Symptoms and modern treatment of knee bursitisthe joint

Prenatal bursitis is a disease characterized by
повреждением тканей и воспалением суставной сумки коленного the joint
(a small bag filled with liquid, which is located between
patella and skin). The main sign of the development of bursitis –
pain in the affected area.

Существует несколько разновидностей bursitisа коленного the joint, в
depending on the involvement in the inflammatory process
articular bags.

In addition to the prepatellary bag in the knee area there is also
suprapatellar articular bag, which is located in place
joints of the knee cartilage. Its inflammation is called
suprapatellar bursitis. However, despite the different names,
symptoms of the disease remain almost the same.

Withчины

Наиболее распространенными факторами, приводящими к
развитию bursitisа коленного the joint, являются:

  • Permanent and prolonged physical activity involving
    work of the knee joints or with strong pressure in this
    areas
  • Directional strike, drop on your knees
  • Infection at the cut or abrasion of the knee
  • Excessive load on knees with concomitant obesity
  • The patient has an infectious disease (syphilis,
    tuberculosis, brucellosis, gonorrhea, etc.)
  • Exercise in extreme conditions (with increased risk
    injury)

The development of inflammation in the knee joint is characteristic not only for
athletes. This condition can develop in every person.
even after a minor injury:

  • Famous actor Tom Hanks in 2013 had surgery
    поводу bursitisа коленного the joint и даже снял процесс лечения на
    video
  • In 2011, singer Barry Manilow underwent surgery for
    complicated prepatellar bursitis. �“Good news: after
    a few nightmarish weeks, I finally rose from the dead. I
    little by little I start to walk, while still with a crutch, but soon
    I will recover completely ”

Knee bursitis is classified:

  • According to the clinical course: chronic, subacute, acute
    bursitis
  • By pathogen: on non-specific and specific
    (туберкулезный bursitis, при гонорее, при сифилисе, бруцеллезе). AT
    this classification is sometimes divided into infectious and
    aseptic (non-infectious)
  • By the nature of the exudate:
    • геморрагический bursitis- в жидкости много эритроцитов
    • serous – in liquid plasma mixed with uniform elements
      of blood
    • purulent – the presence of disintegrated leukocytes, destroyed cells,
      microorganisms
    • фибринозный bursitis — высокое содержание фибрина

Symptoms

Основные характеризующие bursitis коленного the joint симптомы,
include gradually increasing pain and swelling right in front of the knee
a cup. AT менее тяжелых случаях отек может не наблюдаться, а
the patient is worried about the stiffness of the movements, which increases with prolonged
physical activity. At the initial stage, pain, on the contrary, can
утихать по мере улучшения кровотока в areas the joint, то есть при
moderate loads the patient’s condition may improve.

Among other signs:

  • The inability to completely unbend the leg at the knee joint;
  • Боль при прикосновении к areas коленной чашечки;
  • Pain when walking (usually on an inclined surface – lifting or
    descent from the mountain, etc.);
  • Swelling, compaction, redness and local temperature rise in
    areas the joint (признаки воспаления).

The pain occurs right above the patella and can
extend to the back of the knee and the inner surface
thighs, and also up or down the leg. The pain increases with
crossing legs, as well as when lifting after a long sitting in
one pose. Больной препателлярным bursitisом не может встать на
knees.

An indirect symptom is sleep disturbance. This is due to
the fact that pain when bending the legs or when changing the position of the body
may increase significantly, depending on the severity of inflammation.
Many patients, based on their own feelings, recommend
put a pillow between your knees (or hips) while you sleep.

Mobility impairment occurs during progression
diseases when undertreated inflammation becomes more
severity, causing severe pain when flexing the leg. With time
muscular weakness develops in the affected limb and
dystrophy.

With остром bursitisе:

  • AT areas сумки образуется припухлость, округлая, болезненная,
    elastic
  • Redness, swelling and pain of soft tissues
  • Ограничивается движение the joint
  • The patient may have general malaise and increase
    temperature
  • Затем покраснение увеличивается, боль усиливается, temperature
    can reach 40C
  • ATозможно развитие гнойного процесса, флегмоны

Своевременное и правильное лечение острого bursitisа останавливает
progression of the disease and it does not turn into subacute, but
then chronic.

With хроническом bursitisе:

  • Movement in the joint is not limited.
  • AT areas сумки — округлая мягкая припухлость
  • But there is no pain, redness and swelling of the surrounding tissue.
  • With хроническом процессе возможно возникновение рецидива
    (injury, reduced immunity)

ATиды bursitisов

Препателлярный bursitis — самый часто встречающийся, при этом
inflamed subcutaneous bag on the front the surface of the knee.
The cause may be padagric arthritis, salt deposits with
pseudogout, rheumatoid arthritis, and also often occurs after
injury, injury to the knee or professional if work
requires frequent kneeling. Unlike arthritis, pain is not
strongly pronounced and movement restrictions are not significant. With 
infection of the contents in the cavity of the bursa increase
lymph nodes, pain increases, temperature rises
body.

Infrapatellar bursitis – arises due to inflammation of the bursa,
located under the tendon under the patella, most often
develops after jumping or injuries. The treatment is rest
cold compresses, taking NSAIDs, painkillers.

Goose bursitis (Baker’s cyst) – inflamed bursa,
located behind the inner surface of the knee joint.
It is more common in women with overweight, accompanied by pain that
more pronounced when descending or climbing stairs.

Treatment

Most cases of prepatellar bursitis are treated with
the use of physiotherapy. The frequency of positive results in
Much depends on the participation of the patient. One of the key
components of treatment is adequate rest after any
physical activity that led to increased pain
sensations.

If deterioration occurs after physiotherapy, it should be excluded
tuberculous etiology of the disease, since massage, thermal
procedures and physiotherapy lead to deterioration and progression
diseases of extrapulmonary tuberculosis.

Actions that have a pronounced irritant effect on
knee joint articular bag should be kept to a minimum.
As soon as the patient feels that he can perform these actions.
no concomitant pain, gradual recovery
activity will mean that there is no further increase in severity,
and the patient’s condition improves.

Ignoring symptoms, or trying to adapt to pain
can lead to the disease becoming chronic. therefore
It is important to start treatment immediately, regardless of the severity
and the condition of the patient.

In the case when the course of the disease becomes chronic,
the healing process slows down significantly and rises
probability of recurrence in the future.

Treatment bursitisа коленного the joint в начальной фазе проходит в
режиме: Лед — Покой —  Давление — Подъем. This mode
allows you to achieve significant improvement if
activities started within the first 72 hours after injury.

The gentle mode includes:

  • Restriction of the loadings capable to worsen a state;
  • Regular application of ice to the area of ​​inflammation;
  • Withменение эластичных сдавливающих бинтов;
  • Maintaining a sore limb in a raised position (above
    heart level).

Accelerate the healing process
противовоспалительных препаратов, оказывающих болеутоляющее и
antiedematous action.

Help in improving the course of the disease can help receive
manual therapy:

  • Massage;
  • Acupuncture;
  • Stretching;
  • Electrotherapy.

With правильно проводимой физиотерапии большинство случаев с
mild manifestations of the disease are usually cured with
restoration of normal functions within a few weeks. With
a more severe and chronic course of recovery can flow
much longer.

Also, it is more likely that a patient
additional interventions will be required (injections
кортикостероидов). Early onset of physiotherapy is
necessary to speed up the healing process and ensure
optimal outcome of the disease with a decrease in the likelihood of it
re-development.

Exercises

Special exercises play an important role in the treatment:

  • Static contractions of the inner quadriceps head

Tighten the muscles of the front of the thigh (quadriceps
muscle), bringing a small towel under the knee and trying to straighten
the leg. Put your palm on the inside of your thigh so you can
feel the tension of the inner part of the muscle as it contracts.
Fix the leg in this position for 5 seconds, then relax.
Repeat the exercise 10 times as much as possible, but not
доводя до появления болезненных sensations.

  • Flexion and extension of the leg at the knee

Bend and unbend the knee joint with maximum
возможной амплитудой, но не доводя до появления болевых sensations.
Repeat 10-20 times, provided that in the process of execution
Exercise does not increase symptoms of the disease.

Exclude from the training program squats, recurring
knee flexion, leg crossing and the like
exercises.

Surgical intervention

Bursitis of the knee, the treatment of which had no effect,
may require aspiration surgery
(отсасывания) содержимого суставной сумки и введение в нее
кортикостероидов.

This procedure is performed using a fine needle under local
anesthesia. After draining the articular bag, the doctor may enter
her hormones are corticosteroids. It is necessary for
stopping the inflammatory process. Then you need
continue wearing an elastic bandage and ensure long
rest of the limb (usually 48 hours). Such treatment is much
more effective than medication (nonsteroidal
противовоспалительными препаратами), так как таблетированные
forms have a general effect on the body, often without penetrating
inside the joints.

In rare cases, treatment is ineffective, and
the only solution is surgical removal of the prepatellar
articular bags. Restoration of normal joint function after
such an operation occurs within a few days, and a return to
full life without limitation of physical activity is possible
carry out in 2-3 weeks.

Antibiotics

If bursitis has an infectious origin (penetration
bacteria in the articular bag), then to prevent the development of purulent
complications need to start treatment with antibiotics.
The selection of the drug is based on the definition
pathogen sensitivity. If after the start of treatment the disease
continues to progress, the articular bag is opened and cleaned
surgically.

Ointments for topical use

In addition to knee pads to improve the condition, relieve swelling,
inflammations and pains can be applied ointment treatment with
противовоспалительными компонентами (см. более подробно в
article ointment for pain):

  • Фастум-гель на основе нестероидных противовоспалительных
    drugs, it is very effective for rapid removal of edema, has
    analgesic effect;
  • Nise-gel, the same mechanism of action;
  • Final and analogs – improve blood circulation at the place of application,
    contribute to the removal of edema;
  • Ointment with menthol (Bom-Benge, Ben-Gay, etc.) –
    противовоспалительный эффект с охлаждающим отвлекающим
    action.

The use of new products – knee Knee Inferno Wrap

Knee Inferno WrapA novelty in the market of auxiliary medical
устройств является наколенник Knee Inferno Wrap®,
stimulating local blood flow due to radiation exposure
a certain spectrum.

The device emits light in a range almost identical to
by sunlight. Due to this, an additional
energy received by the body of the patient and used to strengthen
восстановительных процессов.

Since the device acts locally, the energy flow
penetrates deep into the articular bag and promotes rapid
elimination of toxins, dead cells and accelerates the growth of new tissue,
increasing its elasticity.

Prevention

There are some simple tips for how
prevent the development of such an undesirable disease:

  • Wear knee pads. This is especially important for people with elevated
    risk of injury (football players, basketball players, wrestlers). Exist
    special cooling knee pads that have pockets for bags with
    ice;
  • Let your feet rest regularly. To avoid long
    load on the knees need to constantly change the look and intensity
    physical activity;
  • After the workout, apply ice and give your legs sublime
    position.

Автор: Коробов Никита Александрович врач-анестезиолог

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