Knee joint bursa
The anserine bursa is located inferior and medial to the knee joint. 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. When patients develop inflammation of this bursa, in addition to the pain they will have swelling and tenderness. Anserine bursitis is generally treated with ice, rest, and oral antiinflammatory and/or pain medicines, although cortisone injections are also given.
The semi membranous bursa is located in the back of the knee. Patients with effusions (fluid in the joint) will often get what is called a Baker’s cyst when the fluid in the knee joint pushed in to the semi membranous bursa. This causes swelling and pain in the back of the knee. This is because fluid can enter the bursa but only through a one-way valve system that does not allow the fluid to return. Over time the fluid accumulates in the back of the knee. If this bursa ruptures, the fluid may dissect down into the calf. Treatment involves recognition, ensuring that the patient does not have thrombophlebitis (blood clot) in the leg. If the diagnosis of ruptured Baker’s cyst is made, then treatment involves aspiration of fluid from the knee joint, injection with glucocorticoid, elevation of the leg, and ice. The prepatellar bursa is located in front of the knee cap. This bursa can become inflamed (prepatellar bursitis) from direct trauma to the front of the knee. This commonly occurs with prolonged kneeling position. It has been referred to as "housemaid's knee," "roofer's knee," and "carpetlayer's knee," based on the patient's associated occupational histories. It 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 usually associated with significant 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.
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. It 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 for 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.
The infra patellar bursa is located just below the knee cap 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. When the bursa is inflamed 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. Treatment involves aspiration of the fluid and injection with glucocorticoid solution. The suprapatellar bursa is located above the patella. Bursitis here is relatively uncommon. Treatment is similar to that for the other types of bursitis. Smaller bursae are located near the collateral ligaments along the sides of the knee. These may become inflamed if the adjacent ligament is stressed or injured. Rest, anti-inflammatory drugs, ice, and physical therapy are usually effective. Corticosteroid injection is sometimes used but this area probably is best not injected because of the possibility of weakening of the ligament leading to subsequent rupture.
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