Bursitis is a disease in which a periarticular bag is inflamed. This pathology occurs in the elbow and knee joints. Of all types of periarticular inflammation, prepatellar bursitis of the knee joint is most often observed . This disease is common in people who are actively involved in sports after injuries.
Prepatellar bursitis: what is it?
In the upper part of the knee joint there is a prepatellar periarticular bag (prepatellar bursa). It is located above the patella. The bursa is filled with a fluid that promotes gliding and protects the joint from unnecessary friction. The inflammation of this bag is called prepatellar bursitis. How is it manifested?
In the International Classification of Diseases ICD-10, prepatellar bursitis is listed under the code M70.4. With this disease, the natural movement of fluid in the periarticular bag is disrupted. An exudate is formed - a fluid released from the blood vessels during inflammation. An infection can get into the liquid contents, which contributes to the inflammatory process.
The immune system begins to fight the infection, a large number of lymphocytes, the protective cells of the body, are sent to the site of inflammation. The influx of lymph causes edema, which is one of the main symptoms of prepatellar bursitis of the knee joint. The photo presented above indicates how strongly pronounced swelling of the knee can be. Due to lymph pressure on adjacent tissues and nerve roots, knee pain occurs. Over time, suppuration may form in the joint area, so bursitis is easier to treat at the beginning of its development.
Why does prepatellar bursitis occur?
Most often, inflammation of the periarticular bag occurs due to a sharp knee hit on a hard surface. The risk of developing prepatellar bursitis is exposed to people who lead an active lifestyle. But this is not the only cause of inflammation in the intraarticular bag. The following causes of bursitis can be distinguished:
- frequent knee bruises;
- crawling and kneeling while doing work (for example, bursitis is often found among roofers, parquet layers, carpet cleaners, plumbers);
- direct infection in the joint through scratches and wounds;
- infectious diseases - brucellosis, tuberculosis, gonorrhea, syphilis (these pathologies are complicated by suppuration inside the bursa);
- metabolic disorders (diabetes, obesity, gout);
- autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus).
But whatever the cause of the inflammation, signs of bursitis begin to appear after a knee injury. Sometimes it can be a minor bruise, but even a small damage can provoke the development of inflammation. If the patient revealed prepatellar bursitis of the knee joint, the symptoms and treatment will depend on the form of the disease and the presence of an infectious process.
Signs of an acute form of the disease
Acute prepatellar bursitis occurs unexpectedly, symptoms grow within a few days. The disease is characterized by the following manifestations:
- A sharp pain in the patella appears. A person can not rest on his knees, any touch on the area of inflammation causes pain.
- There is a strong swelling in the patella with reddening of the skin.
- Movement in a sore joint is limited.
- The body temperature rises, a general malaise is felt.
- The pain intensifies when palpating the area of inflammation.
Signs of a chronic form of the disease
In the absence of adequate treatment, acute bursitis becomes chronic. Chronization of the inflammatory process can occur with prolonged pressure on the knee joint and in people of advanced age. The clinical signs of inflammation change slightly. Pain, redness and swelling of the knee joint still persist. They become thicker than the wall of the bursa, because of this the joint area can increase in size several times. There is a sensation of lumps inside the patella due to the formation of folds on the wall of the periarticular bag.
Signs of purulent bursitis
If an infection gets into the intraarticular bag, then suppuration occurs inside the bursa. Symptoms of the disease become much worse.
- The temperature rises sharply, the general well-being of the patient worsens.
- The skin in the joint area becomes hot to the touch, redness is pronounced.
- There is pain and pulsation inside the joint.
What are the consequences of bursitis?
Suppurative prepatellar bursitis requires immediate treatment, otherwise the abscess may spread to other tissues or break through on its own. This leads to complications:
- If the abscess breaks into a blood vessel, blood poisoning can occur - sepsis.
- With the spread of inflammation and suppuration to the nearby bone, osteomyelitis can begin.
- If purulent inflammation spreads to surrounding tissues and lymph nodes, phlegmon and lymphadenitis occur.
- Purulent contents can enter directly from the bursa into the joint. Then a severe form of purulent arthritis occurs .
- Fistulas form on the skin. These are channels with purulent contents that appear after an independent breakthrough of an abscess in a bursa.
- With prolonged prepatellar bursitis of the knee, the limb may partially lose its motor function.
How does bursitis occur in childhood
Young children are not prone to prepatellar bursitis. Their weight is too small, and when the child falls to his knees, the blow is small. Children under one year of age rarely get infectious bursitis, since each baby has immunity transmitted from the mother. A possible way to have bursitis in children is through injuries and knee fractures. But the child usually has flexible bones, and fractures heal quickly. Bursitis can begin in young children only when help with a knee fracture was provided too late.
But adolescents quite often suffer from bursitis. Often, inflammation of the bursa is observed in boys of puberty, who love an active lifestyle and are intensely involved in sports. Most often this occurs after injuries during training. There is another cause of adolescent bursitis. In the puberty, children grow quickly. Sometimes joint growth lags behind the overall growth of the body. And then teens begin to have problems with the joints, including bursitis of the knee joint.
Diagnosis of the disease
Usually, the diagnosis is not difficult for the doctor because of the characteristic picture of the disease. Edema and redness in the patella area are already visible with an external examination. However, sometimes it is necessary to distinguish prepatellar bursitis from other diseases and injuries of the joint area: arthrosis, synovitis, osteomyelitis, tendon rupture. Then the doctor prescribes additional examination methods:
- x-ray of the knee;
- Ultrasound of the knee joint;
- MRI
- puncture of a bursa for the purpose of research of joint fluid
This will help assess the condition of the periarticular bag, surrounding tissues and bones, so that, based on the results of the studies, make a diagnosis and prescribe treatment.
How to treat non-infectious bursitis?
Treatment of prepatellar bursitis of non-infectious origin is usually conservative. A puncture is done only if a lot of blood has accumulated in the bursa after an injury. The question of the need for this procedure should be decided by the attending physician, since there is a small risk of infection.
At the first stage, it is necessary to provide rest for a sick limb. The area of the joint is tightly bandaged with a bandage, if necessary, compresses are applied. For pain, analgesics are prescribed. For severe pain, inject Prednisolone into the joint bag. Treatment of acute bursitis takes about 7-10 days.
How to treat chronic knee bursitis?
In the treatment of chronic prepatellar bursitis of the knee joint, non-steroidal anti-inflammatory drugs are prescribed: Diclofenac, Nise, Nimesil, Ibuprofen.
Physiotherapeutic procedures are used:
- massage;
- electrophoresis;
- Exercise therapy;
- magnetotherapy;
- ultrasound therapy;
- laser treatment.
If inflammatory exudate accumulates in the bursa, then a puncture is performed.
Treatment of purulent bursitis
If bursitis is of an infectious origin and suppuration has already occurred, then the cavity is drained. A thick needle makes a puncture and purulent contents are pumped out. The cavity of the periarticular bag is washed with solutions of antibiotics and antiseptics. After this procedure, the patient is shown rest.
A broad-spectrum antibacterial course is prescribed. The duration of antibiotic treatment is about 1-3 weeks. Together with antibacterial drugs, the doctor prescribes glucocorticosteroids. If the patient is worried about signs of intoxication (headache, nausea, vomiting, temperature), then they put droppers with solutions of sodium chloride, Perftoran, Ringer. After removal of pus, a course of treatment with glucocorticoid drugs and physiotherapeutic procedures is carried out.
Operation
Surgical treatment of prepatellar bursitis of the knee joint is a radical method. It is necessary to make an incision and remove the bursa if, due to severe pain, a person loses the ability to walk and serve himself. This means that the walls of the periarticular bag are thickened so much that the bursa can no longer provide sliding joints. After surgery, the patient wears a special retainer on the knee for 3-5 days. Then the doctor prescribes a course of physiotherapy exercises. Usually, after surgery, a person returns to a normal lifestyle within a month. You can rely on a sore knee after 2-3 months.
Traditional methods of treating bursitis
Home treatments can be used for bursitis as adjunctive therapy. Before using traditional medicine, you should consult your doctor. With bursitis, compresses from vegetables can help. It is useful to alternate compresses from potatoes, beets and cabbage. Vegetables should be applied to the affected joint at night. On the first night, several cut raw potatoes are applied to the sore spot, covered with cling film and bandaged. On the second night, you need to repeat the procedure with beets, and on the third - with cabbage.
You can add a decoction of pine needles, cones and branches to the water for taking a bath. All ingredients need to be boiled for 30 minutes in water, and then infuse the broth for 24 hours. The finished extract should be brown. The broth is added to the water and take a bath for 20 minutes. It will take about 1.5 liters of extract. With bursitis, it is useful to consume a mixture of propolis and butter inside. It is necessary to mix the components in equal parts. The composition is taken 1 teaspoon 3 times a day. It is better to use a propolis remedy 1 hour before eating.
How to prevent the disease?
To prevent the development of prepatellar bursitis, you need to protect the knee from excessive loads and injuries. This is especially true for those who are actively involved in sports. Each workout needs to start with a warm-up. If during sports activities there is a risk of knee damage, then you need to protect the joint with special devices (knee pads). This will help to avoid serious injuries and complications in the form of prepatellar bursitis. In the photo above you can see one of these knee protectors. In case of damage to the skin, it is necessary to treat wounds and abrasions with disinfectant compositions and apply bandages as soon as possible. This will help prevent infection in the periarticular bag. Only careful attitude to joints and timely treatment of injuries will help to avoid bursitis.