Bursitis is inflammation or irritation of a bursa sac. They’re filled with fluid that helps in ease rubbing and friction between tissues like bones, muscles, tendons, and skin. Bursitis is common around major joints like shoulder, elbow, hip, or knee. Here we’ll discuss about knee bursitis or patellar bursitis.
Epidemiology:
Prepatellar bursitis affects men more often than women and it can emerge at all ages. 80% of the people with patellar bursitis are men aged between 40 – 60 years. 1/3 of the patellar bursitis is septic and 2/3 is non-septic. An infectious patellar bursitis emerges more often with children than grown-ups. Prepatellar bursitis occurs often, with at least an annual incidence of 10/100 000. The incidence of patellar bursa is probably underestimated because most of the case are non-septic and only patients with the most severe cases of patellar bursitis requires admission in the hospital.
Symptoms:
- Knee pain
- Stiffness
- Swelling
- Restricted movement
- Pain increase during movement
- Differential warmth around the knee
- Erythema
- Tenderness
- Decrease range of motion.
Causes:
The most common causes of bursitis are repetitive motions or positions that put pressure on the bursa around a joint. Such as:
- Throwing a baseball or lifting something over your head repeatedly
- Leaning on your elbows for long periods
- Extensive kneeling for tasks such as laying carpet or scrubbing floors
Other causes include injury or trauma to the affected area, inflammatory arthritis such as rheumatoid arthritis, gout and infection.
Risk factors: Some factors are responsible to increase the risk of patellar bursitis.
They are:
- Age: Bursitis becomes more common with aging.
- Over weight: Being overweight can increase the risk of developing hip and knee bursitis.
- Occupations or hobbies: If person’s work or hobby requires repetitive motion or pressure on particular bursa, the risk of developing bursitis increases. Examples include carpet laying, tile setting, gardening, painting and playing a musical instrument.
Other medical conditions: Certain systemic diseases and conditions — such as rheumatoid arthritis, gout and diabetes etc also increase the risk of developing bursitis.
Diagnosis:
At first the physician should discuss about the medical history to find out the point of overuse; also look for the symptoms by moving the patient’s foot and ankle into different positions and applying pressure.
Investigation:
- X-ray: To rule out arthritis.
- MRI: It is used to identify bone spurs.
Musculoskeletal ultrasound: To check out other ligament, muscles and tendons tear.
Treatment
In chronic condition patient must concern with a physiotherapist for better solution. A physiotherapist will apply two types of treatments. They are:
Manual therapies:
Towel stretch
- Sit on the ground with the feet straight out in front.
- Take the towel and wrap it around the toes on one foot.
- Gently pull back until a stretch runs from the bottom of the foot up to the back of the lower leg.
- Hold this stretch for 30–60 seconds.
- Switch to the other leg and repeat.
Isometric strengthening
Patient may role out a towel. Place it below the knee gape. Than press the knee and hold for minimum 10 seconds.
Straight leg raise
- While lying on your back, bend one leg while extending the other straight in front of you. It can apply with sitting on a chair.
- Tighten the muscles on your leg and slowly lift your straight leg.
- Hold your leg about a foot off of the floor and squeeze for 3-5 seconds.
- Slowly lower your leg to the floor.
- Repeat with the other leg.
Electrical therapies:
- UST- It is a sound wave which passes through in deep tissues and also makes a resonance that increase blood circulation and release pain.
- TENS- Electromagnetic wave that helps to reduce pain.
- HIL- Helps in deep penetration and reduce pain.
Prevention:
In order to prevent knee or patellar bursitis patient should avoid injury or an overload of knee muscles. It is very important to do an appropriate warm-up and cool down, while playing sports. For example, if patient plays volleyball, it is advisable to wear knee pads. This will prevent falling on the kneecap. Also when patient spent a lot of time on standing posture than it is advisable to wear knee pads.