Bursitis

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[edit] Bursitis

Around the knee there are several sacs filled with a slippery substance and these are called "bursae". When a bursa gets inflamed, this condition is called "bursitis", here shown in the elbow region. Normally a bursa does not hurt, but bursitis does hurt a lot and is associated with an accummulation of fluid due to the inflammation, which is painful. Repetitive movement or kneeling can cause such a bursitis. The carpenter's knee(or"infrapatellar bursitis") is common in carpenters, tile setters or other workers who do a lot of kneeling.

Injury of the prepatellar bursa can happen with a blow to the patella and is another form of bursitis. As this bursa lies just underneath the skin surface, the redness really shows and often patient and physician alike think it might be a skin infection, when in reality it is an inflammatory condition originating from the prepatellar bursa. Protection with an elastic bandage and avoiding further irritation is often what heals these in a 3 to 4 week period. Anserine bursitis is a conditon where a bursa, which lies underneath the pes anserinus, a common tendon at the medial aspect of the knee below the knee cap, becomes tender and inflamed. This condition occurs in middle aged and elderly patients. The diagnosis is made clinically and the therapy is injection of a small amount of corticosteroid injection into the affected area (Ref. 2, p.17).

A Baker's cyst is a popliteal cyst that was there prior to the painful swelling and was part of a degenerative process of the knee joint. When the popliteal cyst gets closed off and inflamed, there can suddenly be a lot of fluid collection in this structure to the point where it makes movement in the affected knee almost impossible. A period of immobilization with treatment using ANSAIDs or COX-2 inhibitors will usually lead to an uneventful recovery. At other times the condition resolves itself by a spontaneous rupture of the cyst, at which time there is an acute pain in the calf area where the fluid is discharged to. The physician will want to rule out a deep vein thrombosis by doing a doppler ultrasound study of the affected lower extremity.

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References:

1. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 157.

2. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 4.

3. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 270.

4. Wheeless' Textbook of Orthopaedics: http://www.wheelessonline.com/

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