What is the treatment for knee bursitis?

Treatment of Knee Bursitis

The treatment of knee bursitis should follow a stepped approach starting with conservative measures including rest, ice, compression, elevation (RICE), NSAIDs, and activity modification, progressing to more invasive interventions only if conservative treatment fails. 1, 2

Types of Knee Bursitis

Knee bursitis commonly affects several bursae:

• Prepatellar bursa (front of kneecap)
• Pes anserine bursa (inside of knee)
• Infrapatellar bursae (below kneecap)
• Medial collateral ligament bursa (inner knee)

Initial Conservative Management

1. RICE Protocol:

   • Rest: Avoid activities that aggravate symptoms
   • Ice: Apply for 15-20 minutes several times daily
   • Compression: Use elastic bandage to reduce swelling
   • Elevation: Keep the affected knee elevated when possible

2. Pharmacological Treatment:

   • Oral NSAIDs (first-line): Naproxen 500mg twice daily or as directed when not contraindicated 1, 3
   • Topical NSAIDs: Apply to affected area for localized pain relief with fewer systemic effects 1, 4
   • Acetaminophen: Up to 4g/day if NSAIDs are contraindicated 4

3. Activity Modification:

   • Identify and address underlying causes (e.g., kneeling, repetitive pressure)
   • Use protective padding for activities requiring kneeling 2, 5

Intermediate Interventions

If symptoms persist after 1-2 weeks of conservative treatment:

1. Aspiration:

   • Consider bursal aspiration for significant effusion or pain relief 6, 7
   • CAUTION: Avoid routine aspiration of microtraumatic bursitis due to risk of iatrogenic infection 2

2. Corticosteroid Injection:

   • May be considered for persistent, non-infectious bursitis 7, 8
   • Ultrasound-guided injection improves accuracy and outcomes 8
   • NOTE: Evidence for corticosteroid injections is limited but commonly used in clinical practice 2

Management of Specific Types

Non-Infectious Bursitis

• Continue conservative measures for 2-3 weeks
• Physical therapy focusing on strengthening exercises for surrounding muscles 1, 4
• Consider weight loss if overweight/obese to reduce joint stress 1, 4

Septic (Infectious) Bursitis

• Requires immediate treatment with antibiotics effective against Staphylococcus aureus 2
• Bursal aspiration for Gram stain, culture, cell count, and crystal analysis 2
• Hospitalization with IV antibiotics for acutely ill patients 2
• Outpatient oral antibiotics may be considered for stable patients 2

Inflammatory Bursitis (e.g., associated with gout, rheumatoid arthritis)

• Treat the underlying condition 2
• Intrabursal corticosteroid injections often used 2

Advanced Interventions

For refractory cases not responding to conservative measures after 4-6 weeks:

1. Surgical Management:
   • Bursectomy may be considered for chronic, recalcitrant cases 6, 7
   • Reserved for cases unresponsive to conservative management 7

Patient Education and Prevention

• Self-management strategies and education about the condition 1, 4
• Use of protective padding during activities that put pressure on the knee 2, 5
• Regular low-impact exercise to maintain joint mobility and muscle strength 1, 4

Monitoring and Follow-up

• Reassess after 1-2 weeks of initial treatment
• If symptoms worsen or signs of infection develop (increased warmth, redness, fever), immediate reevaluation is necessary
• For chronic cases, periodic follow-up to adjust treatment plan as needed

Common Pitfalls to Avoid

• Failing to distinguish bursitis from other conditions (arthritis, tendinitis, fracture)
• Injecting corticosteroids into an infected bursa
• Overlooking underlying conditions that may contribute to bursitis
• Premature return to aggravating activities before adequate healing

By following this treatment algorithm and addressing both symptoms and underlying causes, most cases of knee bursitis can be effectively managed without the need for surgical intervention.