Introduction
A bursa is a closed, fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. 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.
Signs & symptoms
Pain
Swelling,
Warmth,
Tenderness,
Redness in the overlying area of the knee.
Causes
Injury – when the bursa fills with blood
Wear and tear due to overuse, such as from athletic competition.
Rheumatoid arthritis
Deposits of crystals, like gouty arthritis and pseudogout.
The prepatellar bursa can also become infected with bacteria, usually Staphylococcus.
Pathophysiology
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. Prepatellar bursitis, also known as housemaid’s knee, is associated with trauma or with repetitive kneeling over an extended period. The prepatellar bursa is also a common site for septic (infectious) bursitis, a diagnosis that should be considered when there is skin injury, erythema, warmth, or severe tenderness over the patella.
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 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. Anserine (pes anserinus) bursitis is not usually associated with overuse but may occur in patients with medial compartmental osteoarthritis. Clinically, patients complain of pain and tenderness over the anteromedial knee that is worse with knee flexion. This condition may be confused with medial meniscal pathology. Popliteal bursae (Baker cysts) are associated with local swelling and pain on walking, jumping, and squatting. Magnetic resonance imaging (MRI) or ultrasonography can differentiate an isolated bursitis from intra-articular injury.
Diagnosis
History taking and Physical examination
- Point tenderness at the site of the inflamed bursa.
- Comparing the condition of both knees, particularly if only one is painful
- Gently pressing on areas of your knee to detect warmth, swelling and the source of pain
- Inspect the skin over the tender area for redness or other signs of infection
- Carefully moving legs and knees to determine the range of motion.
Imaging techniques
- X-ray.These can be useful in revealing a problem with a bone or arthritis.
- MRIs use radio waves and a strong magnetic field to produce detailed images of structures within your body. This technology visualizes soft tissues, such as bursae.
- Using sound waves to produce images in real time, ultrasound can help your doctor better visualize swelling in the affected bursa.
Aspiration techniques
To rule out an infection or gout in the bursa, a sample of the bursa fluid is taken for testing by inserting a needle into the affected area and draining some of the fluid. This can also be used as a part of treatment.
Treatments
Bursitis often improves over time, so treatment is usually aimed at symptom relief. The treatment of any bursitis depends on whether or not it involves infection.
Non-infectious (aseptic) prepatellar bursitis
Ice compresses
Rest
Anti-inflammatory medications
Pain killers
In severe cases, aspiration of the bursa fluid and/or a local cortisone injection. This procedure involves removal of the fluid with a needle and syringe under sterile conditions. Sometimes the fluid is sent to the laboratory for further analysis.
Septic bursitis
The bursal fluid can be examined in the laboratory to identify the microbes causing the infection. It requires antibiotic therapy, oral or often intravenously in severe cases. Repeated aspiration of the inflamed fluid may be required. Surgical drainage and removal of the infected bursa sac (bursectomy) may also be necessary.
Physical Therapy
A physical therapist or specialist in sports medicine, can do therapies to improve flexibility and strengthen muscles. This therapy might alleviate pain and reduce risk of recurring episodes of knee bursitis. Protective knee braces might help if you can’t avoid kneeling, and compressive knee sleeves can help reduce swelling.
Surgical and other procedures
Invasive treatments for knee bursitis treatment include:
- Corticosteroid injection.If the bursitis is persistent and not responding to basic treatments, your doctor might inject a corticosteroid drug into an affected bursa to reduce inflammation. The inflammation usually subsides rapidly, but you might have pain and swelling from the injection for a couple of days.
- Your doctor might aspirate a bursa to reduce excess fluid and treat inflammation. He or she will insert a needle into the affected bursa and draw fluid into the syringe. Aspiration might cause short-term pain and swelling, and you might need to wear a knee immobilizer for a short period after the injection to reduce the chance of recurrent swelling.
- If you have severe chronic or recurrent bursitis and don’t respond to other treatments, your doctor might recommend surgery to remove the bursa.
Prognosis
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 correction, and antibiotics.
Complications
Chronic and untreated bursitis can result in a build-up of calcium deposits (calcific bursitis) in the soft tissues, resulting in permanent loss of movement to the area.
Disease & Ayurveda
Knee bursitis – Kroshtukaseersha
Nidana
Kshata – trauma
Diet & behaviour causing vitiation of Vaata & Rakta
Purvaaroopa
Not mentioned
Samprapti
Due to inury/ obstruction to channels, vitiated doshas mainly Vaata/Rakta gets located in the knee joint causing pain, swelling and other symptoms of inflammation.
Lakshana
Jaanumadhye maharuja: sthoola: sopha: – Big swelling in the knee joint with severe pain
Kroshtukaseershavth – resesmbles the head of a jackal
Divisions
Not mentioned
Prognosis
yaapya
Chikithsa
Samana
Lepana with rooksha-tikta dravyas
Parisheka with soolaha-sothahara dravyas
Upanaha with Vaataraktaharadravyas
Sodhana
Snehana- Mriduswedana
Vasti
Virechana
Raktamokshana
Commonly used medicines
Sahacharadi kashayam
Rasnerandadi kashayam
Guggulutiktakaghrutam
Brands available
AVS Kottakal
AVP Coimbatore
SNA Oushadhasala
Vaidyaratnam oushadhasala
Home remedies
To ease pain and discomfort of knee bursitis:
- Rest your knee.Discontinue the activity that caused knee bursitis and avoid movements that worsen your pain.
- Take over-the-counter pain relievers.Short-term use of an anti-inflammatory drug, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), can help relieve pain.
- Apply ice.Apply an ice pack to your knee for 20 minutes at a time several times a day until the pain goes away and your knee no longer feels warm to the touch.
- Apply compression.Use of a compressive wrap or knee sleeve can help reduce swelling.
- Elevate your knee.Prop your affected leg on pillows to help reduce swelling in your knee.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha and cause obstruction in channels
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from very hot & cold climates.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid climbing of stairs.
Yoga
Vigorous exercises are not allowed in painful conditions.
Only stretching, moderate walking, and mild cardio exercises are advised. Also, specific yogacharya including bhujangaasana, salabhasana, vajrasana is recommended. Caution must be there to consider the range of movement and flexibility.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Salabhasana
vajrasana
Bhujangasana
exercises for leg pain
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/books/NBK557508/
https://pubmed.ncbi.nlm.nih.gov/22778241/
Author information
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