What is the treatment for intrapatellar and suprapatellar bursitis of the knee?

Treatment for Intrapatellar and Suprapatellar Bursitis of the Knee

The treatment for intrapatellar and suprapatellar bursitis of the knee should begin with conservative measures including rest, ice, compression, elevation (RICE), NSAIDs, and activity modification, with more invasive treatments reserved for refractory cases. 1, 2

Initial Conservative Management

• Rest and Activity Modification: Reduce activities that aggravate the condition, such as kneeling or direct pressure on the affected area 1
• Ice: Apply ice to the affected area for 15-20 minutes several times daily to reduce inflammation 2, 3
• Compression: Use elastic bandages to reduce swelling and provide support 2, 3
• Elevation: Keep the affected knee elevated when possible to minimize swelling 3
• NSAIDs: Oral anti-inflammatory medications such as naproxen (starting dose 500mg followed by 250mg every 6-8 hours as needed) to reduce pain and inflammation 4
• Padding: Use protective padding to prevent further trauma to the affected bursa 2

Aspiration and Injection Therapy

• Bursal Aspiration: May be considered for acute traumatic/hemorrhagic bursitis to shorten symptom duration, but generally not recommended for chronic microtraumatic bursitis due to risk of iatrogenic infection 1
• Corticosteroid Injections: Can be considered for cases that don't respond to initial conservative measures, though high-quality evidence demonstrating benefit is limited 1, 5
• Caution: Local injections should be performed with strict aseptic technique to avoid introducing infection 6

Treatment Based on Specific Bursitis Type

Acute Traumatic/Hemorrhagic Bursitis

• Conservative treatment with RICE protocol and NSAIDs 1, 6
• Aspiration may help reduce symptoms more quickly 2

Chronic Microtraumatic Bursitis

• Address underlying causes (e.g., avoid kneeling, use knee pads) 1
• Conservative treatment as outlined above 2, 6
• Avoid repeated aspirations due to infection risk 1

Septic Bursitis

• Requires prompt diagnosis through bursal aspiration and fluid analysis (Gram stain, culture, cell count) 1
• Antibiotics effective against Staphylococcus aureus are typically the initial treatment 1
• Outpatient oral antibiotics for mild cases; hospitalization and IV antibiotics for severe cases 1
• Surgical intervention may be necessary for cases not responsive to antibiotics 1, 6

Inflammatory Bursitis (e.g., from gout or rheumatoid arthritis)

• Treat the underlying condition 1
• Intrabursal corticosteroid injections are often used 1

Physical Therapy and Rehabilitation

• Stretching and Strengthening: Exercises to improve flexibility and strength of surrounding muscles, particularly the quadriceps 7
• Ultrasound and Electrical Stimulation: May be beneficial as adjunctive treatment modalities 3

Advanced Interventions for Refractory Cases

• Immobilization: For particularly acute or refractory cases, immobilization with a brace or walker-type device may be considered 7
• Surgical Intervention: Reserved for cases that fail conservative management, with surgical excision of the bursa being the procedure of choice for recalcitrant cases 6, 5

Important Considerations and Pitfalls

• Differential Diagnosis: Bursitis must be distinguished from arthritis, fracture, tendinitis, and nerve pathology 5
• Infection Risk: Always consider the possibility of septic bursitis, particularly with acute onset of symptoms, fever, or significant erythema 1
• Avoid Steroid Overuse: While corticosteroid injections can be helpful, repeated injections may lead to tissue atrophy and other complications 5
• Patient Education: Educate patients about preventive measures and activity modifications to prevent recurrence 3