Knee Bursitis in Older People

Introduction

Bursae are small, closed, fluid-filled sac-like structures located near the joints, bony prominences, or in between the muscles, bone, joints, tendons, and ligaments. Major bursae are in the shoulders, knees, elbows, and feet. Bursae provide a cushion-like effect and help reduce the friction between the tissues. Inflammation of the bursa is termed bursitis; it can be rapid in onset (acute) or occur slowly over time (chronic). Acute bursitis is due to injury or infection, and chronic bursitis may occur following repetitive use, movement, or compression.

What Is Knee Bursitis?

Inflammation of the bursa located near the knee joint or the tendons of the hamstrings is termed knee bursitis. It is also known as Pes Anserine bursitis or goosefoot bursitis. Most commonly affected are the bursae over the kneecap or below the knee joint.

What Are the Causes of Knee Bursitis?

Causes of knee bursitis include:

• Trauma or any injury, such as a fall or a hit, may be associated with bleeding.

• Infection in the affected area leads to the penetration of the microorganism into the deeper tissues, known as septic bursitis.

• Conditions such as rheumatoid arthritis and psoriatic arthritis.

• Sitting for long periods can put prolonged pressure on the knee.

• Overuse, repeated movements, or strain on the bursa.

• Abnormal posture or walking manner can result in joint stress leading to inflammation of the bursa.

What Are the Signs and Symptoms of Knee Bursitis?

The signs and symptoms vary depending on the bursa affected and the cause of inflammation. It includes:

• Pain on movement and rest.

• Increase in the intensity of pain over time.

• Tender and warm on touch.

• Swelling and redness of the affected area.

• Fever and chills.

• Stiffness and limited range of motion.

• Inability to kneel or bend.

What Are the Risk Factors of Knee Bursitis?

There are several risk factors associated with knee bursitis, which include:

• Joint Diseases: Diseases such as rheumatoid arthritis, gout, etc., are disorders that affect the joints causing pain and inflammation; these may increase the risk of bursitis or aggravate if the patient is already suffering from bursitis.

• Previous Surgery: Prosthetic joint implants or previous joint surgeries can irritate the tissues, or a restricted range of motion post-surgery can lead to the development of bursitis.

• Obesity: In some elderly, obesity can be a problem; lack of activity and increased pressure on the hips and knees can result in bursitis.

• Physical Activity: Repetitive motion during any physical activity, occupation, or hobby, such as gardening, painting, etc., can result in bursitis.

• Medical Conditions: People suffering from spinal diseases, limb discrepancies, and metabolic disorders such as diabetes are at risk of developing bursitis.

• Bone Spurs: Excessive calcium deposits, bone spurs (bumps or projections of bone) near a bursa can irritate, leading to bursitis and affecting movement.

How Is Knee Bursitis Diagnosed?

Knee bursitis can be diagnosed by medical history, signs and symptoms, and certain diagnostic procedures, which include:

• Radiological Examination: Diagnostic tests, such as X-rays, and magnetic resonance imaging (MRI), are considered in cases of trauma and can help rule out swelling or tears, or joint abnormalities, which in turn cause knee bursitis. Ultrasound is recommended to visualize the fat tissues overlying a bursa, which helps differentiate cellulitis from infectious bursitis.

• Joint Aspiration: During this test, the fluid from the swollen joints is aspirated using a fine needle and sent to the laboratories to check the cell count and cell culture and detect the presence of infection in cases of suspected septic bursitis and rule out conditions such as gout or other infectious diseases.

How Can Knee Bursitis Be Managed in Older People?

Most cases of bursitis heal themselves; however, various modalities have been tried to reduce the patient's suffering, especially pain in the affected area. Suppose pain and swelling persist for a long duration. In that case, it is recommended to consult a healthcare provider, as untreated bursitis can lead to permanent thickening or enlargement of the bursa leading to chronic pain and muscle atrophy (decreased use of the joint, leading to loss of surrounding muscle). Treatment options:

• Ice Packs: The most common initial approach in managing knee bursitis in older people is conservative treatment by using compression or ice packs and elevation of the affected parts, relieving pain. It is important to explain to the patients to rest adequately and not to move the affected area vigorously. This type of treatment is known as RICE therapy.

• Medications: Drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) like Acetaminophen, Ibuprofen, Naproxen, etc., are the first choice in managing pain. Corticosteroid injections can be administered alone or with local anesthetics for inflammation of the bursa in the deeper tissues. Corticosteroids are often avoided for superficial bursa as they may be associated with a risk of complications such as injury to the local tendon, septic bursitis, atrophy of the skin, or the development of sinus tracts. Oral or systemic antibiotics can be administered in patients with septic bursitis caused by gram-negative organisms.

• Surgery: In cases of septic bursitis that are not resolved by either oral or systemic antibiotics, it may require surgical excision. The procedure involves placing the patient's supine position and applying a tourniquet on the thigh. After the surgical area is cleaned under aseptic precautions, local anesthesia is administered. Surgery can be either open or laparoscopic, wherein a motorized shaver is introduced through a portal, and total bursa removal is done, known as bursectomy. This is followed by the application of surgery ports, which will be sutured with the help of adhesive tapes.

• Physical Therapy: It includes stretching and other range-of-motion exercises, which can help reduce pain and improve the patient's condition.

• Padding: If the bursa is superficial in location, sufficient protection can be provided by pads, cushions, and custom-fitted braces to prevent pressure on the knee.

How Can Knee Bursitis Be Prevented?

Patients must be educated to avoid activities that cause pain; or repetitive motions during physical activities and take frequent breaks in between. In addition, following a healthy diet and maintaining body weight can reduce pressure in the areas where bursitis may develop.

Conclusion

Inflammation of small fluid sacs called bursa near the knee joint is called knee bursitis. It is caused due to infection, trauma, overuse, or conditions such as rheumatoid arthritis. It is associated with pain, inflammation, fever, stiffness, and limited range of motion. It is usually managed conservatively; however, some severe cases may require surgical intervention. Physical exercises and a healthy lifestyle can help prevent knee bursitis in older adults.