Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Bursitis

The knee is surrounded by several bursae.

Prepatellar bursitis
The prepatellar bursa is located anterior and distal to the patella. Its location makes it vulnerable to traumatic bursitis. Team handball players, American football players, soccer players,
wrestlers, and gymnasts are at increased risk. One study reported that 9.5% of wrestlers had prepatellar bursitis over a 6-year period.
Acute traumatic bursitis is caused by a single direct blow to the area resulting in hemorrhagic bursitis.Healing may take a week. Return to sport is possible as soon as the symptoms have disappeared, the swelling and inflammation have subsided, and there is a more or less normal range of motion. Protective padding is important to prevent recurrence.

Recurrent bursitis can result from recurrent trauma. This chronic situation is more difficult to treat. Aspiration is usually necessary and then cortisone can be injected into the area. A compression bandage is helpful. Immobilization for a short period may be necessary. Sometimes surgical excision of the bursa is
indicated when there are multiple recurrences, or the inflamed bursa extends beyond the patella. Return to sport after surgery is possible within 2–3 weeks.Septic (infected) bursitis requires aggressive medical treatment.

Infrapatellar bursitis
A small bursa is located under the distal part of the patellar tendon and the proximal anterior part of the tibia. Pain in this area can be a residual problem after Osgood-Schlatter disease. Bursitis may be combined with the presence of a small bone fragment. The symptoms are pain in this area, localized tenderness, and
sometimes problems with extending the knee against resistance. Treatment is conservative; occasionally surgery is needed.

Baker’s cyst (popliteal bursitis)
A distended bursa in the hollow behind the knee (the popliteal space) is a relatively uncommon condition
which manifests itself as a swelling of the posterior joint capsule of the knee joint. The bursa
is sometimes connected with the joint, and when an irritant condition is present with an effusion in the joint,
synovial fluid may be pressed out into the bursa so that it becomes distended.

Symptoms and diagnosis
– A sensation of pressure mainly affecting the popliteal space is experienced, especially on bending. This feeling may also be transmitted to the calf muscles.
– It is difficult to bend and straighten the knee joint completely.
– Aching and tenderness are felt after exertion of the knee joint.
– The distended bursa appears as a rounded, fluctuant swelling, usually the size of a golf ball but sometimes as big as a tennis ball, when the knee joint is held in extension.
– Ultrasonography or MRI of the knee can show the elements of the bursa.
– Arthroscopy may reveal the cause of the effusion in the knee joint.

Treatment
The athlete should rest; the symptoms may then disappear.
The doctor may:

– treat any cause of the effusion in the knee joint;
– remove the bursa surgically if it is causing problems.

Healing
The injured athlete can return to sporting activity 4–8 weeks after surgery. Baker’s cyst often disappears spontaneously in children.

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