Housekeepers are on their knees for a long time during the cleaning process; and miners, bodybuilders and movers are people of heavy physical labor. Such a lifestyle is fraught with the development of an occupational disease – bursitis of the knee joint.
Features of the disease
Bursitis is an inflammatory disease of the periarticular bags – bursitis. They are represented by capsules with elastic walls and viscous contents – synovial fluid. Similar bags are located around the joints (between the muscle and tendon scaffolds), while being a kind of “shock absorbers” that soften the pressure on the joint.
On average, the body has about a hundred bursa. So, around the knee joint there are three large bags: above, before and the popliteal, located on top, front and bottom of the patella, respectively. A certain type of bursitis is also considered a Becker cyst, which occurs on the back of the knee joint.
Why does knee bursitis appear?
With constant exposure to the joint (long kneeling) or heavy physical labor, the pressure inside the bursa increases. It is this factor that leads to the hyperfunction of special cells that produce synovial fluid in the bag. As a result, the amount of bursa contents increases significantly, the bag shells are stretched, inflamed, which leads to bursitis of the knee joint. One or several periarticular bags may be affected.
This is facilitated by:
- excessive loads (large body weight, specific professions: housekeepers, miners, athletes, etc.);
- chronic diseases of the musculoskeletal system (arthrosis, rheumatism, gout);
- orthopedic pathologies leading to an uneven distribution of weight on the joint (clubfoot, flat feet, foot deformities);
- traumatic lesions of the knee (bruises, sprains and tendons);
- metabolic disorders or intoxication conditions (food, industrial substances or ethanol);
- autoimmune, allergic or hormonal diseases (for example, thyrotoxicosis – increased secretion of thyro >
Symptoms of the disease
A characteristic manifestation of bursitis of the knee joint is the appearance of a rounded formation around the articular surfaces. The protrusion consistency is tight, the symptom of fluctuation is often observed – the presence of fluid in the capsule.
In the tissues around the edema, limiting mobility. The skin over the joint area is hyperemic – red and hot. Soreness is usually mild, while increasing with palpation of an enlarged bursa.
The general condition of the patient suffers little: the temperature rises slightly (to subfebrile numbers), mood and performance decrease, weakness and headaches appear. If the disease was the result of a knee injury, the patient’s health deteriorates sharply: the temperature rises to 39-40 0 C, sweating, drowsiness appears, inguinal lymph nodes increase.
If the necessary treatment is not followed, the disease can become chronic. In this case, the severity of symptoms decreases, and the pain syndrome can disappear altogether. In the bursa cavity, fibrin filaments (connective tissue) and / or dense small formations usually appear – the so-called “Rice grains.”
The course of Becker’s cyst is extremely similar to typical bursitis of the knee joint, however, a bursa appears on the back of the joint – under the knee. With a sufficient size of the neoplasm, the bag can squeeze the neurovascular bundle, leading to the development of pain, swelling of the leg, sensory disturbances in the foot and stiffness in the joint. The danger of this pathology is the possible compression of the veins, thrombosis, separation of thrombotic masses and subsequent pulmonary vein thrombosis with a possible fatal outcome.
How to diagnose the disease?
The diagnosis is usually made on the basis of examination and palpation of the affected area. To clarify the ailment, an X-ray examination, ultrasound diagnosis or tomography can be performed.
In some cases, puncture (puncture) of a bursa with a fence of contents may be required. The fluid from the bag is subject to research on the flora and sensitivity of the latter to antibacterial agents.
The first stage of treatment is immobilization of the limb in the affected joint. To do this, a bandage with an elastic bandage or a plaster cast is applied to the joint. Perhaps the use of an orthosis or other means.
Be careful! The first aid for the appearance of bursitis of the knee joint is the application of a immobilizing dressing and cold at the site of the lesion.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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If the bacterial nature of knee bursitis is proved, drug treatment begins with the use of broad-spectrum antibiotics, but only a doctor can prescribe them: Amoxicillin, Ceftriaxone, Erythromycin. In the event that a joint puncture was performed with the determination of antibiotic sensitivity, the drug is replaced with the necessary one or left unchanged.
For non-infectious – “clean” – bursitis, non-steroidal anti-inflammatory drugs are used in tablets (Ibuprofen, Paracetamol), ointments (Diclofenac Naproxen) or solutions for intramuscular injection (Ortofen). With severe pain, anesthetics are prescribed (Analgin, Ketorolac).
If the patient has contraindications for the use of non-steroidal anti-inflammatory drugs, hormone therapy with glucocorticoids is prescribed (Metipred, Florinef, Decadron). Similar drugs are also resorted to if the previous treatment was ineffective. But it is worth noting that prolonged use of corticosteroids leads to the destruction of articular cartilage.
Strong pain can lead to reflex muscle spasm, which will require muscle relaxants (Sirdalud, Midokalm) to relieve. Also, to eliminate intoxication (with the appearance of dizziness, nausea, vomiting, weakness), detoxification drugs are used – Sodium thiosulfate, Polysorb. At the same time, abundant water intake is effective (up to 3 liters per day in the absence of renal pathologies).
If bursitis has arisen against the background of other diseases or if a general increase in the body’s resistance is required, immunity stimulants can be prescribed: Galavit, Immunal.
A course of physiotherapeutic procedures (7-10 sessions) can accelerate recovery. Usually, in the acute period, exposure to cold is necessary, but during rehabilitation, warming is effective: magnetic and laser therapy, exposure to a high-frequency magnetic field, application of paraffin baths and mud therapy. Such procedures are aimed at improving blood flow in the affected area, as well as accelerating the restoration of damaged tissues.
During the acute process (when conservative methods of therapy are unsuccessful), it is possible to puncture the bursa and remove its contents, followed by washing with antibiotics. In rare cases, its “incision” is necessary with the installation of a drainage tube.
If bursitis of the knee joint has not previously been treated, and the ailment has turned into a chronic form, surgical removal of the periarticular bag may be necessary – a bursectomy. The operation is performed under local anesthesia: the patient is injected with an anesthetic and the contents of the bursa and its capsule are removed. A drainage system is installed in the wound. In the postoperative phase, physiotherapy sessions and physiotherapy exercises are necessary.
- prevention of excessive loads on the knee: weight loss, normalization of physical labor in housekeepers, miners, jumpers, etc .;
- control of diseases of the musculoskeletal system (arthrosis, rheumatism, gout);
- correction of orthopedic pathologies that lead to an inadequate distribution of the load on the joint (clubfoot, flat feet, foot deformities);
- timely treatment of injuries (bruises, sprains and tendons);
- diagnosis and correction of metabolic and intoxication disorders (food, industrial and alcohol);
- therapy of allergic conditions, adequate treatment of hormonal pathology of the thyroid and pancreas (with thyrotoxicosis, diabetes mellitus);
- disinfection of all wounds with antiseptics, as well as treatment of foci of chronic infections (tonsillitis, caries);
- timely treatment of purulent skin lesions (erysipelas, furunculosis and carbunculosis), as well as the musculoskeletal system (osteomyelitis);
- prevention of infection with specific infections (tuberculosis, syphilis, gonorrhea): a healthy lifestyle, the use of a condom during intercourse, as well as periodic consultations with a venereologist and TB specialist.
Remember, the danger of bursitis of the knee joint lies in possible complications: scarring, calcification, immobilization, as well as the spread of infection throughout the body – sepsis – with a possible fatal outcome.
We noticed the symptoms of the disease – be sure to consult a doctor!