Bursitis

Bursitis is usually relieved when the activities which brought on the initial irritation, such as too much pressure on the knees, are stopped.

A bursa is a sac-like structure lined by cells that have the capacity to secrete fluid. There are many bursae in the body, and they help adjacent structures to glide smoothly over one another. For example, the prepatellar bursa lies between the knee cap and the overlying skin on the front part of the knee. The pes anserine bursa lies between the tibia (shin bone) and the overlying hamstring tendons on the inside of the knee. With bursitis, a bursa becomes inflamed, thickened, often secretes fluid and can become painful.

Causes
Inflammation of a bursa occurs typically with overuse injuries and chronic friction at the site of the bursa. Direct trauma causing injury and inflammation in the bursa is another cause of bursitis. Occasionally, a bursa can become infected.

Symptoms
Bursitis often presents itself as pain and swelling in the region of the bursa. Prepatellar bursitis can appear as a bump over the patella, which enlarges after repetitive bending and straightening of the knee or after kneeling. Pes anserine bursitis often causes a tender and painful area on the inside of the leg just below the knee. More severe bursitis can become red, warm and tender to the touch.

Diagnosis
Your doctor can detect bursitis by examining your knee and by learning more about recent activities that may have caused the condition. X-rays typically cannot diagnose the bursitis but may be taken to detect other problems or injuries to the bones and other structures about the knee that may contribute to the development of bursitis.

Treatment
Bursitis is often eliminated if the activity that caused the bursitis is stopped. For prepatellar bursitis, this may involve restricting activities that involve kneeling or putting pressure on the knees. For pes anserine bursitis, this may involve restricting activities such as running, which involve repetitive bending and extending of the knee.

The following may also be helpful in combating bursitis:

• Rest . All activities which contribute to pain in the region of the inflamed bursa should be restricted. Talk with your doctor about a plan for gradually returning to full activity.
• Ice . Ice packs may be used for about 20 minutes at a time, each hour to help alleviate pain and decrease swelling.
• Bandage/Compression Wraps . Your doctor may recommend that you use a soft elastic wrap or bandage at the knee to help reduce swelling.
• Elevation . Elevating the knee should help ease pain and swelling. Ideally, the foot should be elevated higher than the knee, and the knee should be elevated higher than the hip.
• Medication . Your doctor may prescribe an anti-inflammatory or pain medication.
• Knee Brace . Your doctor may prescribe a knee brace to help stabilize the joint.
• Crutches . Your doctor may advise you to use crutches to take pressure off the knee, reduce pain and increase mobility. You should be protected with crutches if weight-bearing is painful or if you are limping.
• Physical Therapy . Your doctor or physical therapist may recommend a range of motion and muscle stretching and strengthening program for your knee.

If swelling and discomfort in the bursa persist, your doctor may recommend draining the bursal fluid and/or injecting cortisone to help reduce the inflammation. Rarely, an infection may develop in a bursa. If this occurs, your doctor will likely recommend draining the bursa with a needle and prescribing antibiotics to help fight the infection. If a bursa remains symptomatic over an extended period of time, an operation to remove the inflamed bursa may be recommended.

Recovery Outlook
The length of recovery from bursitis varies from person to person depending on the severity of the bursitis and how well the treatment plan is followed.

Prevention
The best way to prevent bursitis is to limit activities that have caused bursitis in the past. For example, repetitive kneeling can cause prepatellar bursitis. Avoiding kneeling or using knee pads can also help prevent prepatellar bursitis.