Bursitis is a disease in which the periarticular sac becomes 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?
At the top of the knee joint is the prepatellar periarticular bursa (prepatellar bursa). It is located above the kneecap. The bursa is filled with fluid, which promotes free sliding and protects the joint from excessive friction. Inflammation of this bursa is called prepatellar bursitis. How does it manifest?
In the International Classification of Diseases ICD-10, prepatellar bursitis is listed under the code M70.4. With such a disease, the natural movement of fluid in the periarticular sac is disrupted. An exudate is formed - a fluid released from the blood vessels during inflammation. Infection can enter the liquid contents, which contributes to the inflammatory process.
Immune systembegins the fight against infection, a large number of lymphocytes, the protective cells of the body, are sent to the site of inflammation. Lymph flow causes swelling, which is one of the main symptoms of prepatellar knee bursitis. The photo above shows how pronounced swelling of the knee can be. Due to the pressure of the lymph on neighboring tissues and nerve roots, pain occurs in the knee. Over time, suppuration can 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 blow to the knee on a hard surface. People who lead an active lifestyle are at risk of developing prepatellar bursitis. But this is not the only cause of inflammation in the intraarticular bag. The following causes of bursitis can be distinguished:
- frequent bruising of the knee;
- crawling and kneeling while doing work (e.g. bursitis is common in roofers, hardwood floors, 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 injury can trigger the development of inflammation. If a patient has 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 suddenly, symptoms worsen over several days. The disease is characterized by the following manifestations:
- There is a sharp pain in the patella. A person cannot lean on his knees, any touch on the area of inflammation causes pain.
- There is severe swelling in the area of the patella with reddening of the skin.
- Movement in the diseased joint is limited.
- Temperature rises, general malaise is felt.
- Pain intensifies when probing 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 elderly people. The clinical signs of inflammation vary slightly. Pain, redness and swelling of the knee joint still persist. The walls of the bursa become thicker, because of this, the joint area can increase in size several times. There is a feeling 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 intra-articular sac, suppuration occurs inside the bursa. The symptoms of the disease become much more severe.
- The temperature rises sharply, the general he alth of the patient worsens.
- The skin in the area of the joint becomes hot to the touch, redness is pronounced.
- Feeling pain and throbbing inside the joint.
What are the consequences of bursitis?
Festering prepatellar bursitis requires immediate treatment, otherwise the abscess may spread to other tissues or erupt on its own. This leads to complications:
- If an abscess breaks into a blood vessel, blood poisoning - sepsis may occur.
- When inflammation and suppuration spread to a nearby bone, osteomyelitis may begin.
- If purulent inflammation spreads to surrounding tissues and lymph nodes, phlegmon and lymphadenitis occur.
- Purulent contents can get from the bursa directly into the joint. Then there is a severe form of purulent arthritis.
- Fistulas form on the skin. These are channels with purulent contents that appear after an independent breakthrough of an abscess in the bursa.
- With prolonged prepatellar bursitis of the knee joint, the limb may partially lose motor function.
How bursitis occurs in childhood
Young children are not prone to prepatellar bursitis. Their weight is too small, and when the child falls to his knees, the blowturns out to be insignificant. Children under one year of age also rarely get sick with infectious bursitis, since every baby has immunity transmitted from the mother. A possible pathway for bursitis in children is injuries and fractures of the knee. But a child usually has flexible bones, and fractures heal quickly. Bursitis can only start in young children when a knee fracture is treated too late.
But teenagers quite often suffer from bursitis. Often, inflammation of the bursa is observed in pubertal boys who love an active lifestyle and play sports hard. Most often this occurs after injuries during training. There is another reason for adolescent bursitis. During puberty, children grow rapidly. Sometimes the growth of the joints lags behind the overall growth of the body. And then teenagers start having joint problems, including knee bursitis.
Diagnosis of disease
Usually, the diagnosis is not difficult for the doctor because of the characteristic picture of the disease. Edema and redness in the area of the patella are already noticeable during 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:
- knee x-ray;
- Ultrasound of the knee joint;
- MRI;
- puncture of the bursa to examine the joint fluid.
This will help evaluatethe condition of the periarticular sac, surrounding tissues and bones, in order to make a diagnosis and prescribe treatment based on the results of the studies.
How to treat non-infectious bursitis?
Treatment of non-infectious prepatellar bursitis is usually conservative. A puncture is done only if a lot of blood has accumulated in the bursa after an injury. Whether or not this procedure is necessary should be decided by the attending physician, as there is a small risk of infection.
At the first stage, it is necessary to provide rest for the diseased limb. The joint area is tightly bandaged with a bandage, if necessary, compresses are applied. For pain, analgesics are prescribed. With severe pain, injections of "Prednisolone" are made into the joint bag. Treatment of acute bursitis takes about 7-10 days.
How to treat chronic knee bursitis?
In the treatment of prepatellar bursitis of the knee joint in a chronic form, anti-inflammatory nonsteroidal drugs are prescribed: Diclofenac, Nise, Nimesil, Ibuprofen.
Using physiotherapy:
- 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 the bursitis is of an infectious origin and suppuration has already occurred, then the cavity is drained. thick needlemake a puncture and pump out the purulent contents. The cavity of the periarticular bag is washed with solutions of antibiotics and antiseptics. After this procedure, the diseased limb is shown rest.
Prescribe a course of broad-spectrum antibacterial drugs. The duration of antibiotic treatment is about 1-3 weeks. Together with antibacterial drugs, the doctor prescribes glucocorticosteroids. If the patient is concerned about signs of intoxication of the body (headache, nausea, vomiting, temperature), then droppers are placed with solutions of sodium chloride, Perftoran, Ringer. After removal of pus, a course of treatment with glucocorticoid drugs and physiotherapy is carried out.
Operation
Is a radical method of surgical treatment of prepatellar bursitis of the knee joint. 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 sac are thickened to such an extent that the bursa can no longer support the sliding of the joint. After the operation, the patient wears a special brace on his knee for 3-5 days. Then the doctor prescribes a course of physical therapy. Usually, after the operation, a person returns to a normal lifestyle within a month. You can lean on a sore knee in 2-3 months.
Folk treatments for bursitis
Home treatments can be used as adjunctive therapy for bursitis. Before using folk remediesmedicine should consult your doctor. Vegetable compresses can help with bursitis. It is useful to alternate compresses from potatoes, beets and cabbage. Vegetables should be applied to the sore 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 bath water. All ingredients must be boiled for 30 minutes in water, and then the decoction should be infused for 24 hours. The finished extract should be brown in color. The decoction is added to water and a bath is taken for 20 minutes. It will take about 1.5 liters of extract. With bursitis, it is useful to use a mixture of propolis and butter inside. You need 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 disease?
To prevent the development of prepatellar bursitis, you need to protect the knee from excessive stress and injury. This is especially true for those who are actively involved in sports. Every workout should start with a warm-up. If during sports activities there is a risk of damage to the knee, then you need to protect the joint with special devices (knee pads). This will help to avoid severe injuries and complications in the form of prepatellar bursitis. In the photo above you can see one of these knee protectors. For skin lesionscovers, it is necessary to treat wounds and abrasions with disinfectants as soon as possible and apply bandages. This will help prevent infection from entering the periarticular sac. Only careful attitude to the joints and timely treatment of injuries will help to avoid bursitis.
