Abstract
A bursa is a closed sac filled with synovial fluid. Traditionally, bursitis has been the preferred term for a painful bursa. Recently, the term bursopathy has been adopted by many since the presence of acute inflammation cannot be determined clinically. The knee has 11 bursae whose principal function is to reduce friction between two tissues, such as tendons, ligaments, and bone. The location of bursae in the knee can be divided into 3 regions: anterior, medial, lateral, and posterior. The most common patient complaints in knee bursopathies are local knee pain, swelling, and tenderness in the area of the affected bursa. The symptoms may or may not be associated with range of motion (ROM) limitation and/or antalgic gait. A complete knee examination including inspection, palpation, ROM, ligament stability, knee special tests, and neurologic examination should be performed in order to rule out other pathologies. Ultrasound is considered an effective, inexpensive, and accessible modality that can be part of the diagnostic evaluation of the superficial knee, including bursae. Magnetic resonance imaging (MRI) may be necessary for evaluation of intra-articular structures like menisci, ligaments, and cartilage. Conservative treatment includes the use of nonsteroidal anti-inflammatory medications and PRICE ( p rotection, r elative rest, i ce, c ompression, and e levation). A stretching and strengthening program should be used to correct predisposing biomechanical imbalances. Bursal infiltration of a mixture of local anesthetic and corticosteroids can be considered for acute pain relief.
Keywords
anserine bursitis, bursopathy, infrapatellar bursitis, medial collateral ligament bursitis, prepatellar bursitis, semimembranosus bursitis
| ICD-10 Codes | |
| M71.561 | Bursitis, not elsewhere classified, right knee |
| M71.562 | Bursitis, not elsewhere classified, left knee |
| M71.569 | Bursitis, not elsewhere classified, unspecified knee |
| M71.80 | Other Specified bursopathies, unspecified site |
| M71.861 | Other Specified bursopathies, right knee |
| M71.862 | Other Specified bursopathies, right knee |
| M71.869 | Other Specified bursopathies, unspecified knee |
| M71.9 | Bursopathy, unspecified |
| M76.40 | Tibial collateral bursitis, unspecified leg |
| M76.41 | Tibial collateral bursitis, right leg |
| M76.42 | Tibial collateral bursitis, left leg |
| M70.40 | Prepatellar bursitis, unspecified knee |
| M70.41 | Prepatellar bursitis, right knee |
| M70.42 | Prepatellar bursitis, left knee |
| M70.50 | Other bursitis of knee, unspecified knee |
| M70.51 | Other bursitis of knee, right knee |
| M70.52 | Other bursitis of knee, left knee |
| M71.161 | Other infective bursitis, right knee |
| M71.162 | Other infective bursitis, left knee |
| M71.169 | Other infective bursitis, unspecified knee |
| M06.261 | Rheumatoid bursitis, right knee |
| M06.262 | Rheumatoid bursitis, left knee |
| M06.269 | Rheumatoid bursitis, unspecified knee |
Definition
A bursa is a closed sac filled with synovial fluid. Traditionally, bursitis has been the preferred term for a painful bursa. Recently, the term bursopathy has been adopted by many since the presence of acute inflammation cannot be determined clinically. Similar terminology has been adopted in the description of tendon pathologies, preferring the term tendinopathy to tendinitis. For discussion purposes, we will continue to use the term bursopathy, even though the term bursitis is more commonly seen in the literature.
The knee has 11 bursae whose principal function is to reduce friction between two tissues, such as tendons, ligaments, and bone. The location of bursae in the knee can be divided into 4 regions: anterior, medial, lateral, and posterior.
Anterior region The anterior knee includes the suprapatellar bursa or recess, the prepatellar bursa, and the deep and superficial infrapatellar bursa. The suprapatellar bursa is a superior recess of the knee joint deep to the quadriceps femoris tendon and anterior to the intercondylar fossa. The prepatellar bursa is located subcutaneously, anterior to the patella. The superficial infrapatellar bursa can be found anteriorly to the tibial tubercle and the deep infrapatellar bursa between the posterior aspect of the distal patellar tendon and the anterior tibia.
Posterior region The posterior knee includes the gastrocnemio-semimembranosus bursa and the popliteus bursa. At the distal aspect of the tendon sheath of the popliteus muscle is the popliteus bursa which, on occasions, communicates with the tibiofibular joint. The gastrocnemio-semimembranosus bursa is located between the semimembranosus tendon, the medial head of the gastrocnemius, and medial femoral condyle. A valvular communication from the joint capsule to the gastrocnemius-semimembranosus bursa is a common anatomical variant. Joint fluid extrusion through this communication into the bursa can result in a popliteal cyst, also known as a Baker cyst.
Lateral region On the lateral knee we can find the iliotibial bursa and the lateral collateral ligament-biceps femoris bursa. The iliotibial bursa is located between the iliotibial band and the lateral femoral condyle. The lateral collateral ligament-biceps femoris bursa lies superficially to the lateral collateral ligament and deep in the anterior arm of the long head of the biceps femoris muscle.
Medial region The pes anserine bursa, the semimembranosus-tibial collateral ligament bursa, and the medial collateral ligament (MCL) bursa are found in the medial region. The pes anserine bursa is found between the upper medial aspect of the tibia and the conjoined tendon of the pes anserinus muscles. The MCL bursa is located between the two layers of the MCL. The semimembranosus-tibial collateral ligament bursa is present posterior and superior to the pes anserine bursa between the semimembranosus tendon and MCL.
Definition
A bursa is a closed sac filled with synovial fluid. Traditionally, bursitis has been the preferred term for a painful bursa. Recently, the term bursopathy has been adopted by many since the presence of acute inflammation cannot be determined clinically. Similar terminology has been adopted in the description of tendon pathologies, preferring the term tendinopathy to tendinitis. For discussion purposes, we will continue to use the term bursopathy, even though the term bursitis is more commonly seen in the literature.
The knee has 11 bursae whose principal function is to reduce friction between two tissues, such as tendons, ligaments, and bone. The location of bursae in the knee can be divided into 4 regions: anterior, medial, lateral, and posterior.
Anterior region The anterior knee includes the suprapatellar bursa or recess, the prepatellar bursa, and the deep and superficial infrapatellar bursa. The suprapatellar bursa is a superior recess of the knee joint deep to the quadriceps femoris tendon and anterior to the intercondylar fossa. The prepatellar bursa is located subcutaneously, anterior to the patella. The superficial infrapatellar bursa can be found anteriorly to the tibial tubercle and the deep infrapatellar bursa between the posterior aspect of the distal patellar tendon and the anterior tibia.
Posterior region The posterior knee includes the gastrocnemio-semimembranosus bursa and the popliteus bursa. At the distal aspect of the tendon sheath of the popliteus muscle is the popliteus bursa which, on occasions, communicates with the tibiofibular joint. The gastrocnemio-semimembranosus bursa is located between the semimembranosus tendon, the medial head of the gastrocnemius, and medial femoral condyle. A valvular communication from the joint capsule to the gastrocnemius-semimembranosus bursa is a common anatomical variant. Joint fluid extrusion through this communication into the bursa can result in a popliteal cyst, also known as a Baker cyst.
Lateral region On the lateral knee we can find the iliotibial bursa and the lateral collateral ligament-biceps femoris bursa. The iliotibial bursa is located between the iliotibial band and the lateral femoral condyle. The lateral collateral ligament-biceps femoris bursa lies superficially to the lateral collateral ligament and deep in the anterior arm of the long head of the biceps femoris muscle.
Medial region The pes anserine bursa, the semimembranosus-tibial collateral ligament bursa, and the medial collateral ligament (MCL) bursa are found in the medial region. The pes anserine bursa is found between the upper medial aspect of the tibia and the conjoined tendon of the pes anserinus muscles. The MCL bursa is located between the two layers of the MCL. The semimembranosus-tibial collateral ligament bursa is present posterior and superior to the pes anserine bursa between the semimembranosus tendon and MCL.
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