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Bursitis on the knee

definition

Bursae are flat, fluid-filled, pillow-like tissue structures that are embedded between hard (e.g. bones) and soft (e.g. muscles) structures. They are located in the vicinity of joints, i.e. in the area of increased mechanical stress, e.g. on the knee. The forces acting on the joints are reduced and dampened by the bursa. This naturally protects the knee joint. If this bursa in the knee joint becomes inflamed, it is called bursitis of the knee. The inflammation leads to increased fluid storage in the bursa, which causes it to expand. The increase in size can cause neighboring structures such as muscles or nerves to become trapped. The result is pain in the knee and restricted mobility in the knee.

root cause

Mechanical overload
The most common cause of knee bursitis is mechanical overload. Repetitive, sustained physical activity with the main stress in the knee joint (such as those carried out by high-performance athletes or tilers) lead to permanent irritation and constant pressure on the knee. It arise small injuries inside the bursawhich ultimately lead to inflammation.

Injuries to the knee
Also Accidents and injuries can be the cause of bursitis in the knee. With a thud, for example, the bursa can fill with blood and cause inflammation. With an open wound in the knee area bacteria or other microorganisms get into this, infect and cause bursitis of the knee (foreign bodies left in the wound after an accident or injury, such as splinters, can also inflame the bursa).
Musculoskeletal and metabolic diseases
Various diseases can cause bursitis of the knee. There is a possibility that musculoskeletal disorders associated with changes in the joints (e.g. Knee osteoarthritis), due to the changed joint structures lead to increased stress on the bursa in the knee and cause bursitis. Metabolic diseases like that too gout where there is to Deposits of uric acid crystals within the joints can also cause inflammation of the bursa in the knee.
A very rare cause of bursitis is tuberculosiscaused by bacteria.

Symptoms

Bursitis of the knee can go unnoticed for a long time. At first, those affected only complain of a slight rubbing or burning sensation in the knee when walking. As the knee continues to be stressed, the symptoms increase over time and the typical signs of inflammation occur. The knee hurts, is reddened, overheated and swollen. The pain is often one-sided and occurs mainly when the knee joint is loaded. Due to the movement-dependent pain, those affected often tend to no longer fully strain the knee and adopt a gentle posture for the affected joint. In rare cases, the inflammation of the bursa can spread to surrounding tissues and the body. This can lead to reddening of the leg and general symptoms such as Fatigue, fever and swelling of the lymph nodes.

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Is there also bursitis without pain?

It is entirely conceivable that bursitis can occur without pain. A painless course is possible, especially in diabetics, as they often have neuropathy with a reduced pain sensation.

But even in otherwise healthy people, bursitis can be painless at the beginning of the disease if no sensitive structures of the joint capsule and its surrounding structures have been irritated. Often the pain only begins with the formation of an effusion.

diagnosis

A targeted questioning by the doctor about physical activities, the job, accidents, injuries or previous illnesses usually leads to the diagnosis you are looking for. In the physical exam interpret swelling, Redness, palpable fluid movements in the knee joint and Pain by pressure or movement on bursitis of the knee. Possibly are the surrounding lymph nodes are visibly and palpably enlarged. If an underlying disease that changes the joints is suspected (e.g. Knee osteoarthritis) can use imaging techniques, such as Ultrasonic or X-ray of the knee joint, Give indications of abnormal joint structures. Is it believed that a metabolic disorder (e.g. gout) Is the cause of the bursitis of the knee, a Blood test caused.

How can I tell the difference between bacterial and bacterial bursitis?

Basically, one can say that bacterial bursitis has a milder course of disease than bacterial bursitis. If those affected observe symptoms that are limited to the joint, such as pain, reddening and swelling only on the knee, an abacterial course can be assumed for the first time.

With bacterial colonization of the bursa, the pathogens often spread, which often leads to general symptoms such as poor performance and fever in those affected. It is not uncommon for those affected to perceive this as a flu-like infection.

Read more on the topic: Bacteria in the blood - how dangerous is it?

If a small wound on the knee can be identified as the cause of the bursitis, it is important to clarify which pathogens could possibly have penetrated the skin defect. Depending on the type of pathogen, typical symptoms are to be expected (Staphylococci→ fever, pus, increased levels of inflammation in the blood, Clostridia → gas fire, tetanus). However, a doctor is always required if symptoms increase or persist for an unusually long time.

Read more on the topic: Inflammation of a wound - you have to pay attention to this!

therapy

Bursitis of the knee is easily treatable and usually heals on its own within four to six weeks. The affected knee should be rested and rested for the first one to two weeks to prevent further irritation of the bursa. The application of splints or bandages is recommended as a supportive measure to immobilize the knee joint. The rest itself should not be carried out for too long in order to prevent muscle loss and permanent restriction of movement in the knee. Here it makes sense to move the knee gently and easily several times a day.

For pain relief, it is advisable to use decongestant measures, such as applying cooling gels or ointments. When using ice packs, you should make sure that the cooling agent is not placed directly on the skin for more than five minutes at a time. Otherwise dangerous frostbite of the skin can occur here. The use of heat should be avoided at all costs. In an inflamed area, this leads to increased pain and worsening of the inflammation.

Anti-inflammatory pain relievers such as Ibuprofen® or Diclofenac® can be used to treat knee bursitis. If, after the treatment of bursitis of the knee, the fluid caused by the inflammation is still in the knee joint, it can be removed by a doctor with minimal medical intervention. The affected knee is punctured with a syringe and the liquid is drained off. In addition, the treating doctor can inject anti-inflammatory or anesthetic agents into the knee. A pressure bandage is then applied.

If the above measures do not improve, if the person concerned suffers from bursitis of the knee several times a year, or if the acute inflammation has turned into permanent inflammation, this may prompt the surgical removal of the bursa. The knee is opened with a skin incision under anesthesia and the whole bursa is removed. The skin incision is then closed with a suture. After the operation, the knee should be immobilized for four to six weeks. During this regeneration phase, the body forms new tissue in the place where the inflamed bursa was once located. This new tissue fulfills a function similar to a bursa. However, renewed inflammation cannot be ruled out.

Also read more on the topic: Bursitis surgery

If a bacterial infection is the cause of the bursitis of the knee, it may be necessary to take an antibiotic. If the cause of the bursitis in the knee is another underlying disease, the therapy depends on the disease causing it.

These ointments can help

Nowadays the use of ointments on normal skin is rather critical, as new studies have shown that the active ingredients contained in the ointments are almost not absorbed by the skin, but rather remain in the top layers of the skin. The benefit of locally applied ointments on the knee is therefore questionable.

If those affected still want to use ointments locally, we recommend diclofenac gel (= Voltaren ointment) for external application. As an active ingredient, it contains a pain reliever that also has an anti-inflammatory effect. So if you assume that the active ingredient is sufficiently absorbed through the skin, it works against both the pain and the signs of inflammation.

An alternative to this can be Octenisept gel or Octenisept solution. If it is placed either as a gel directly on the swollen joint or, when using the solution, using soaked compresses on the affected area, it has a very good anti-inflammatory effect and can lead to a significant reduction in swelling. The effect is mainly based on the external disinfecting and cooling effect.

Read more on the topic: Ointments and creams

When do you need antibiotics?

The use of antibiotics only makes sense if the knee is infected with bacteria. The pathogens are mainly secured by a puncture of the knee joint. If there is no result of the puncture, antibiotics are used mainly in the case of increased inflammation parameters in the blood and accompanying symptoms of infection in the patient, such as in the form of fever. The more severe the disease, the more likely the antibiotics are administered intravenously by means of an infusion.

Read more on the topic: Joint inflammation

Which home remedies can help?

Above all, it is behavior and local measures that can contribute to faster healing of bursitis on the knee. The simplest measure is the physical protection of the joint combined with an elevation of the affected region. This can significantly reduce the swelling. If the affected joint is also cooled at intervals, this relieves the pain and also has a decongestant effect.

A proven home remedy is to use curd compresses over the affected joint. The effectiveness is based on various mechanisms. Since the quark is spread directly from the refrigerator in a thin, damp drying cloth and then wrapped around the joint in the cloth, it cools directly locally. In addition, there is evaporation cooling due to the wetness of the quark. The lactic acid contained in the quark is said to absorb inflammatory substances from the knee joint, although there is no medical evidence for this.

Other home remedies such as using apple cider vinegar or grated ginger on the joint are not recommended as they often lead to massive external irritation.

For more information, see: Home remedies for bursitis

homeopathy

From a medical point of view, homeopathic therapy for bursitis can be tried out by those affected if the course is very mild. However, it should only be used in addition to local measures such as cooling, elevated storage and protection, as there is no evidence for the sole use of homeopathic remedies.

In the case of severe and bacterial inflammation of the bursa, however, homeopathy is not advisable, as in most cases only rinsing the joint and even surgical removal of the bursa are effective. In addition, there may be interactions with antibiotics and painkillers, which would then delay the healing process.

Can you tap a bursitis on the knee (kinesio tape)

Taping the knee in the case of bursitis only helps if the cause of the inflammation and the associated effusion is overuse of the joint. Because only if there is a serous fluid in the joint does it make sense to drain it via the lymphatic system, as is the basic idea behind taping. Figuratively speaking, the tape provides a "drainage rail" for the effusion and ensures that it drains off as quickly as possible.

If there are pathogens in the knee, tape dressing is not advisable to prevent the pathogen from spreading.

Read more on the topic:

Kinesio tape
Taping the knee

A bandage can help

Well-applied bandages help to minimize or reduce the effusion of bursitis because they exert a circular pressure on the tissue and thus prevent fluid from spreading in the tissue. Therefore, they are definitely recommended for the treatment of bursitis. Affected people should, however, be careful not to apply the bandages too tightly so that sufficient blood flow to the affected area is still guaranteed.

Read more on the topic:

Knee brace
Knee joint effusion - how dangerous is it?

How long does knee bursitis last

Experience has shown that an uncomplicated bursitis on the knee lasts about 10-14 days. However, depending on the cause of the disease and the individual health of the person affected, bursitis on the knee can last up to four weeks.

In addition, the behavior of the person affected has a major impact on the course of recovery. If the medically prescribed physical protection of the joint is consistently observed, faster healing is to be expected than with continuous stress.

If a bacterial infection of the knee joint can be determined as the trigger, the healing depends strongly on the response of the pathogen to the selected antibiotic. If there is resistance, the therapy can be extended by days to weeks.

Surgical therapies such as a complete bursitis on the knee joint require about three weeks to heal. The first week after the operation is due to the immobilization of the knee joint and the remaining two weeks to the final healing and gradual loading of the knee joint.

Also read our article: Duration of bursitis on the knee

How long will I be on sick leave with knee bursitis?

It all depends on the individual case, how long you are on sick leave with bursitis on your knee. If the course of the disease is uncomplicated, the duration of the disease can be expected to last 10-14 days. In order to ensure optimal healing of the bursitis, the affected person must be given an additional 3-4 days to gradually build up the physical strain. A sick leave of around 14 days can therefore usually be expected. A sick leave of up to 4 weeks may be necessary for complicated processes.

When do you need an operation?

Surgery should be the last treatment option for bursitis, as it is usually associated with irreversible consequences such as scarring of the access route. In the case of acute bacterial bursitis, however, it is often the only measure that protects the joint from permanent damage.

Worsening symptoms in the form of increasing swelling and general symptoms such as fever despite adequate therapy with NSAIDs and antibiotics are therefore a reason for surgical rehabilitation of the knee.

Read more on the topic:

The operation of a bursitis
Swelling after surgery - tips for treatment

When should you puncture a bursitis?

Any complicated bursitis should be punctured. Doctors summarize all joint inflammations under a complicated course, in which there may be blood or pus in the joint space. If these fluids are not removed, they irreversibly destroy joint structures.

Read more on the topic: Bruise in the knee

In addition, a puncture should be performed if the swelling is so immense that tension cracks in the skin are to be expected. Here mostly only a relief of the effusion helps to alleviate the pain symptoms of the patient.

In very rare cases, a recurrent bursitis is a reason for a puncture to clarify the cause of the inflammation.

Read more on the topic: Puncture of a Baker's cyst

Is a puncture very painful?

Each knee puncture is performed by means of a needle stick into the joint in order to remove the fluid contained there. If the knee puncture is performed correctly, no local anesthesia is performed in order not to falsify the results of the puncture examination. Therefore, a clearly perceptible “prick” must always be expected. However, the removal of the liquid is usually not painful, but rather resembles a changing feeling of pressure.

Read more on the topic: Pain after a puncture

Complications

In the case of bursitis of the knee, it is important to keep the leg still for weeks and to protect it. This can lead to a Muscle weakness come in the affected leg, which is why you should regularly perform light movements.
In addition, it increases Risk of thrombosis by immobilizing the leg. If the leg is not moved much, as is often the case with bedridden people after an operation, one will develop Standstill of the column of blood in the leg and the speed of blood flow decreases. Certain blood components can accumulate and cause dangerous blood clots, a so-called thrombosis, to form. Therefore, it may be necessary to have thrombosis prophylaxis anticoagulant drugs to be carried out on medical order.

General complications after surgical removal or treatment of bursitis of the knee can occur Secondary bleeding, Pain, Wound healing disorders and Scars in the surgical area be. There is also the risk of injuring nerves, ligaments, tendons or muscles in the knee area during the operation.

prophylaxis

It is recommended after the bursitis of the knee has healed regular stretching and strength exercises to strengthen the muscles. The knee joint is additionally protected and stabilized. In the case of repetitive one-sided activities during work, sport or leisure, you should do it in between Relief breaks inserted and, if necessary, alternate the knee that is under load. This enables the tissue to recover from the stress. Especially during sporting activities, you should pay attention to joint-friendly running shoes and correct execution of the movement sequences. When working with increased stress on the knee joint, as e.g. is carried out by tilers, it is advisable to pad the knee against the hard surface. A pillow as a base, knee pads or orthopedic protective bandages can be considered as an aid here.

Which doctor treats bursitis?

In theory, any doctor can diagnose and treat bursitis. It does not matter whether those affected turn to a family doctor or an orthopedic surgeon. In the case of recurring bursitis, however, a closer look should be given to the cause of the recurring clinical picture.

If overuse is the cause, a family doctor can treat the bursitis without referral to a specialist. If there is a certain cause of wear and tear on the joint, an orthopedic surgeon can better explain possible therapy options. As a rule, it is therefore necessary for the family doctor to refer the affected person to a specialist in individual cases.