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What is a Bursa?
• A bursa is a soft, fluid-filled closed sac
lined with a synovial-like membrane that
sometimes contains fluid that develops in
the area and is subject to pressure or
friction.
What is a Bursa?
• Purpose:
– Decrease friction by cushioning muscles or
tendons and bones that move back and forth
across each other
– These are typically thin, but may become
thickened and fluid-filled with increased
stress
What is Bursitis?
• Bursitis is an inflammation of a bursa.
• Bursitis is characterized by a painful
inflammation or irritation of the soft,
fluid-filled sac that covers and cushions
the movement between the bones,
tendons, and muscles near the joints.
Types of Bursitis
Suprapatellar Bursitis
• The bursa is located directly above the knee
• The bursa is not a true bursa but rather is an
extension of the tibiofemoral joint capsule
• Inflammation of this bursa usually results
from a mechanical irritation during kneeling
activities
– Commonly referred to as “Nun’s Knee”
Prepatellar Bursitis
• The bursa is located anterior to the patellar
tendon
• Characterized by swelling with effusion of the
superficial bursa overlying the lower pole of
the patella
• This type of bursitis is caused by injury to the
anterior knee, such as a fall directly onto the
patella
– Commonly referred to as “Housemaid’s Knee”
Infrapatellar Bursitis
• The bursa is located between the tuberosity of
the tibia and the patellar tendon and is
separated from the synovium of the knee by a
pad of fat
Anserine Bursitis
• The bursa separates the Pes Anserinus from
the distal portion of the MCL and the medial
femoral condyle
• Involves pain and tenderness at proximal
medial tibia
• Characterized by sudden onset of knee pain
with localized tenderness and swelling at Pes
Anserinus
Causes of Bursitis:
• Overuse
• Direct blow to the knee
• Repeated stress
– i.e. repetitive kneeling
• Infection
Patient population affected by Bursitis:
• It frequently develops based on the patient’s
occupation, not sports.
• Commonly occurs from overuse injuries
– i.e. runners, wrestling, volleyball
• Commonly occurs in obese women in association
with osteoarthritis
Diagnosis
• Radiographic imaging may reveal tissue
swelling
• Ultrasound imaging may detect fluid
collection
• MRI may be helpful but is not required on
an urgent basis
Clinical Presentation
• Localized tenderness with pain on pressure
against bursa
• Swelling
• Restricted internal or external rotation
• Joint movement that is accompanied by pain
• Referred pain
• Palpable occasional fibro-cartilaginous
bodies
Examination findings
• Palpable tenderness
over bursae
• Localized pain and
swelling over the
patella
• Restricted internal
and external rotation
Goals of Treatment
• Reduce pain levels
• Reduce inflammation and swelling
• Return patient to normal activities as soon
as possible without risk for further injury
Non-operative Treatment
Two types of Bursitis Treatment
• Bacterial:
– Involves antibiotic treatment with operative
drainage
• Inflammatory:
– Involves ice, rest, anti-inflammatories,
injection of corticosteriods
Physical Therapy
• Strengthening exercises
– Focus on Isometrics
• Stretching exercises
– Focus on Quadriceps, Hamstrings,
Gastrocnemius
Modalities
• RICE therapy (Rest, Ice, Compression,
Elevation)
– Used to control pain and swelling
• Compression dressings
– Used to control the level of swelling around the
knee
• Knee protection pads
– Use with certain sports/activities that perform
repetitive motions
• i.e volleyball, wrestling, construction worker
Pharmacology
• Anti-inflammatory medications
– Used to control pain and inflammation
• Non-steroidal anti-inflammatory
medications
– Used to control inflammation
• Corticosteroid injections
– Used to help reduce swelling of the bursa
Operative Treatment
Surgery
• Various surgical procedures for treating
Bursitis:
– Aspiration and injection of drugs
– Incision and drainage when acute bursitis fails
to respond to nonsurgical treatment
– Excision of chronically infected and thickened
bursae
– Removal of underlying bony prominence
Recommendations
• Avoid direct blows to the kneecap
• Avoid prolonged kneeling
• Use proper protective kneepads to help prevent
inflammation of the bursae
• Take your time with return to normal activities.
– Returning too soon may worsen the injury
• Note: The longer you have symptoms before you
start treatment, the longer it will take to recover
Resources
• Ferri: Ferri’s Clinical Advisor 2011, 1st Edition.
Copyright © 2010 Mosby, An Imprint of Elsevier.
• Lazoff, Marie. First Consult. Elseiver Inc. Copyright
© 2011
• Marx: Rosen’s Emergency Medicine, 7th Edition.
Copyright © 2009 Mosby, An Imprint of Elsevier.
• Dutton M. Orthopaedic Examination, Evaluation,
and Intervention. 2nd Edition 2008.
• DeLee: DeLee and Drez’s Orthopaedic Sports
Medicine, 3rd Edition. Copyright © 2009 Saunders,
An Imprint of Elsevier.