Knee Bursitis

February 2, 2017

Bursitis of the knee occurs when fluid fills up the knee, causing the kneecap to become reddened, painful and swollen. In the body, small sacks of fluid called bursae are found around joints to protect and stabilize these important areas. In the knee, there are 11 bursae that cover the kneecap to protect it from damage. When these burst, whether from trauma or overuse, the knee loses mobility and becomes painful to use when walking.

Types of Knee Bursitis

There are three most common types of knee bursitis –

  • Pre-patellar – The prepatellar bursa lies just above the knee cap between the skin and the knee cap. Prepatellar bursitis has historically been referred to as “housemaid’s knee”, which is derived from being a condition that was commonly associated with individuals whose work necessitated kneeling for extended periods of time. Prepatellar bursitis is common in professions such as carpet layers, gardeners, roofers and plumbers.
  • Infra-patellar – The infrapatellar bursa essentially consists of two bursae, one of which sits superficially between the patella tendon (below the kneecap) and the skin and the second referred to as the deep infrapatellar bursa is sandwiched between the patella tendon and tibia bone (shin). It can occur conjunctively with a condition called “Jumper’s Knee”, which involves repetitive strain and irritation to the patella tendon, often from jumping activities.
  • Anserine – The third most common knee bursitis, pes anserinus, occurs in the lower, inside part of the knee in close proximity to the upper aspect of the shin bone (tibia). It usually affects middle-aged women and overweight individuals.
  • Suprapatellar bursitis occurs above the kneecap. The suprapatellar bursa extends superiorly from beneath the patella under the quadriceps muscle. It is vulnerable to injury from both acute trauma and repeated microtrauma. Acute injuries are from direct trauma to the bursa via falls directly onto the knee, as well as from overuse injuries, including running on soft or uneven surfaces, or from jobs that require crawling on the knees, such as carpet laying.

Busra – A bursa is a thin sack filled with synovial fluid, the body’s own natural lubricating fluid. This slippery sack allows different tissues such as muscle, tendon, and skin slide over bony surfaces without catching. The bursa essentially reduces the friction between structures.

A bursa is normally very thin, but they can become inflamed and irritated. This is what is known as bursitis.

Bursa are of two types –

  • those naturally occurring in the body since birth
  • those that develop at places of repeated friction and pressure, called Adventitious bursae

Both the types are affected by similar conditions.


Usually the bursa becomes irritated or injured after overuse from repetitive motion or strenuous activity. A bacterial infection may also cause bursitis. Other health problems, such as gout or rheumatoid arthritis, can also cause bursitis.

There are a few causes of bursitis of the knee –

  • Overuse – The most common cause of this injury is overuse, which is how it got the nickname housemaid’s knee or clergyman’s knee. When a person puts excessive pressure on this already very thin and delicate area, it can cause the bursae to become inflamed. This in turn can lead to an infection.
  • Acute trauma – When a person receives acute trauma to his or her knee, bursitis can easily develop. The fluids released after a trauma can easily cause infection in this delicate region. When this occurs, the knee becomes inflamed, which can in turn trigger bursitis of the knee. First, blood will flow from the injured area to the spot of inflammation. Then, a cellular reaction will begin and leukocytes will flow to the area, causing an infection.
  • Disease – Several diseases, such as gout, CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia) syndrome, diabetes, sarcoidosis, mellitus, alcohol abuse and chronic obstructive pulmonary disease also can cause bursitis of the kneecap.

Risk Factors

Knee bursitis is a common complaint, but the following factors may increase your risk of developing this painful disorder.

  • Excessive kneeling – People who work on their knees for long periods of time — carpet layers, plumbers and gardeners — are at increased risk of knee bursitis.
  • Participation in certain sports – Sports that result in direct blows or frequent falls on the knee — such as wrestling, football and volleyball — may increase the risk of knee bursitis. Runners may develop pain and inflammation in the anserine bursa, located on the inner side of the knee below the joint.
  • Obesity and osteoarthritis – Anserine bursitis, affecting the inner side of the knee below the joint, often occurs in obese women with osteoarthritis.


The symptoms of knee bursitis include –

  • Swelling over, above or below the kneecap.
  • Limited motion of the knee.
  • Redness and warmth at the site of the bursa.
  • Painful movement of the knee.

Knee bursitis swelling is within the bursa, not the knee joint. People often call any swelling of the knee joint “water on the knee,” but there is an important difference between fluid accumulation within the bursa and within the knee joint.

Symptoms of knee bursitis are usually aggravated by kneeling, crouching, repetitive bending or squatting and symptoms can be relieved when sitting still.


Physiotherapy – Many patients with knee bursitis start to feel better within a few weeks of the injury. The physiotherapy treatment will aim to –

  • Reduce pain and inflammation, this is achieved with the application of electrical modalities, ice, therapeutic taping and education regarding activity modification
  • Normalise the knee joint range of motion.
  • Strengthen the knee muscles: quadriceps and hamstrings.
  • Strengthen the lower limb: calves, hip and pelvis muscles.
  • Normalise the muscle lengths.
  • Improve the proprioception, agility and balance.
  • Improve the technique and function eg walking, running, squatting, hopping and landing.
  • Minimise the chance of re-aggravation.

Medication – Anti-inflammatories or NSAIDs are also used in combination with physiotherapy to help alleviate the pain and swelling. If the bursa becomes infected or if the symptoms persist for a prolonged period the doctor may recommend that the bursa be aspirated. Alternatively, the doctor may also recommend an injection of a glucocorticoid steroid that is mixed with a local anesthetic. If infection occurs, some may require antibiotics.

Surgery is rarely needed for pes anserine bursitis. The bursa may be removed if chronic infection cannot be cleared up with antibiotics.

Complementary and Alternative Treatment

Acupuncture can help reduce swelling and inflammation, and relieve pain.

Chiropractic – Although no well-designed scientific studies have looked at whether chiropractic treatment helps bursitis, chiropractors often treat persons with this condition. They report that some persons have less pain and increased range of motion.

Movement Therapy – Exercising the muscles around your joints will help reduce pressure on the joint and bursa. Gentle yoga may help bursitis by increasing flexibility and reducing muscle tension. Other movement therapies, such as Pilates and Tai Chi, may also help improve muscle and ligament strength and reduce the tension caused by repetitive motions.

Massage – People should not use massage if your bursitis is caused by an infection. Otherwise, massage, especially myofascial release therapy, may help to relax and may reduce the discomfort from a sore joint.


Glucosamine sulfate is a substance found in cartilage, the tissue that covers the ends of bones in a joint. Some evidence suggests it may help treat the pain of osteoarthritis, and it may also help reduce inflammation in bursitis. Glucosamine increases the risk of bleeding.

Omega-3 fatty acids such as fish oil or flaxseed oil – Although evidence is mixed on whether fish oil helps reduce inflammation, it seems to reduce the amount of inflammatory chemicals your body makes over time.

Vitamin C with flavonoids used to help repair connective tissue (such as cartilage).

Bromelain an enzyme that comes from pineapples, reduces inflammation. Bromelain may increase the risk of bleeding, so people who take blood thinners should not take bromelain without first talking to their doctor.

Turmeric is sometimes combined with bromelain because it makes the effects of bromelain stronger.

White willow acts similar to aspirin.


Reference –

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