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Knee Bursitis

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The knee bursa is a small fluid filled sac located between the front of the knee cap (the patella) and the overlying skin (Figure 1). This bursa allows the knee cap to slide freely underneath the skin as we bend and straighten the knee.

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This bursitis causes pain, swelling, tenderness and a lump in the area on top of the knee cap (Figure 2). It may be very difficult to kneel down and put the knee on the floor due to the tenderness and swelling.

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Types of Knee Bursitis:
Depending on the location, there are a few different types of knee bursitis including; suprapatellar, prepatellar (the most common/popeye knee), infrapatellar and pes anserine (Figure 3).

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Causes:
Trauma is one cause of knee bursitis. Direct injury or fall onto the knee cause damage the bursa with development of sudden large swelling. In people who have occupational kneeling, bursitis is chronic and develops slowly as seen in carpet layers, tillers, wrestlers, etc. Infection may also cause knee bursitis. Inspect the bursa for any breaks in the skin leading to infection. Red hot, painful and a swollen bursa are signs of a possible infection. Inflammation is a third cause of knee bursitis.

Treatment of patellar bursitis:
Antibiotics should be used in an infection is suspected or confirmed. Other treatment options include anti-inflammatory medications, ice therapy, and aspiration. The fluid from the aspiration will be sent for cultures and crystals. Occasionally, surgery may be needed to debride and excise the bursa. A protective covering should be placed around the knee while avoiding activities that aggravate the condition (Figure 4).

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