- Acute inflammation may occur which typically settles with time
- Usually asymptomatic or only mildly painful.
- Cysts can rupture causing intense calf pain and swelling which settles over a few days with rest +/- compression and ice.
- Range of movement of the knee frequently preserved.
- Surgical excision not usually indicated
- Bacterial infection with systemic upset and spreading cellulitis and fever not responding to oral antibiotics typically requires admission (infectious diseases during daytime hours or acute medicine OOH) for intravenous antibiotics.
Bursitis
General advice
Symptoms and Signs
- Swelling, tenderness, in the overlying area of the knee.
- Can be associated with warmth and erythema
- Usually only mildly painful.
- Pain when kneeling (pre-patellar bursa) or on full knee extension (Baker’s cyst)
- Can cause stiffness and pain with walking.
- Range of movement of the knee frequently preserved.
Initial management
- Rest
- Analgesia & NSAIDs as appropriate
- Non-infected and painful- refer to MSK Physiotherapy if not settling with conservative management
- Early infections may settle with oral antibiotics
Primary Care diagnostics
XR
Useful Resources
Who to refer
Surgical excision is only considered in chronic recalcitrant cases with careful counselling regarding the risks of surgery.
Who not to refer
- Baker's cyst - see additional information.
- Pre-patellar and infra-patellar bursitis surgery - See additional information
How to Refer
- SCI Gateway/Orthopaedics/Knee
- If the patient is under the care of NHS Physiotherapy, investigations and onward referral to knee service, if appropriate, will be organised by Physiotherapy service without the need for further GP intervention.
Information to include when referring:
- Duration, any cause of symptoms
- Site/spread and if pain constant or intermittent, and/or walking at night
- Active and passive ROM
- Treatment to date
- XR results