A bursa is a small flat cushion-like structure usually found in between a muscle and a bone. It helps provide protection and reduces friction. It is sometimes thought of as a small fluid-filled cushion, one to three inches in size, but usually it is quite flat, similar to a barely filled plastic bag of water. These are present in many areas of our skeletal system, and frequently cause pain in the knees, shoulders, elbows and hips. There are two main knee bursae, and several others. One is on the inside of the knee, just below the joint. The other main bursa is in front of the kneecap.
Pain will occur when the patellar bursae become injured, pinched or inflamed. When the bursa is inflamed, it is called patellar bursitis. (the ‘itis’ refers to something that is inflamed - like appendicitis). When the bursa is inflamed or injured, the bursa produces more fluid causing swelling and pain.
A bursa may become painful with injury or strenuous or repetitive activities. Often a fall or excessive kneeling on the kneecap will cause pre-patellar bursitis. Sometimes knee bursitis is due to a more serious disease, such as rheumatoid arthritis or even infection.
When the knee is at rest there is less pain, but it usually will feel painful with walking, pressing on the front of the knee is painful, and occasionally redness and swelling is present. The pain may be very sharp if patellar bursitis is severe.
Along with a history of the knee symptoms, an examination using specific motions may suggest bursitis is present. Usually X-rays are done, but because the bursa is made of soft tissue, X-rays or CT scans are often not sufficient. An MRI or ultrasound examination may show if bursitis is present.
The treatment of knee bursitis depends upon the cause and severity of the pain. In general, if pain does not improve with ice and rest, then medical evaluation is a good idea. Physical therapy and anti-inflammatory medications may be tried to reduce pain. More severe pain may be treated with removal of fluid or injections of cortisone-like medications into the knee bursa. Rarely, surgery may be required to remove the bursa.
Various medications may be used to reduce pain. These may include over the counter medications such as Tylenol (generic = acetaminophen) Aleve (generic = naproxen), Motrin (generic = ibuprofen) or aspirin. Prescription medications which belong to a group of medications called ‘non-steroidal anti-inflammatory medications (or ‘NSAIDs’ for short) are commonly recommended. Some of the more commonly prescribed of these include medications such as Celebrex, Motrin, Naprosyn, Mobic,Voltaren, Relafen and Lodine. (a complete list is available at the reference below).