2. What is a Bursa? A bursa is a soft, fluid-filled closed sac lined with a synovial-like membrane that sometimes contains fluid that develops in the area and is subject to pressure or friction.

3. What is a Bursa? Purpose: – Decrease friction by cushioning muscles or tendons and bones that move back and forth across each other – These are typically thin, but may become thickened and fluid-filled with increased stress

4. What is Bursitis? Bursitis is an inflammation of a bursa. Bursitis is characterized by a painful inflammation or irritation of the soft, fluid-filled sac that covers and cushions the movement between the bones, tendons, and muscles near the joints.

5. Types of Bursitis

6. The bursa is located directly above the knee The bursa is not a true bursa but rather is an extension of the tibiofemoral joint capsule Inflammation of this bursa usually results from a mechanical irritation during kneeling activities – Commonly referred to as “Nun’s Knee” Suprapatellar Bursitis

7. Prepatellar Bursitis The bursa is located anterior to the patellar tendon Characterized by swelling with effusion of the superficial bursa overlying the lower pole of the patella This type of bursitis is caused by injury to the anterior knee, such as a fall directly onto the patella – Commonly referred to as “Housemaid’s Knee”

9. Infrapatellar Bursitis The bursa is located between the tuberosity of the tibia and the patellar tendon and is separated from the synovium of the knee by a pad of fat

10. Anserine Bursitis The bursa separates the Pes Anserinus from the distal portion of the MCL and the medial femoral condyle Involves pain and tenderness at proximal medial tibia Characterized by sudden onset of knee pain with localized tenderness and swelling at Pes Anserinus

12. Causes of Bursitis: Overuse Direct blow to the knee Repeated stress – i.e. repetitive kneeling Infection

13. Patient population affected by Bursitis: It frequently develops based on the patient’s occupation, not sports. Commonly occurs from overuse injuries – i.e. runners, wrestling, volleyball Commonly occurs in obese women in association with osteoarthritis

14. Diagnosis Radiographic imaging may reveal tissue swelling Ultrasound imaging may detect fluid collection MRI may be helpful but is not required on an urgent basis

15. Clinical Presentation Localized tenderness with pain on pressure against bursa Swelling Restricted internal or external rotation Joint movement that is accompanied by pain Referred pain Palpable occasional fibro-cartilaginous bodies

16. Examination findings Palpable tenderness over bursae Localized pain and swelling over the patella Restricted internal and external rotation

17. Goals of Treatment Reduce pain levels Reduce inflammation and swelling Return patient to normal activities as soon as possible without risk for further injury

18. Non-operative Treatment

19. Two types of Bursitis Treatment Bacterial: – Involves antibiotic treatment with operative drainage Inflammatory: – Involves ice, rest, anti-inflammatories, injection of corticosteriods

20. Physical Therapy Strengthening exercises – Focus on Isometrics Stretching exercises – Focus on Quadriceps, Hamstrings, Gastrocnemius

21. Modalities RICE therapy (Rest, Ice, Compression, Elevation) – Used to control pain and swelling Compression dressings – Used to control the level of swelling around the knee Knee protection pads – Use with certain sports/activities that perform repetitive motions i.e volleyball, wrestling, construction worker

22. Pharmacology Anti-inflammatory medications – Used to control pain and inflammation Non-steroidal anti-inflammatory medications – Used to control inflammation Corticosteroid injections – Used to help reduce swelling of the bursa

23. Operative Treatment

24. Surgery Various surgical procedures for treating Bursitis: – Aspiration and injection of drugs – Incision and drainage when acute bursitis fails to respond to nonsurgical treatment – Excision of chronically infected and thickened bursae – Removal of underlying bony prominence

25. Recommendations Avoid direct blows to the kneecap Avoid prolonged kneeling Use proper protective kneepads to help prevent inflammation of the bursae Take your time with return to normal activities. – Returning too soon may worsen the injury Note: The longer you have symptoms before you start treatment, the longer it will take to recover

26. Resources Ferri: Ferri’s Clinical Advisor 2011, 1 st Edition. Copyright © 2010 Mosby, An Imprint of Elsevier. Lazoff, Marie. First Consult. Elseiver Inc. Copyright © 2011 Marx: Rosen’s Emergency Medicine, 7 th Edition. Copyright © 2009 Mosby, An Imprint of Elsevier. Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2nd Edition 2008. DeLee: DeLee and Drez’s Orthopaedic Sports Medicine, 3 rd Edition. Copyright © 2009 Saunders, An Imprint of Elsevier.