Table of Contents
What is Knee Bursitis?
Knee bursitis, a familiar yet painful condition, occurs when the bursae—a small, fluid-filled sac that cushions between bones and tendons near joints—becomes inflamed. This inflammation primarily affects the knee joint, leading to significant discomfort and impacting daily activities. Individuals with knee bursitis often experience difficulty in walking, climbing stairs, and performing daily physical activities.
Knee bursitis typically affects males more than females between 40 to 60 years of age. The prevalence of knee bursitis is one in every 1,000 individuals will face this painful condition each year.
Most cases of knee bursitis are non-septic, meaning they don’t involve infection, which can be a slight relief. However, a significant one-third of cases are septic, involving infection and thus raising concerns due to increased complications and longer recovery times. Septic bursitis tends to appear more in children.
Additionally, individuals with weakened immune systems are particularly vulnerable, facing higher risks of developing bursitis.
Pathophysiology of Knee Bursitis:
Knee bursitis is the inflammation of one or more bursa around the knee joint. The pathophysiology of the knee includes various biochemical processes. These include:
Initial Trauma and Inflammatory Response:
The onset of inflammation in the bursa is followed by trauma to the bursa. Trauma results in increased blood flow to the affected area, which is a natural body healing process, increasing fluid production through synovial cells within the bursa. This fluid protects and cushions the joint but can lead to swelling when produced in excess.
Simultaneously, trauma increases the migration of leukocytes, or white blood cells, at the injury site. This migration of leukocytes into the bursa is a hallmark of the body’s effort to heal but also contributes to the symptoms of swelling and pain typical in bursitis.
Progression to Septic Bursitis:
In cases where trauma involves a break in the skin or other pathways for bacteria to enter, septic bursitis can occur. This more severe form of bursitis happens when bacteria spread hematogenously—that is, through the bloodstream—and infect the bursa. Bacteria significantly worsen the inflammatory response and can lead to more severe pain and swelling.
Types of Knee Bursitis?
There are various types of knee bursitis. These include the following:
1 – Anserine Bursitis (Athletes Bursitis):
Anserine bursitis is an inflammatory condition that affects the lower inner side of the knee joint. It most commonly involves athletes having an active lifestyle. It results from the overuse of the knee, where repetitive movements and strain cause inflammation of the bursa between the shinbone and the three tendons of the hamstring muscle. Clinically characterised by pain and tenderness in the inner side of the knee joint and reduced joint mobility.
2 – Prepatellar Bursitis:
Prepatellar bursitis, or “housemaid’s knee,” specifically affects the bursa overlying the kneecap (patella). This condition is commonly seen in individuals whose activities involve frequent kneeling, such as housemaids, hence the name. Clinically, patients typically present with noticeable swelling over the patella, a key indicator for diagnosis.
3 – Infrapatellar Bursitis:
Infrapatellar bursitis is the inflammation of the bursae located near the lower part of the knee. There are two types of infrapatellar bursae: superficial and deep. The superficial infrapatellar bursa is situated between the tibial tubercle and the overlying skin, making it more exposed and vulnerable to irritation from external pressures. On the other hand, the deep infrapatellar bursa is found between the posterior part of the patellar tendon and the tibia. Both have different clinical presentations. Let’s discuss each.
Superficial infrapatellar bursitis:
Superficial infrapatellar bursitis, also named clergyman’s knee, is a condition that arises from chronic stress, leading to inflammation and fluid accumulation in the knee joint area. On clinical examination, there is superficial palpable swelling over the tibia.
Deep infrapatellar bursitis:
It occurs due to inflammation of the bursa behind the patellar tendons close to the tibia. Unlike superficial infrapatellar bursitis, it is not clinically visible. It occurs due to frequent jumping activities, such as in basketball players.
4 – Suprapatellar Bursitis:
It involves the bursa above the knee joint between the quadriceps tendon and the femur. It results from repetitive motion injuries.
5 – Baker’s Cyst:
Baker cyst, also named popliteal cyst, usually involves the gastrocnemius-semimembranosus bursa. It is located between the medial head of the gastrocnemius muscle, semimembranosus tendon and medial side of the femoral condyle. It occurs due to the accumulation of extra synovial fluid in the bursae. This accumulation occurs due to certain diseases, such as osteoarthritis and rheumatoid arthritis.
6 – Medial Collateral Ligament Bursitis:
This bursa is situated between the superficial and deep layers of the medial collateral ligaments. Clinically, the bursitis of this ligament is sometimes misdiagnosed as a medial meniscus tear or medial collateral ligament tear.
7 – Iliotibial Bursitis:
This bursa is located between the lower part of the iliotibial band and the adjacent tibial surface. It most commonly occurs due to overuse of the knee joint, making it more prevalent in athletes and active individuals.
Septic knee bursitis vs aseptic knee bursitis:
Septic bursitis is also called infectious bursitis, which is caused by an infection in the bursa by specific pathogens. This infection induces an inflammatory response in the bursa, producing pus and swelling. The clinical presentation of septic bursitis is high-grade fever with rigours and chills.
Unlike septic bursitis, aseptic knee bursitis is a non-infectious condition triggered by mechanical stress or injury to the knee joint. Fever presentation is rare in aseptic bursitis.
What are the causes and risk factors of knee bursitis?
There can be various causes of knee bursitis that are usually linked with your lifestyle activity. These are:
Repetitive trauma to bursae:
Knee bursitis is commonly triggered by continuous, repetitive stress to the knee joint. One frequent cause is repetitive kneeling, which exerts pressure on the prepatellar bursae at the front of the knee, leading to inflammation. This inflammation prompts an increased production of synovial fluid, accumulating in the bursae and resulting in bursitis. This condition is particularly prevalent among individuals in certain professions where kneeling is a routine part of the job, including housemaids (often referred to as “Housemaid’s Knee”), clergymen, and cleaners. These occupations are at a higher risk due to the nature of their work, which often involves prolonged periods of kneeling.
Direct trauma to the knee:
Direct trauma to the knee joint can damage or rupture the prepatellar bursae, which results in swelling of the bursae with synovial fluid or blood.
Infection:
Knee bursitis can also arise from an infection within the knee joint, leading to a condition known as septic bursitis. When an infection occurs, it stimulates the production of T and B lymphocytes, critical components of the immune system, which initiate an inflammatory response. This heightened immune activity not only combats infection but also contributes to the swelling of joints. Certain populations are at a higher
- Diabetic
- Rheumatoid arthritis
- Immunocompromised
- Alcoholic
Risk factors for knee bursitis:
Multiple factors increase the risk of knee bursitis. These factors are:
- Age (elders are prone to this condition)
- Muscle spasms
- Heavyweight lifting with improper training
- Diabetic
- Rheumatoid arthritis
- Osteoarthritis
- Gout
- Obesity
- Immunocompromised
What are the signs and symptoms of knee bursitis?
The symptoms of knee bursitis depend on the type of bursa inflamed and its severity. The symptoms of knee bursitis gradually increase with overuse of the joint. The symptoms of knee bursitis according to the site of bursae involved are:
Prepatellar bursitis:
Symptoms of prepatellar bursitis include:
- Intense pain during doing some activity and resolve by taking rest
- Visible swelling in front of your knee joint
- Warm and tenderness
Infrapatellar bursae:
The symptoms of infrapatellar bursitis include
- Pain just below the kneecap
- Swelling below your kneecap
Suprapatellar bursitis:
The symptoms of suprapatellar bursitis occur above the kneecap. These symptoms include:
- Dull pain even at rest and worsens on activity
- Warmth and tender to touch
Anserine bursitis:
Anserine bursitis causes pain on the inner side of the leg (Lower part). Moreover, pain can spread from the front of the knee to the leg.
Bakers cyst:
Baker cysts can be painless. In a baker cyst, the swelling is behind your knee joint, which can impede the movement of the knee joint.
Other symptoms:
If some infection causes knee bursitis, it produces the following symptoms.
- High-grade fever with rigours and chills
- Reddish and swollen skin
- Warmer as compared to the normal one
How do ANF Therapists diagnose knee bursitis?
Diagnosing knee bursitis with the help of ANF Therapy®️ is a step-by-step procedure. This procedure involves a detailed patient history and a physical examination of the knee joint. It includes the following steps:
1-History:
History is the first primary step in diagnosing knee bursitis. The ANF Orthopedic Therapist gathers information about the history of the disease, including biodata, presenting complaints, drug history, and medical history.
- What is your age?
- Where do you feel pain?
- Is it painful at rest or during walking?
- What is your occupation?
- Any history of trauma
- Do you have diabetes or any other medical illness?
- Are you taking any medications for this disease?
- Any history of fever spike
- Can you walk upstairs?
2-Physical examination:
In this part, the ANF Therapist will examine the whole body of the patient, including:
- Temperature of the area on palpation
- Tenderness and erythema
- Location of swelling
- Colour of the swelling
- Knee joint’s range of motion
3- Neurological examination:
In this step, the ANF Therapist will assess the neurological function of the knee joint. He will check the following:
- Power
- Patellar tendon reflex
- Dermatomal distribution
- Muscle tone
Moreover, the neurological examination includes a thorough examination of all nerves to assess the severity of inflammation and areas of ANF Devices application. Neurological examination also helps distinguish healthy and inflamed nerves. Moreover, this step also involves an examination of tissues layer-by-layer. First, the ANF Therapist will palpate superficially and then move towards deeper layers. He will perform a “clinical surgery” technique with his hand during palpation to assess knee bursitis.
Management of knee bursitis with ANF Therapy®️: Innovative treatment for treating knee bursitis:
1-Anti-inflammatory Devices:
These Devices are applied over the knee joint and at the area of the bursa. The main goal of these devices is to reduce inflammation and pain by promoting the body’s natural healing process.
2-Antioxidant Devices:
Antioxidant Devices are also applied over the bursa of the knee joint to remove harmful free radicals (that boost the inflammatory response) and restore the natural function of antioxidants in the body like glutathione and carnosine to combat oxidative stress.
3-Neurological Devices:
These Devices are applied to regenerate the body’s natural healing process. These are meant to strengthen the weakened nerve system and help the body restore damaged oscillations.
Expected outcomes:
ANF Therapy®️ is an emerging treatment designed to repair damaged tissue, enhance normal body frequencies, and significantly reduce inflammation, oxidative stress and free radicals. It promotes self-healing mechanisms and restores normal body function.
ANF Therapy®️ has treated multiple patients with knee bursitis. Many experience rapid pain relief, usually within minutes or hours after the application of ANF Devices. However, individual responses may vary depending on the severity of the condition. The benefits of ANF Therapy®️ include:
- Significant reduction of pain and inflammation of knee bursitis
- Increase knee range of motion
- Reduced muscle spasms
- Restore damaged oscillation and promote self-healing
The duration of treatment varies, ranging from several days to a month, depending on the patient’s severity and response to the therapy.
Principle of ANF Therapy®️:
ANF Therapy®️ operates on the principle of neurofrequency modulation. It corrects weak and damaged frequencies in the patient’s body that are causing pain and inflammation. Placing ANF Devices on specific body areas stimulates neuroreceptors of the body and creates communication between the nervous system and other body parts.
Benefits of ANF Therapy®️ over other treatment options:
ANF Therapy®️ stands out by offering effective pain relief that targets the root causes of discomfort, not just the symptoms. This innovative treatment works by correcting damaged neurological frequencies, enhancing its ability to repair damaged tissues, and promoting the body’s natural healing processes.
Unlike many invasive treatments that can lead to post-surgical complications, ANF Therapy®️ is a non-invasive solution, especially beneficial for conditions like knee bursitis, and it avoids the risks associated with surgery.
Moreover, ANF Therapy®️ eliminates the need for costly medications that can upset your stomach and lead to other side effects. This frequency therapy provides a focused, efficient approach to alleviating all the primary symptoms of knee bursitis without unwanted complications.
Join ANF Therapy®️ To Upskill Your Clinical Practice
ANF Academy offers clinical training for medical professionals to provide them with detailed knowledge about frequency medicine. It mainly focuses on neurological oscillations, neurobiochemical processes and their bodily functions, advanced palpation skills, and techniques to assess the neurological system. The ANF Clinical Training Program provides expertise on the ANF methodology for managing injuries and inflammation effectively, aiming for optimal patient outcomes.
Training Highlights Include:
- Mastering advanced clinical skills and techniques for neurological examinations.
- Techniques for identifying the differences between healthy and inflamed nerves.
- Methods to investigate the physical effects (signs and symptoms) of disrupted neurological oscillations.
- Strategies to pinpoint and treat the underlying causes of pain, injury, or pathology, focusing on addressing root causes rather than merely symptoms.
The ANF Clinical Training Program:
- It starts with developing the ability to locate, palpate, and evaluate nerves and the level of inflammation.
- Enhances advanced clinical skills to discover the interconnections among different body systems and the underlying causes of symptoms.
- Provides education on the various stages of treatment using ANF neuro tech Devices tailored to match the healing phases of injured tissues.
For further information about ANF education programs and clinical training, visit www.anfacademy.com
What are the differentials of knee bursitis?
There are some differences in knee bursitis that you have to rule out before confirming the diagnosis. These differentials include:
- Septic arthritis
- Cellulitis
- Patellar tendonitis
- Patellofemoral pain syndrome
- Tibial apophysitis
- Subluxation of patella
How to prevent knee bursitis?
There are some preventive measures to prevent the risk of knee bursitis. These prevention include:
Avoid frequent bending of knees:
Try to prevent frequent bending of the knee joint because it puts stress on the joint and increases the risk of inflammation.
Prevent obesity and maintain a healthy lifestyle:
Obesity is a key factor that increases the risk of knee bursitis. Because it puts regular pressure on the joints and can cause bursitis, it’s mandatory to maintain a healthy lifestyle to manage your weight efficiently.
Take regular breaks from work:
Continuous activity without having a break increases the risk of knee bursitis. Taking regular breaks from the daily sequencing or bending activities minimises the risk of knee bursitis.
Use knee pads:
Use knee pads for patients involved in daily kneeling activity in their occupation. Knee pads were found to be very useful in protecting the knee joint from damage because the knee pad acts as a cushion and protects from injury.
Complications of knee bursitis:
The most common complication of the knee bursitis is infection. Other complications that result due to management options include;
- Infection during needle aspiration
- Fistula formation
- Subcutaneous atrophy due to frequent use of steroid injections
- Bleeding
- Rupture of patellar tendon
References:
- Rishor-Olney, C. R., Taqi, M., & Pozun, A. (2024, January 4). Prepatellar bursitis. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK557508/
- Cole, J. D., MD. (n.d.). Prepatellar bursitis diagnosis. Arthritis-health. https://www.arthritis-health.com/types/bursitis/prepatellar-bursitis-diagnosis
- Doctor, K. (2022, July 15). Knee Bursitis | 7 Treatment Tips | Jeremy Burnham, MD. Jeremy Burnham, MD – ACL & Complex Knee Surgeon. https://www.jeremyburnhammd.com/knee-bursitis-causes-symptoms-treatment/
About Authors
Writer:
Dr. Shahzaib Nasir
Dr. Shazaib Nasir, MBBS, RMP, is a medical writer at ANF Academy. He graduated from Multan Medical and Dental College, Pakistan. He works as a medical officer in the Oethpaedics department at Ibn-e-sina Hospital and Research Institute, Multan. He deals with patients suffering from chronic orthopaedic problems and pain. He is passionate about healthy eating and exercising. Moreover, he believes that frequency medicine can be the future of Orthopaedics.
Editor:
Dr. Shama Nosheen
Dr. Shama Nosheen, MBBS, RMP, is a skilled medical editor and writer at ANF Academy, specializing in medical communications. For 5 years, she has been working with renowned international healthcare companies as a medical writer, aiming to bridge the gap between patients and doctors. She is a graduate of Nishtar Medical University Multan. She grabbed American Board certification (ABAMS) in Aesthetic Medicine after graduation. Working with ANF Academy, she has developed a thorough understanding of ANF Therapy®️ that works on the principles of frequency medicine.
Reviewer:
PT. Irina Heinisuo Berná
Her background includes a Degree in Physiotherapy and a Master’s in Innovation and Research in Health Sciences, enriching her expertise in holistic health care. At ANF Academy, she seamlessly integrates clinical practice, academic teaching, and research into her daily activities to shape the future of ANF Therapy®️. Irina’s work symbolizes integrating education and compassionate care to improve global health outcomes.
Final Reviewer:
Dr. Mikel H-G Hoff
Dr. Mikel H-G Hoff, Founder of ANF Therapy®️, holds a bachelor’s degree in medicine and a Ph.D. in biochemistry, specializing in the bio function of the human body, specifically the neurological system. He is a manual therapist and sports psychologist. He is committed to revolutionizing healthcare by educating medical professionals and directly treating patients to enhance their quality of life. His extensive background in sports injury therapy, manual therapy, and various medical specializations, including biochemistry and nerve system signalization, empowers him to deliver pain-free solutions and lasting patient outcomes.
