Knee Bursitis: Causes, Symptoms, and Treatment Options


Knee bursitis (inflammation of the knee bursa) is a condition that results in pain and inflammation around the knee. This can be a very debilitating condition, making it difficult to walk, climb stairs, or participate in other activities. In this article, we discuss the causes of knee bursitis, the symptoms you may experience, and some available treatment options.

What is Knee Bursitis

Knee bursitis is a painful disorder that causes pain and inflammation in the small, fluid-filled sacs (bursae) that cushion the bones, tendons, and muscles around the joints. The knee has three main bursae: the suprapatellar, infrapatellar, and prepatellar bursae. There is also a bursa just below the medial side of the knee, called the pes anserine bursa.

Types of Knee Bursitis

  • Suprapatellar bursitis – located just above the patella (kneecap)
  • Infrapatellar bursitis – located just below the patella
  • Prepatellar bursitis – located in front of the bursa
  • Pes anserine bursitis – located where the hamstring tendons attach to the tibia (shin bone).
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What Causes Knee Bursitis

Knee bursitis is usually caused by an injury or overuse of the joint. A bursa sac is normally paper thin and isn’t detectable. However, the appropriate inciting event can lead to inflammation which causes the bursa to fill up with inflamed fluid. As bursitis worsens, the knee bursa enlarges and becomes even more susceptible to significant bursitis.

Most commonly, it results from repetitive motions, like deep knee bending. It can also come from prolonged pressure on the joint, such as repetitive kneeling (especially prepatellar bursitis or infrapatellar bursitis). This is commonly the cause in people exposed to occupations that require these positions (trim carpenters, etc). In fact, prepatellar bursitis is sometimes called “carpet layer’s knee” and “housemaid’s knee.”

However, it can also be caused by an infection, osteoarthritis, rheumatoid arthritis, or gout. Pes anserine bursitis is commonly seen in conjunction with knee arthritis. This may be because altered biomechanics from arthritis put more strain on the hamstrings, resulting in inflammation and ultimately pes anserine bursitis. However, this is not proven.

Knee Bursitis

Risk Factors for Developing Bursitis

Knee Bursitis Symptoms

The most common symptom of knee bursitis is knee pain, which is typically worst when the affected joint is used. Other symptoms may include tenderness, redness, and knee swelling. The swelling can be severe and often causes a noticeable deformity over the front of the knee. The swelling with bursitis is limited specifically to swelling in the bursa, and outside of the joint.

If there is swelling inside of the knee joint (also known as an effusion), that is caused by something other than bursitis. In some cases, the skin over the affected joint may feel warm to the touch. It can also be brought on by an injury or infection.

Knee Bursitis
Bursitis. inflammation of bursae (synovial fluid). Prepatellar bursitis (housemaid’s knee) and Infrapatellar bursitis

How is Knee Bursitis Diagnosed

Bursitis of the knee is usually diagnosed based on clinical examination by medical providers such as orthopaedic surgeons or sports medicine doctors. They will perform comprehensive history which will include questions about occupational risks, knee risk factors, and duration of the injury. They will ask about a history of direct trauma, repetitious motion, and systemic symptoms such as fevers and chills, which could indicate a knee bacterial infection.

Subsequently, they will perform a focused physical exam of the affected area and look for areas of developing knee bursitis and localized swelling above the kneecap, in front of the knee cap and adjacent tendon, below the kneecap bone, and near the inner knee. They will also assess for any swelling inside of the knee joints which could indicate septic arthritis (infection in the knee joint)

7 Treatment Options for Knee Bursitis

Although bursitis of the knee can be painful, it is usually not a serious condition. Treatments for knee bursitis include a combination of rest, ice, compression, and over-the-counter medication to alleviate pain. In some cases, however, knee bursitis may require more aggressive treatment. Initial treatment for noninfectious bursitis includes

  1. Rest
  2. Compression (frequent and sustained pressure is best)
  3. Padding that will cushion pressure points
  4. Avoidance of repetitive bending or kneeling
  5. Ice for the first 48-72 hours, then heat (warm compresses)
  6. Over-the-counter anti-inflammatories (e.g. Advil or Aleve) to treat inflammation
  7. Elevation

If the knee pain does not improve after two or three weeks of conservative treatment, your doctor may accelerate treatment. Further doctor-administered treatments may include physical therapy, prescription medication to reduce inflammation, cortisone medication by mouth, or corticosteroid injections. In rare cases, surgery may be necessary to remove the inflamed sacs and the chronically inflamed bursa in the setting of chronic bursitis.

Sometimes the bursa may become infected, called septic bursitis. Antibiotics are used in these cases and on occasion septic bursitis requires surgical resection.

However, most people with knee bursitis and swollen bursa eventually recover with conservative treatment and do not require surgery.

Is Knee Bursitis Serious?

Most of the time, mild bursitis resolves spontaneously. In these cases, bursitis of the knee is self-limited and responds to non-surgical treatment. However, in some cases, the bursa can become infected. This is known as septic bursitis.

In these cases, antibiotics may be prescribed. Aspiration or surgical drainage of the infected bursa fluid may be needed. Sometimes infectious bursitis requires drainage and occasionally a stay in the hospital is required to treat infectious bursitis.

How to Prevent Knee Bursitis

The good news is that there are several things you can do to prevent knee bursitis. First, always warm up before participating in any physical activity. This helps to increase blood flow to the area and loosen the muscles and tendons around the knee.

Second, be sure to stretch regularly, especially after exercise. This helps to keep the muscles and tendons around the knee flexible and less likely to become strained.

Third, avoid activities that require overly-repetitive deep knee bending or kneeling on the front of the knees.

Keep your core, hip, and thigh muscles strong. This helps to keep extra stress off the knee joint.

Finally, if you experience any pain or discomfort in your knee, be sure to rest it and ice it as soon as possible. By following these simple tips, you can help prevent bursitis of the knee and keep your knees healthy and strong.

FAQ. Frequently Asked Questions

How can I get rid of bursitis in my knee?

Knee bursitis is a condition that can cause pain and inflammation around the knee joint. It is often caused by repetitive motion, such as kneeling or bending, and can be aggravated by direct pressure on the knee. Treatment for knee bursitis typically focuses on relieving pain and inflammation.

Rest is important, as is avoiding activities that aggravate the condition. Compression and padding can also help to reduce pain and inflammation, and ice may be used for the first 48-72 hours after injury. Heat (warm compresses) may also be helpful.

Over-the-counter anti-inflammatories, such as Advil or Aleve, can also be used to help reduce pain and inflammation. If these conservative measures do not improve the condition, further treatment may be necessary.

What does bursitis in the knee feel like?

Symptoms of bursitis in the knee include swelling, warmth, stiffness, and pain when moving or touching the affected area. In severe cases, the pain may be constant, even when resting. In general, the swelling associated with bursitis is usually localized to a specific region (front of the knee, above the kneecap, or beneath the kneecap). Swelling in the joint (known as an effusion) is due to something going on inside of the joint, as opposed to the bursae, which are located outside of the joint capsule.

How long does it take for bursitis of the knee to heal?

In most cases, the symptoms of bursitis will improve within a few weeks. However, some people may experience recurrent episodes of bursitis or chronic pain. In general, the longer bursitis has been going on, the longer it will take to resolve after starting treatment.

Is it OK to walk with knee bursitis?

Walking can aggravate the symptoms of knee bursitis, so it’s important to listen to your body and take it easy if you’re experiencing pain. However, walking is not likely to cause further damage to the joints and may help reduce inflammation.

How can I avoid knee bursitis?

There are several things you can do to avoid developing bursitis in your knees. First, always warm up before participating in any physical activity.

Second, be sure to stretch regularly, especially after exercise.

Third, avoid activities that require overly-repetitive deep knee bending or kneeling on the front of the knees.

Finally, if you experience any pain or discomfort in your knee, be sure to rest it and ice it as soon as possible.

References

  1. Aaron DL, Patel A, Kayiaros S, Calfee R. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg. 2011 Jun;19(6):359-67. doi: 10.5435/00124635-201106000-00006. PMID: 21628647.
  2. Le Manac’h AP, Ha C, Descatha A, Imbernon E, Roquelaure Y. Prevalence of knee bursitis in the workforce. Occup Med (Lond). 2012 Dec;62(8):658-60. doi: 10.1093/occmed/kqs113. Epub 2012 Jul 9. PMID: 22778241.
  3. Reid CR, Bush PM, Cummings NH, McMullin DL, Durrani SK. A review of occupational knee disorders. J Occup Rehabil. 2010 Dec;20(4):489-501. doi: 10.1007/s10926-010-9242-8. PMID: 20490901.

Dr. Jeremy Burnham is a sports medicine knee surgeon who treats knee conditions for patients in the Baton Rouge, Livingston, Ascension, Hammond, Walker, Denham Springs, New Roads, St. Francisville, Central, Zachary, Baker, Prairieville, Gonzales, Geismar, St. Gabriel, Woodville, Centreville, Opelousas, Lafayette, Lutcher, and Alexandria communities of Louisiana and Mississippi.

Interested in Specialized Sports Medicine Care?

Interested in Specialized Sports Medicine Care?