is affected, the severity of inflammation, and what has caused inflammation. Generally, the affected area of your knee feels warm, tender, and swollen when pressure is applied. 

In addition, knee discomfort, stiffness, irritation, and pain may occur, during both rest and movement. Knee symptoms along with fever may indicate infection, and the condition is known as septic bursitis. It is a serious condition that necessitates immediate medical intervention.

Bursae act as cushions and reduce friction between the surfaces of the bone and soft tissue and are present at various joints in the body.

What is knee bursitis?

Knee bursitis is a painful condition caused due to inflammation of the bursa, a small fluid-filled sac present in the knee joints. 

Of all the knee bursae, prepatellar bursitis, which affects the bursa in front of the kneecap, is the most common form of knee bursitis. 

Prepatellar bursitis

  • Develops when the bursa in front of the knee swells excessively and becomes irritated. 
  • The prepatellar bursa is located at the front of the knee, between the skin, and the patella bone (kneecap).
  • The presence of a lump the size of a lime or bigger in the front of the knee may indicate prepatellar bursitis. 
  • The lump in the front of the knee may feel like a water balloon when pressed, and the knee feels irritated, stiff, and uncomfortable.
  • A prepatellar bursa may become inflamed for a variety of reasons, including:
    • Persistent discomfort
    • Injury 
    • Underlying inflammatory condition
    • Repeated irritation from kneeling
  • Prepatellar bursitis is commonly known as housemaid's knee, carpet layer's knee, coal miner's knee, and carpenter's knee. These nicknames come from occupations that often demand kneeling.
  • Notably, prepatellar bursitis does not always hurt. Even when it has progressed to a chronic stage, prepatellar bursitis causes little to no discomfort 

Other types of knee bursitis

  1. Pes anserine bursa
    • The typical signs include pain and swelling on the medial side (inner side) of the knee, two to three inches below the actual knee joint.
    • It reduces friction between the tibia (bone of the shin) and tendons of the hamstring muscles.
  2. Iliotibial bursitis
    • Manifests as soreness and swelling on the lateral side (outer side) of the knee. 
    • It reduces friction between the shin bone and the iliotibial band (a thick, fibrous band of tissue that runs from the outer hip to just below the knee).
  3. Infrapatellar bursitis
    • Located just below the prepatellar bursa, between the epidermis, and the upper part of the tibia. 
    • A rare kind of bursitis. 

The pes anserine and iliotibial bursae are located deep beneath the skin, so it is uncommon for these bursae to develop septic bursitis.


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What are the causes of knee bursitis?

Knee bursitis may occur due to various causes, including:

Risk factors

  • Sex: Knee bursitis is more common in men than in women; 80 percent of the patients with bursitis are men.
  • Age: Bursitis can manifest at any age but is common among adults aged between 40 and 60 years. 
  • Occupation: Workers who spend considerable time kneeling, such as carpenters, plumbers, and gardeners are more vulnerable.
  • Sports players: Football players, wrestlers, volleyball players, and runners are more prone to bursitis due to overuse.
  • Arthritis and obesity: Being overweight and having osteoarthritis increases your risk of getting inner knee bursitis, also known as pes anserine bursitis.
  • Low immunity: The risks of developing bacterial infections and knee bursitis increase among people with diabetes, people undergoing chemotherapy, or people with an HIV infection.

What are the symptoms of knee bursitis?

Knee bursitis usually causes various levels of pain and can reduce your mobility, depending on the area affected.

Typical symptoms of knee bursitis include:

  1. Swelling at the site
    • An irritated bursa filling with fluid results in swelling around the injured area. 
    • If ignored, a small lump may develop under the skin, which may increase in size if left untreated. 
  2. Tenderness and pain
    • Most people with knee bursitis report pain and soreness, as seen in other knee diseases.
    • Warmth and redness may be present around the affected knee. 
    • The degree of discomfort and tenderness varies from person to person.
    • People with severe bursitis may experience intense pain when moving, bending, or straightening the leg.
    • Some people may only feel pain when touching or applying pressure to the affected knee.
    • The joint may stiffen, restricting the range of motion or flexibility of the knee joints.
  3. Fever
    • Fever and chills may occur if there is an infection.
    • These symptoms subside if prompt treatment is given to reduce infection and inflammation.

What are the complications of knee bursitis?

Bursitis should be examined and treated by a skilled orthopedic doctor because it may progress to cause major problems, such as:

  1. Septic bursitis
    • Septic bursitis is caused by bacterial infection of the inflamed bursa, which needs to be treated by a doctor right away. 
    • Along with the usual bursitis symptoms, such as the warmth of the affected area, you may have a fever and a general sensation of sickness. 
    • This may lead to various other complications, such as:
  2. Calcific bursitis
    • Bursitis, if left untreated for a long time, can cause the affected bursa to accumulate more calcium deposits and harden. 
    • Calcific bursitis eventually causes the affected joint to lose its ability to move.
  3. Ruptured bursa
    • Bursitis, if left untreated, has the potential to burst or tear the affected bursa. 
    • As the bursa ruptures, the inflamed bursa fluid seeps into the joint and surrounding tissue and causes inflammation.

How to diagnose knee bursitis?

It is quite a task to diagnose acute bursitis during physical examination because various other conditions, such as cellulitis, inflammatory arthritis, and joint effusion due to a ligament injury, also present with similar symptoms.

You may need to undergo various tests to confirm the diagnosis:

  • X-ray: Required to rule out any fractures if the injury was caused by blunt force.
  • Blood tests: May help diagnose the presence of infection or inflammation and other related conditions, such as gout.
  • Joint aspiration: Your doctor may aspirate the joint and send the fluid for additional analysis if the result of blood tests is uncertain.
    • In addition to assisting with diagnosis, joint aspiration releases pressure on the bursae and reduces discomfort.

An ultrasound or MRI scan can be done to examine the soft tissue and get a better look at your knee joint.


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What are the treatment options for knee bursitis?

The following treatments could be recommended by your doctor depending on the cause of your knee bursitis:

  • Treatment for septic bursitis with antibiotics
  • Injections of corticosteroids to reduce inflammation
  • Aspiration surgery to remove any extra fluid from the knee
  • Physiotherapy, hydrotherapy, and sports therapy to reduce discomfort and strengthen the knee
  • Assistance in achieving and maintaining a healthy weight
  • Surgical removal if the bursa does not respond to treatment

Preventive measures

You may prevent the recurrence of bursitis post-treatment by making lifestyle modifications and practicing the following:

  • The bursa is subject to greater pressure if you are overweight; therefore, maintain a healthy weight.
  • Prevent potential infections by keeping any wounds on the skin around the joint clean.
  • Use padded foam cushions or additional padding to reduce pressure on your joints. 
  • Wear properly fitting shoes and protect your feet with insoles. 
  • Take regular breaks from your work or activity that may put your joints under pressure.

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Medically Reviewed on 11/2/2022
Image Source: iStock image

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Prepatellar Bursitis:

What Are the Treatments for Knee Bursitis?