Inflammatory Conditions

Bursae are synovial fluid-filled structures or "cushions" that pad bony prominences as protection against repetitive impact from external forces or snapping anatomic structures, such as ligaments or tendons. Several bursae around the knee can become inflamed, irritated, and rarely, infected, including the prepatellar bursa, infrapatellar bursa, pes anserine bursa, and iliotibial (IT) band bursa (beneath IT band laterally). Knowing their anatomic location is important so that these bursae can be palpated directly (Fig. 30-26).

Treatment of bursitis includes compression, ice, protective padding, and avoidance of impact on the bursa. NSAIDs may help to reduce swelling. If the fluid collection is large or an infection is suspected, aspiration of the bursa can be performed in the office with a large-bore needle under sterile conditions. The bursa fluid should be clear and straw colored or may be bloody in a traumatic injury. If an infection is not suspected clinically once the fluid is withdrawn, a corticosteroid can be injected. Corticosteroids should never be injected if infection is a possibility. Oral antibiotics can be started if an infection is present. Local I&D may be required with infection and abscess. Aspiration does not replace compression wrap, ice, and avoidance of impact. Reaccumulation of fluid may occur, but total volume usually decreases. Serial aspirations are an option in patients with recurrent aseptic bursitis.

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