Inflammation of the joint capsule of the knee joint. Bursitis of the knee joint - a complete description of the disease, symptoms and treatment Surgical treatment of chronic bursitis of the knee joint dangers

Knee bursitis is an inflammatory process that affects the bursa of the knee.

The bursa is a small pocket that contains a small amount of fluid.

Synovial bursae are located at the junction of the tendon and muscle, thus they are responsible for reducing the load on the joint.

There are 3 synovial bursae near the knee joint and each can be subject to inflammation, and this can be either bursitis or synovitis

Types and causes of development

Depending on the type of synovial bursa, it is customary to distinguish between synovitis and bursitis of several types:

Suprapatellar (infrapatellar) bursitis of the knee joint - this type is also called popliteal bursitis, since it develops in the popliteal synovial bursa. The reasons for the development of this type are injuries to the tendons in the area under the knee.

Baker's Cysts - The onset of a Baker's cyst may indicate either synovitis or bursitis due to the similarity of symptoms. However, this type of bursitis develops on the inner lower side of the knee and quite often the disease affects obese people.

Prepatellar bursitis - this type of bursitis of the knee joint is most common. Development occurs in the synovial patellar bursa, and the causes are various injuries and damage to the patella.

Despite the fact that synovitis and bursitis are similar in the initial phase of their development, the underlying causes of bursitis are:

Frequent knee injuries
high loads on the knee joint,
infectious diseases that affect the bursa,
minor bruises, wounds and abrasions near the synovial bursa.

Separately, it is worth mentioning the development of the so-called pes anserine bursitis. Here, the inflammatory process does not affect the entire joint capsule of the knee joint, but only a separate area.

Most often, bursitis of the anserine bursa develops in older people, as it is a complication of deforming osteoarthritis of the knee joint.

Much more rarely, pes anserine bursitis can be diagnosed in younger people.

In medical practice, pes anserine bursitis is rarely used; its synonym is anserine bursitis, which is how this disease is designated.

Returning to young people, most often pes anserine bursitis is diagnosed in athletes or in people who are forced to work in an uncomfortable position for the knee.

In addition, anserine bursitis develops against the background of:

diabetes mellitus,
meniscus tear,
knee arthritis.
flat feet,
obesity.

Symptoms

The symptoms of knee bursitis depend on the phase in which the inflammation occurs. The main manifestations include the following:

The manifestation of pain, and if it is acute bursitis of the knee joint, then the pain is sharp, acute and pronounced.

Both synovitis and bursitis of the knee cause slight stiffness in the area of the inflamed joint.
Redness and swelling are clearly visible above the inflamed joints, as in the photo.
muscle weakness appears,
the patient complains of malaise and decreased performance,
an increase in local temperature is recorded.

As we have said many times, the problem with diagnosing a prisoner is that bursitis and synovitis have similar symptoms, and at the initial stage it is difficult to differentiate them.

Treatment of knee bursitis

Before treating knee bursitis, it is necessary to exclude specific infections that may cause inflammation.

These infections most often include:

Brucella,
Gonococci,
Spirochetes.

Naturally, both synovitis and bursitis must be distinguished from arthritis; this is done on the basis of tests.

As for the treatment itself, for example, in case of acute bursitis at an early stage, the patient should be at rest. A pressure bandage and warm compresses are used for the knee.

In addition, the disease is treated with painkillers and non-steroidal anti-inflammatory drugs.

If there is purulent inflammation with discharge, it will be necessary to undergo a course of antibiotics, and antibiotics are injected directly into the knee joint, these are intra-articular injections into the knee joint.

The disease involves the use of local therapy to reduce pain. Both synovitis and bursitis can be treated in the initial stages with ointments and creams with a warming, anti-inflammatory and analgesic effect.

Limitation of mobility in the joint requires the use of a complex of physical therapy. These are special exercises that are developed individually.

Performing a complex of physical therapy leads to the restoration of the basic functions of the knee. Exercise therapy is used in this case as an additional treatment for bursitis of the knee joint.

Physiotherapeutic procedures are also prescribed additionally. As the knee joint recovers, it is recommended to increase the load, and for this you will need to start playing sports, preferably swimming.

As for invasive treatment methods, we can talk about the development of chronic bursitis. It is this development that will require the use of a puncture to remove accumulated fluid.

After the exudate has been drained, it is necessary to rinse the cavity of the bag with a special solution of antibiotics and antiseptics, this should prevent complications and the development of purulent inflammation, as in the photo.

Post-traumatic bursitis involves the use of a hydrocortisone solution, which is injected into the synovial bursa.

The prognosis for the treatment of bursitis always depends on several factors, these are:

the degree of change in the tissues of the knee joint,
prevalence of the inflammatory process,
the ability of the inflammatory process to further develop and invade new tissues and areas of joints,
the patient's body's resistance to the inflammatory process.

Unconventional treatment

In some cases, non-traditional methods can be used in the treatment of bursitis. However, it is worth immediately clarifying that traditional medicine should act as an additional remedy in combination with medications, but not the main one.

A compress of vegetables is often used, and vegetables can be alternated, these could be potatoes, cabbage, beets.

For example, we take potatoes, cut them into thin layers before going to bed, place them on clean material and wrap them around the inflamed joint.

A film and a woolen scarf are placed on top of the joint; such a compress should be on the knee joint all night. This treatment helps relieve some of the inflammation and reduce pain.

The next night, you can use the same principle using a compress of raw beets, then a compress of chopped, fresh cabbage. Treatment continues until the inflammation is relieved

Another interesting recipe involves using a compress with sugar. To do this you will need:

Heat the sugar in a dry frying pan, but so that it does not start to melt,
then the hot sugar is poured into a small bag made of thick fabric,
a bag of sugar is applied to the affected joint overnight,
The top is covered with cellophane and wrapped in a warm scarf.

The procedure can be repeated until complete recovery, that is, until inflammation is relieved

Celery tea can help treat bursitis. This drink strengthens the body as a whole and has a negative effect on any inflammatory processes.

For preparation you need 1 tablespoon of celery seeds and a glass of boiling water. The tea is infused for 2 hours, after which you can take it twice a day for 14 days.

Knee bursitis: is surgery necessary?

Our joints are surrounded by bursae, also called bursa. They are shaped like a small pocket filled with liquid. There are three such bags in the popliteal region. Knee bursitis is an inflammation of the synovial bursae located in the knee area.
Content:

Causes of knee bursitis
Signs of the disease
Diagnosis of the disease
Treatment of bursitis

Due to the number of bursae, knee bursitis is divided into three types:

Infrapatellar. Most often, such bursitis appears due to tendon injuries. Location: popliteal bursa.
Baker's brushes. The cause of such bursitis can be excess weight. Usually the inside of the knee becomes inflamed.
Prepatellar. Typically occurs due to injuries to the kneecap. The location of the lesion is the knee area. This type is the most common.

The photo of bursitis shows pronounced thickenings.

Causes of knee bursitis

What can cause popliteal bursitis? Popliteal bursitis, as well as patellar bursitis, usually occurs as a result of:

injuries in the knee area;
heavy loads on the knee joints;
infectious diseases that caused complications on the bursa;
disturbances in the metabolic process in the body and, as a result, a decrease in the elasticity of the tendons;
autoimmune processes in the body;
abnormalities of bone development;
intoxication of the body.

Signs of the disease

The symptoms for this disease are as follows:

Swelling in the area of the knee joint.
Acute pain on palpation.
Limitation of joint mobility.
Redness of the skin in the affected area.
General malaise of the patient, and in some cases fever.

It must be said that bursitis is a disease to which any of us is susceptible. Who thinks about caution and pays attention to minor impacts of the knee on a hard surface? Meanwhile, you need to pay attention, since consequences in the form of bursitis may not keep you waiting.
If the disease still overtakes you, how to cure it? Going to the doctor is the very first step on the path to recovery.

Diagnosis of the disease

First, the doctor will conduct an examination. Sometimes bursitis can be easily felt and no additional diagnostic tests are required. If the doctor is unsure or the symptoms are poorly expressed during palpation, the following studies are prescribed:

radiography,
ultrasonography,
puncture of the joint capsule to collect effusion - fluid that has accumulated.

Treatment of bursitis

In the acute form of the disease, surgical intervention is usually not required. Conservative methods are usually used for treatment. First of all, these are bandages and bandages to elevate the joint and limit mobility, since the most important thing with bursitis is rest. Sometimes you can apply ice packs to reduce pain. But it also happens differently; it is recommended to use a warming ointment and a heating pad. If the pain is too severe, anti-inflammatory drugs are prescribed, such as novocaine or hydrocortisone.

If there is an infection in the synovial bursa, antibiotics are used, for example, levomycin. When the symptoms of acute pain are relieved, UHF therapy and dry heat can be used.

In cases of chronic bursitis, surgery is sometimes necessary. The type of surgical intervention is determined by the doctor. These can be punctures (punctures) to remove pus from the synovial bursa and treat it with chemical solutions. Repeat this procedure several times. Much less often, the upper bursa is removed, as well as the bursa is opened and tamponed. The most radical operation is to remove the bag without opening it.

Alternative Treatments

Treatment at home also gives good results. For bursitis, compresses made from blue clay and grated potatoes help. Baths with eucalyptus oil or a decoction of herbs such as St. John's wort and thyme have a beneficial effect on joints, helping to restore their elasticity. This is a good remedy for indolent chronic bursitis. You can prepare your own very effective infusion for rubbing the affected areas. This remedy is also used as a prevention of bursitis and simply if your legs are tired:

You should take (all 100g each) ammonia and pure medical alcohol, aloe juice and camphor oil, petroleum jelly and turpentine. Add two large ampoules of novocaine to this mass, mix and leave in a dark place for about five days. Before use, warm the mixture, shake and rub the sore spot.
Grind 6 tablets of analgin, a bottle of valerian, a bottle of iodine, mix a bottle of triple cologne and add powdered analgin to the liquid. Also leave for 5-7 days. After rubbing your feet, you need to wrap them up.

But besides medications, there are also gifts of nature that also relieve inflammation and help get rid of bronchitis. When bursitis has been tormenting you for a long time, treatment with folk remedies can help you reduce the pain.

A bath of pine needles is very effective for bursitis. Moreover, you can take not only needles, but also cones. They are soaked in cold water and then brought to a boil. Leave in a sealed container to allow the broth to infuse. Add to the bath. For a full bath you will need about one and a half kilograms of branches, cones and needles. You can simply do baths for the affected areas, then the cost of funds will be less.

Try celery tea. It is infused for an hour and a half, and then drunk twice a day. Compresses made from propolis infused with vodka will help against joint swelling. They should be used until the tumor disappears.

By consulting a doctor in a timely manner and using comprehensive treatment, bursitis can be avoided or completely cured. It's all up to you, because slender legs and a flying gait adorn a person at any age.

Bursitis of the knee joint and its treatment

Our knee joint is easily vulnerable. Quite often, various pathological processes are observed here - injuries, arthritis, arthrosis, bursitis. Treatment of knee bursitis largely depends on its type, stage and location.

Causes

Bursitis is an inflammation of the periarticular bursa (Latin bursa - bursa). This bursa contains synovial or joint fluid. The main functions of this fluid are to reduce pressure on the joint and nourish the intra-articular cartilage. Our knee joint has a complex anatomical structure, because takes on a significant portion of the physical activity. And there are 3 joint capsules:

Patellar or prepatellar – located at the top of the knee
Infrapatellar (another name is suprapatellar) – located under the patella, in the area of the tendons of the muscles of the front of the thigh
Goose - located at the bottom of the inside of the knee.

The main reasons for the development of bursitis:

Prolonged stress on the knee
Skin damage in the knee area
Open wounds of the knee joint
Sepsis
Overweight
Severe concomitant diseases - rheumatism, gout, psoriasis.

Moreover, each type of bursitis has its own provoking factors. For example, prepatellar bursitis, the most common of the knee bursitis, mainly develops from prolonged traumatic stress while kneeling. This happens in certain occupations. It’s not for nothing that it’s called the parquet floorer’s, roofer’s, housewife’s knee. Inflammation of anserine bursae mainly affects overweight women. And infrapatellar bursitis is caused by infections or frequent injuries while playing certain sports (jumper's knee).

Symptoms

Symptoms of knee bursitis include:

Knee deformity
Local soft tissue swelling
Skin that is red and hot to the touch
Limitation of movements in the knee joint.

The cause of these pathological manifestations is inflammatory changes in the walls of the bursa and the accumulation of pathological fluid - exudate - in its cavity. The composition of the exudate can be identical to tissue fluid, i.e. serous, as well as purulent in sepsis, hemorrhagic (bloody) in severe injuries.

The severity of the manifestations depends on the location of the bursitis. With inflammation of the prepatellar bursa, stiffness of movement occurs after kneeling for a long time. Then, when walking, it decreases. Anserine bursitis, on the contrary, manifests itself after a long walk or climbing stairs. Suprapatellar bursitis of the knee joint occurs with severe swelling in the upper part of the knee and severe pain. Sepsis often leads to this type of bursitis. In these cases, local manifestations occur against the background of a general serious condition, a sharp increase in temperature, and damage to other organs and systems.

Common Treatment Methods

Treatment of knee bursitis is carried out with medications, physiotherapeutic procedures, massage and physical therapy. It should be noted that the treatment of different forms of this disease has fundamental differences. For infectious wound and traumatic bursitis, antibiotics are required. Moreover, not one, but two or three drugs from this group are prescribed (Lincomycin, Doxycycline, Amoxiclav, Ceftriaxone). Although some sources dispute the advisability of antibiotics, in this case they are required. Moreover, along with the intramuscular and intravenous routes, they are administered directly into the cavity of the bag.

There are also conflicting opinions regarding the puncture of the bursa. According to some statements, the puncture subsequently leads to irreversible structural and movement disorders in the joint. There is a high risk of developing sepsis. But if fluid or pus has accumulated in the joint, they must be removed. Otherwise, any drug treatment loses its meaning, and knee bursitis cannot be cured. In addition, exudate is removed not only for therapeutic purposes, but also for diagnostic purposes. Based on the results of a microscopic examination or bacterial culture, the nature of the inflammation can be determined and sensitivity to antibiotics can be determined.

In addition to antibiotics, anti-inflammatory drugs - steroid hormones (Kenalog, Diprospan) are injected into the joint cavity. And here there is disagreement. The fact is that these drugs to some extent inhibit cell growth, and therefore prevent tissue regeneration (restoration). But the pros (suppression of inflammation) convincingly outweigh the cons here.

Another popular group is non-steroidal anti-inflammatory drugs. Along with inflammation, they effectively eliminate heat, swelling, and pain. These include Indomethacin, Diclofenac, Voltaren, Ibuprofen. To achieve the effect, they should be used in combination - in tablets, injections, and externally in the form of ointments. True, these drugs negatively affect the functions of the stomach, intestines, and blood clotting. Therefore, before using these and other medications, you should always consult your doctor. Only a specialist knows how to treat knee bursitis with maximum benefit and minimal risk for the patient.

Along with medications, massage, physiotherapeutic procedures (electrophoresis, paraffin, magnet), and physical therapy exercises are carried out. All this is carried out already at the recovery stage of knee bursitis. The purpose of these measures is to finally eliminate inflammation, stabilize the knee, and expand the range of motion in this joint.

Treatment with folk remedies

Folk remedies for knee bursitis effectively eliminate pain and swelling. After their use, movements are facilitated and metabolic processes in all tissues of the joint are enhanced, incl. and in bursas. However, these remedies are only an addition to the above methods. Contrary to some claims, bursitis cannot be cured with home remedies alone.

And yet, they are effective. Therefore, here are some of the most effective ways to treat bursitis with folk remedies at home:

Baths with pine needle extract. Pine needles, cones and twigs for 30 minutes. boil in an enamel bowl. Then the resulting decoction is infused for another day. The result is a brownish liquid. In the bathroom dilute 1-1.5 liters. this liquid. Take a bath for 15 minutes.
In a similar way, you can prepare a decoction of hay dust. Duration of bathing is 10-15 minutes.
1 tbsp. a spoonful of crushed golden mustache is boiled in 250 ml. water for 5-7 minutes. The container must have a tightly closed lid. The resulting decoction is infused for an hour and then used as a compress.
Propolis tincture. To obtain it, infuse 1 part of propolis in 10 parts of vodka for 5 days. The resulting tincture is used as a compress.

It should be noted that these products are contraindicated for skin lesions and purulent bursitis. Therefore, before using them, you should definitely consult your doctor.

The knee joints bear the load of the human body and are often affected by injuries, infectious or systemic diseases. The peculiarity of their structure and functioning leads to the appearance of pathological signs of various localizations.

Causes

Pathologies of the musculoskeletal system include damage to the skeleton and soft tissues. Human joints are formed by bones with cartilage on the heads, ligaments, and menisci. All these structures are surrounded by bags filled with synovial fluid.

To understand their condition, patients ask the surgeon: what is bursitis of the knee joint, why does it have different clinical manifestations.

On a note!
Bursitis is an inflammation of the bursae located in the knee area with an increase in the production of synovial fluid, the appearance of swelling and pain.

The disease occurs due to various reasons:

knee injuries;

intoxication;

infection in the joint;

allergic reactions;

autoimmune disease;

metabolic disorders.

Symptoms

The most striking signs of inflammation occur during an acute process. The main symptoms of knee bursitis include:

Constant dull pain, aggravated by supporting the affected leg or bending the knee.
The appearance of swelling in the joint area. The formation has a round shape, a dense consistency, and is painful on palpation.
Joint swelling occurs. The range of motion in the knee may be reduced.
The skin above the knee joint in the projection of the swelling turns red, its temperature rises.
The lymph nodes in the popliteal fossa are enlarged and may be painful on palpation.
In some cases, body temperature rises.

If you carefully examine the photo of knee bursitis, you will notice the above visual manifestations of the disease.

On a note!
Symptoms have different localizations. The reason for this is the structural features of the knee joint. It includes 8 bursae with deep or superficial location. Some of them communicate with the capsule, while others have the form of closed cavities.

So, in acute bursitis of the knee joint, inflammation more often affects certain bursae:

prepatellar bursae not associated with the joint: subcutaneous, subfascial, subtendinous;
deep infrapatellar bursa (secondary as a result of arthritis).

Surgeons have described various localizations of bursitis.

Prepatellar bursitis

This is an inflammation of the prepatellar bursa. It occurs under stress, repeated joint injuries, and prolonged kneeling.

Rarely develops. The clinical picture includes:

the appearance of swelling;
swelling of the anterior surface of the joint;
moderate pain syndrome;
local increase in temperature with redness of the skin.

Infrapatellar bursitis

This inflammation looks like this: a mobile soft-elastic formation appears on both sides of the patella, the symptoms intensify with pressure and extension of the leg. Mobility is slightly impaired.

This type of bursitis is often post-traumatic in nature.

This inflammation of the joint capsule is determined under the tendon of the quadriceps femoris muscle and looks like a large round tumor up to 8-9 cm in size. The patient complains of pain in the area of inflammation, unpleasant pulling sensations along the front surface of the thigh and decreased mobility in the knee joint.

On a note!
This type of bursitis may be accompanied by fever.

More often it is chronic and leads to deposits of calcium salts (calcareous bursitis).

Popliteal bursitis

The disease is associated with the popliteal bursa. Patients turn to the surgeon with complaints of pain along the posterior-outer surface of the joint. Popliteal bursitis must be differentiated from damage to the collateral ligament or lateral meniscus of the knee joint.

A so-called Baker's cyst appears along the back surface of the joint, in the popliteal fossa. It is a protrusion of a stretched bag filled with fluid. This disease occurs secondary to synovitis in arthrosis, rheumatoid arthritis, and after injuries.

A small cyst is practically invisible and does not cause significant discomfort to the patient. There are no unpleasant sensations. When a significant volume is reached, it is determined under the knee, closer to the inner surface. To the touch, the cyst has a dense elastic consistency and is shaped like an egg. In this case, patients may note:

violation of leg flexion at the knee joint;
presence of a tumor under the knee.

On a note!
These signs occur independently or against the background of existing joint pathology. Symptoms become more pronounced after prolonged walking or climbing stairs.

Such chronic knee bursitis can resolve without any treatment, when the symptoms disappear when the cyst empties into the joint cavity. Sometimes complications arise:

breakthrough of formation with a clinical picture resembling deep vein thrombophlebitis;
cyst infection.

The disease occurs infrequently in adults. It occurs against the background of arthrosis of the knee joint and excess body weight.

I am bothered by painful sensations on the inside of the knee. They bother you at night when there is pressure from one knee on the other. Palpation of this area is moderately painful; you can visually notice some swelling.

Since the symptom often occurs against the background of gonathrosis, patients report pain in the joint that intensifies in the evening.

Disease codes according to ICD 10 belong to the M 70 heading:

M70.4 – prepatellar bursitis;
M 70.5 – other bursitis of the knee joint;
M 70.9 – diseases of soft tissues due to overload, not refined.

Development of the disease

If the disease occurs as a result of acute injury, tissue infection is possible; serous inflammation is replaced by purulent inflammation. In this case, the patient will complain of unbearable, “jerking” pain along the anterior surface of the joint, aggravated by palpation, local hyperthermia and redness.

On a note!
Typically, acute bursitis lasts up to 2-3 weeks, then the symptoms of inflammation disappear. Recovery is coming.

The addition of infection is dangerous for the development of purulent arthritis and the formation of phlegmon in surrounding tissues. With a decrease in immunity and refusal of antibacterial treatment, septic complications are possible.

However, up to 50% of patients are at risk for developing chronic bursitis. Lack of timely treatment worsens the long-term prognosis. In this case, the disease will occur with episodes of exacerbation and remission. During an exacerbation, the pain syndrome and other local signs are not so pronounced; they are more “erased” in nature. This kind of bursitis is dangerous due to gradual changes in the affected joint. Scars and adhesions occur, and mobility is impaired.

With a single traumatic injury, bursitis of the knee joint occurs acutely. Timely treatment leads to recovery, and the prognosis for the patient in this case is favorable.

If knee bursitis occurs against the background of chronic injury or overload of the joint, the symptoms develop gradually with the formation of a protracted inflammatory process. The long course of the disease leads to a gradual deterioration of the condition; it will not be possible to cure it without any consequences.

Bursitis against the background of metabolic or autoimmune disorders develops as a chronic disease with periods of exacerbation and remission. In the absence of adequate treatment, the prognosis for the patient is unfavorable.

Diagnosis of bursitis

Deals with issues of diagnosis and treatment of bursitis. When applying, the patient will undergo a full examination:

Conversation clarifying the time of onset of symptoms, connection with stress, injury or other conditions.
Examination with palpation. The method will help to clarify the localization of pain, assess changes in the configuration of the knee joints, the presence of pain, hyperemia, and increased temperature.
Laboratory research methods are necessary for the differential diagnosis of bursitis and arthritis. The doctor will prescribe a general blood test, biochemical and immunological tests, and a general urinalysis.
Instrumental diagnostics are aimed at detecting pathological changes, differential diagnosis with a tumor, hemangioma, arthritis.

An ultrasound or MRI will help determine the location of the joint lesion.

On a note!
X-ray examination is used only for the differential diagnosis of bursitis and arthritis.

When the knee joint bursae are inflamed, the following can be seen in the image:

change in the size of the joint space due to exudate in the bursa cavity;
deposition of calcium salts and osteoporosis in chronic bursitis;
urate masses at the site of articular surfaces in gout;
fragments of bone tissue in joint cavities with tuberculous lesions.

What and how to treat

The main methods of treating inflammation of the bursa are:

compliance with the protective regime;
use of medications;
physiotherapy;
traditional medicine;
surgical treatment
lifestyle change.

Regimen for bursitis

To alleviate the condition of a patient with acute bursitis or at the stage of exacerbation of a chronic process, it is recommended to follow the following rules:

Ensuring knee joint rest. The patient needs bed rest, the limb should be kept elevated.
Unloading the joint. The use of elastic bandages and canes is recommended.
Cold on the knee area. This measure in the first few days from the onset of inflammation will help relieve pain and swelling.

On a note!
Patients often ask about a diet for bursitis. There is no special diet. However, you should pay attention to your diet and limit its calorie content if you are overweight, and ensure adequate consumption of proteins, vitamins and plant fiber.

Drug treatment

Taking medications for inflammation in the joint is aimed at relieving pain and reducing inflammation. For acute bursitis, medications are used in courses; a chronic process requires maintenance treatment for autoimmune or metabolic disorders. Surgeons prescribe the following groups of drugs:

Non-steroidal anti-inflammatory drugs in the form of tablets (Nimesulide, Meloxicam, Aspirin, Ibuprofen). Local treatment of knee bursitis with NSAIDs is possible only if the integrity of the skin is preserved.
Hormonal drugs into the bursa cavity for severe inflammation (Hydrocortisone, Kenalog, Diprospan).
Broad-spectrum antibiotics for the development of an infectious process. Surgeons recommend treatment with a number of penicillins and cephalosporins.

Compresses with dimexide are recommended in the absence of wound surfaces. They are prescribed for both acute and chronic inflammation. To enhance the effect, it is recommended to mix the main substance with novocaine and corticosteroid hormone. The duration of the procedure should not exceed 30-40 minutes, the course of treatment should not exceed 10 days.

Exercise therapy and physiotherapy

Hardware treatment of bursitis is used in inpatient and outpatient settings. The procedure scheme is selected by a specialist, taking into account possible contraindications for the procedure. The following methods have been proven to be effective:

shock wave therapy;
electrophoresis with drugs;
UHF therapy;
magnetotherapy.

On a note!
The use of physical therapy is recommended for patients after injuries and chronic bursitis. You should not perform exercises through pain during an acute process. Patients are recommended to exercise on an exercise bike, swimming, and active and passive flexion of the legs at the knee joints.

Treatment with folk remedies

To combat bursitis, local and general methods are used. Before starting treatment, the patient should consult with the surgeon.

Locally, for acute pain, ice, cabbage compresses, and aloe are prescribed. To relieve residual symptoms of the disease, baths with pine needles, hay, and hot lotions with herbs are used. The course of such treatment can take up to 1-2 weeks.

For oral administration, followers of traditional medicine recommend infusions and decoctions of herbs that have an anti-inflammatory, cleansing effect: clover, chamomile, St. John's wort, horsetail, linden.

Surgery

bursa infection;
ineffectiveness of conservative therapy;
development of chronic bursitis.

Surgical treatment for purulent bursitis consists of puncture of the cavity, rinsing and administration of antibacterial agents. In case of severe inflammation, the surgeon will drain the knee bursitis: opening the bursa and inserting a special drain into it, through which the inflammatory exudate will drain.

In cases of chronic inflammation and the ineffectiveness of conservative treatment methods, a bursectomy of the knee joint is recommended. Before surgery, the doctor assesses the patient’s condition – the duration of the disease, the degree of mobility impairment, the severity of pain, the number of intra-articular hormone injections performed.

The operation is performed in two ways: open and endoscopic.

With an open bunionectomy, the surgeon opens the bursa, excises it and sutures it. During endoscopic surgery, manipulations are performed through punctures; This method speeds up the patient’s recovery. The effectiveness of the surgical method is high.

Over the course of 4 years, I “grew” a tumor under my knee the size of a good egg. At first I didn’t notice the presence of this formation, then I hit my foot at a construction site and the next day I could not bend my knee. There was pain and some kind of round lump. Without attaching any importance to this, I did not take any treatment and did not see a doctor for another couple of weeks, until my frightened wife took me by the hand and took me to the surgeon.
I was examined and a cyst was discovered. It was painful to bend my leg. The traumatologist warned that it would not go away on its own, only surgical treatment was needed. After studying the reviews of other patients about the operation, he agreed to arthroscopic removal. It cost me a lot, but after 3 days I was already on my feet. Six months have passed since the treatment. No complaints.
Nikolay, Moscow

The human knee joint performs a serious function - it helps a person move and make fast and dynamic movements. If discomfort appears in the knee area, a person cannot walk normally, he begins to limp and suffer from discomfort.

A symptom such as knee pain may be a sign of a serious pathology, such as knee bursitis. It usually leads to serious impairment of motor activity, so it is important to know the symptoms of the disease and how to treat knee bursitis correctly. Timely and competent therapy will help get rid of pain and reduce the risk of serious complications.

Bursitis is an inflammation of the joint space formed by the synovial membrane, which contains joint fluid, it is called the synovial bursa or bursa. The joint capsule with fluid plays an important role in the functioning of the entire joint; thanks to this structure, its normal mobility is ensured, and the articular fluid lubricates the cartilage, preventing them from rubbing.

When the bursa becomes inflamed, serious disturbances occur; the joint ceases to be properly lubricated, as the synthesis of synovial fluid is disrupted. As a result of such violations, the cartilage begins to slowly fray, the joint stops moving normally, and the damaged areas are overgrown with bone tissue. This whole process is accompanied by very painful sensations.

The development of the disease occurs in several stages:

At the first stage, bursitis is called acute; it occurs for the first time and is very painful, with swelling and impairment of activity.
At the second stage, the signs of the disease subside and the pain dulls;
At the third stage, bursitis becomes chronic, since despite the absence of pain, the joint continues to deteriorate due to a lack of joint fluid. In this case, the motor activity of the knee is impaired, and relapses may occur regularly, accompanied by symptoms of acute bursitis.

Causes

Bursitis usually does not appear without a reason; sometimes it is provoked by various infections, but most often the disease occurs after mechanical damage to the joint and surrounding tissues. The following situations can trigger knee bursitis:

Bacterial infection. Infection can occur through a wound or spread through blood from other parts of the body, more often in advanced cases.
Injuries and physical stress. Excessively active training, in which most of the load falls on the knee joints, can provoke the inflammatory process of the bursa. Also, the disease often occurs after bruises or sprains, for example, from a fall or a sudden and awkward movement.
Autoimmune diseases and metabolic disorders, in this case salts can be deposited in the joint, provoking an inflammatory process.
Endocrine disorders, hormonal imbalances.
Hypothermia. In this case, the inflammation is non-infectious;
Arthritis, arthrosis;
If a person kneels for a long time, for example at work, inflammation in the knee joint may also occur.

It is important to note that sometimes it is not possible to establish the exact cause of the disease; it is possible that many negative factors influence it at once, for example, an unhealthy lifestyle, working on your feet. After all, joints can become inflamed if you do not monitor your diet and work and rest schedule, so they can suffer under increased load and vice versa, with a passive lifestyle.

Kinds

There are three bursae in the knee joint, and each of them can become inflamed. Depending on the location of the infection, bursitis is divided into three main types:

Also, bursitis of the knee joint is divided into acute and chronic, and in the presence and absence of infection into purulent and serous, respectively.

Symptoms

As a rule, knee bursitis is always accompanied by pain, especially when moving and impaired motor activity; in this case, slight swelling and compaction may appear in the bursa area. Depending on the type of bursitis, other characteristic symptoms may occur:

It is worth noting that in the acute form the symptoms are usually pronounced, but if the disease becomes chronic, the pain disappears and may not bother the patient at all, or may occur after heavy exertion. But in this case, exacerbations always occur, which reveal the disease.

Diagnostics

Only a competent specialist can identify the symptoms of knee bursitis and prescribe treatment, since there are many joint pathologies that are accompanied by pain, swelling and even fever. Therefore, it is very difficult to diagnose yourself, especially without knowledge in the relevant field and test results.

Bursitis is treated by orthopedists, traumatologists and surgeons, but first of all, the patient will probably have to visit a therapist and tell him about his complaints. The general practitioner must issue a referral to the required specialist. At the first examination, the specialist interviews the patient; it is important to remember what chronic diseases the patient suffers from, whether there have been recent injuries and infectious diseases.

The doctor will also conduct an external examination and palpation. Based on the data obtained, the specialist will certainly be able to establish a preliminary diagnosis, to confirm which he will order a series of studies. The exact list of tests can only be announced by the attending physician, but most often they are referred for the following studies:

Puncture of joint fluid;
Radiography;
Urine and blood tests.

Based on the patient’s tests and medical history, the doctor makes an accurate diagnosis and prescribes the necessary treatment. Bursitis can be completely cured only under the supervision of a specialist, otherwise it will become chronic and cause a lot of inconvenience. Therefore, at the first signs of illness you should consult a doctor.

Treatment

The treatment method depends primarily on the type of bursitis, since each case requires different medications. But for any type of inflammation, non-steroidal anti-inflammatory drugs are prescribed to relieve pain; in addition, they relieve fever and reduce the inflammatory process in the bursa. In addition, during the acute phase of the disease, complete rest of the limb is indicated to reduce the risk of joint destruction.

Infectious bursitis of the knee joint is treated with antibacterial drugs, and a therapeutic puncture of the synovial bursa is indicated, during which the doctor removes the pus and rinses the bursa cavity with an antiseptic. A drainage of the joint capsule may also be installed to drain pus. In advanced cases, surgical removal of the bursa is indicated.

For serous (non-infectious) bursitis, taking anti-inflammatory drugs, as well as attending physiotherapy, is indicated. For severe pain, the doctor may inject corticosteroids, these are hormonal drugs that quickly relieve inflammation and pain. And in case of excessive secretion of synovial fluid, especially with a Baker's cyst, a medicinal puncture is indicated.

How to perform a medicinal puncture:

At the first stage, the doctor treats the skin with an antiseptic and injects a local anesthetic;
Then a large syringe with a long needle is taken, which is inserted into the cavity of the bursa, the doctor pumps out the synovial fluid or pus, and takes some for analysis if necessary;
Next, the doctor rinses the bursa cavity with an antiseptic and may administer medications, depending on the type of bursitis.

The puncture is completely painless and does not cause any complications; it helps to quickly get rid of the inflammatory process and alleviate the patient’s condition.

For any type of bursitis, medications are prescribed for external use, most often ointments with a non-steroidal anti-inflammatory drug. The doctor may also prescribe homeopathic ointment or herbal medicine in complex treatment to alleviate the patient’s condition.

Therapeutic treatment for any type of bursitis involves the use of physiotherapy methods. It is important to note that with purulent bursitis, you should never heat the sore spot, as this will lead to a worsening of the condition. That is why it is better to resort to such treatment methods only on the recommendation of a doctor.

Bursitis of the knee joint is treated with the following procedures:

Radiation therapy;
Warming with paraffin;
Therapeutic exercise after relieving inflammation and other symptoms.

Folk remedies

Treatment of knee bursitis at home is possible only after consultation with a doctor. Experts do not approve of treating bursitis exclusively with traditional methods, as this can be very dangerous, because no lotions will rid the body of the infection if it is present.

In addition, the anti-inflammatory effect of folk remedies is very weak; the disease can quickly become chronic, and the patient will not even notice it, and will most likely think that the pain has gone away thanks to folk recipes. In this case, bursitis will soon make itself felt, but in the form of an exacerbation of the chronic form.

To avoid constant pain and relapses, you need to immediately consult a doctor and be treated normally, undergoing all prescribed procedures and taking medications. Competent therapy will help you get rid of the problem forever and never think about it again.

Prevention and prognosis

Bursitis is a very serious and dangerous condition if left untreated. If the inflammation is provoked by an infection, suppuration will soon appear, the infection will spread to the bones and osteomyelitis will occur; if bacteria and pus enter the blood, sepsis is possible. These complications are very dangerous for human life and often cause death.

If bursitis is non-infectious, it is complicated by the fact that it becomes chronic. In this case, the person is initially bothered by periodic pain, which gradually becomes constant. Quite often the disease worsens, swelling of the knee appears and it becomes impossible to step on the leg due to pain.

In the chronic form of the disease, adhesions and scars form in the bursa, due to which the joint suffers from a lack of synovial fluid and is destroyed. As a result, arthritis occurs, the joint loses motor activity and the person becomes disabled.

With timely diagnosis and proper treatment, you can get rid of bursitis forever. But in the future, it is necessary to follow preventive measures to avoid the occurrence of the inflammatory process again:

It is necessary to take care of your knees, especially those that have suffered from bursitis. You should not put too much strain on your knee joints; it is not recommended to stand on your feet for a long time without rest.
Avoid overcooling and overcooling the knee joints in particular;
It is recommended to treat all infectious diseases in a timely manner under the supervision of a doctor; be sure to consult a doctor in case of injuries to a sore joint;
It is imperative to lead a healthy lifestyle, that is, eat right and do exercises.

In each large joint of the human body there is a periarticular sac - a bursa, filled with fluid, the main purpose of which is to reduce friction and stress on the joint tissue.

Bursitis is an inflammatory process of the cavity that occurs due to injury or infection. There are three periarticular bursae in the knee.

The attending physician, when deciding how to treat knee bursitis, will determine the location and severity of the inflammation. Based on the results of the study, the disease is assigned an ICD code.

Bursitis of the knee joint - what is it, causes and signs

Near the knee joint there are three bursae filled with fluid. Inflammation of the periarticular bursa can be caused by several main reasons:

The symptoms of the disease are pronounced and depend on the location and intensity of the inflammation. It is customary to identify the following symptoms of bursitis:

Pain.
Changing the shape of the knee.
Edema.
Changes in color and temperature of soft tissues.
Limitations in mobility.

The consequences of bursitis of the knee joint can be permanent limitation of mobility and sepsis. At an advanced stage, surgery will be required to remove the joint capsule.

Types of knee bursitis

It is customary to distinguish three main types of bursitis, depending on the location of the inflammation. Namely:

Anserine bursitis.
Prepatellar.
Infrapatellar.

A person has three periarticular bursae in his knee. Depending on where exactly the inflammatory process began, one or another form of bursitis is diagnosed. In addition to this basic classification, in medical articles you can find the following terms related to one or another form of the disease:

Ossifying bursitis - characterized by the presence of compactions in the knee area. As a result of the disease in this form, the patient experiences significant limitations in mobility.
Anserine bursitis most often develops in overweight women. The internal cavity of the joint, called the “crow's foot”, becomes inflamed at the junction of the semitendinosus, sartorius and graceful muscle tissues.
Acute bursitis - characterized by intense pain localized at the site of inflammation of one of the bursae. Inflammation occurs quickly. A large amount of serous exudate is released.
Chronic bursitis - occurs in people whose professional activities involve constant injury or stress on the knee. The synovial bursa grows slowly, exudate collects in it, and the bursa membrane changes. Growths and cysts appear.

Surgery for bursitis is rarely required and is prescribed as a last resort when traditional drug therapy has failed. During surgery, the inflamed joint capsule is removed, which leads to disability for the patient.

Why is bursitis in the knee dangerous?

The danger is no longer associated with the disease itself, but with the complications to which it leads. Prepatellar, suprapatellar and other types of bursitis are characterized by increased secretion of exudate. The composition of the substance may vary. The greatest concern is purulent discharge. If timely measures are not taken, the disease can be fatal.

Another unpleasant consequence of the inflammatory process is the removal of knee bursitis. This measure is resorted to only in extreme cases, as it leads to permanent limitation of joint mobility.

The consequences of knee bursitis depend on the location of the inflammatory process, the nature of the manifestation and the reasons that triggered the onset of the disease. Thus, infrapatellar bursitis of the knee joint generally responds well to drug therapy, while infectious bursitis is often associated with the need for long-term use of antibiotics.

How to treat bursitis in the knee (traditional methods)

Drug treatment for knee bursitis includes taking painkillers and anti-inflammatory drugs. If there is purulent discharge, a course of antibiotics is prescribed, which are injected directly into the cavity of the joint capsule.

Drugs for treatment are prescribed exclusively by the attending physician, based on the results of a diagnostic study of exudate sampling. The intensity of drug intake is selected based on the general condition of the patient. To reduce pain, relieve inflammation and treat the knee joint with bursitis, ointments are prescribed.

If mobility is limited due to bursitis of the knee joint, a set of exercise therapy exercises is prescribed. Classes are designed individually and help restore basic knee functions.

The patient is additionally scheduled to attend physical therapy. As recovery progresses, it is recommended to gradually increase the load, play sports, and visit the pool.

Self-administration of medications for treatment is strictly contraindicated. In case of relapse of the disease, all necessary tests must be re-taken before prescribing therapy.

Traditional methods for knee bursitis

Effective treatment of knee bursitis with folk remedies is associated with measures that help strengthen the immune system and restore the normalization of the body's metabolic processes. Taking apple cider vinegar and crushed golden mustache leaves has a good effect.

You can relieve swelling with a compress of burdock leaves. A decoction of crushed plant roots helps. A spoonful of the crushed mixture is poured into 0.5 liters. water. Boil for 5 minutes. Apply a compress for 2 hours.

You can reduce the unpleasant symptoms of suprapatellar bursitis of the knee joint with the help of propolis tincture with vodka. The mixture is prepared in a ratio of 1 to 10. Infuse for 5 days.

Treating knee bursitis at home does not replace the need to see an orthopedic doctor. Some types of inflammation can only be relieved with drug therapy.

Rehabilitation of the knee joint after bursitis

The speed at which knee mobility is restored is largely dependent on the efforts of the patient himself. To shorten the rehabilitation period, it is necessary to perform physical exercises and play sports.

It is necessary to avoid activities that lead to the formation of microtraumas of the joint. At this stage, folk remedies are effective: infusions and compresses that reduce swelling.

To date, there is no worthy alternative to traditional treatment methods. Traditional methods can only be used as an adjuvant to promote the patient’s rapid recovery.

Each joint experiences stress in the form of friction from the tendons, ligaments and muscles associated with it. Therefore, in the process of evolution, humans developed special slit-like bags located near the attachment site of these ligaments. When an infectious agent enters there, it occurs bursitis - inflammation of the bursa. The article will discuss the mechanism of development of bursitis of the knee joint, its symptoms and treatment.

In the area where the bursa is located, the tissues surrounding the knee joint move with the greatest amplitude. The inside of the bursa is lined with synovial membrane. There are a total of 8 bursae located in the area of the knee joint. There are 4 bursae located near the joint - at the top of the knee, at the bottom, above the patella, behind the joint. The anatomical name is suprapatellar, infrapatellar and prepatellar bursa.

What is bursitis

Bursitis of the knee joint is an infectious inflammatory process localized in the prepatellar bursa. They are located:

under the skin (subcutaneous bursa);
under the tendon (subtendinous);
under the fascia (subfascial).

Code according to ICD 10 (International Classification of Diseases 10th revision), bursitis of the knee joint is placed in the chapter M70.4– prepatellar bursitis, M 70.5– bursitis of another bursa.

Causes of bursitis

There are several factors that can trigger the development of bursitis.

Post-traumatic occurs after fractures, dislocations, ruptures of connective tissue. Bursitis, which develops due to frequent stress on the knees, also falls into this category. For example, athletes, builders, law enforcement officers. This type of bursitis has the most favorable prognosis.
Infectious– penetration of pathogenic microbes, such as staphylococcus, into the bursa leads to suppuration of the bursa. Treatment of such a focus of inflammation should begin as early as possible, in order to avoid serious consequences, such as blood poisoning, leg amputation.
Secondary occurs due to concomitant diseases: arthritis and arthrosis, endocrine disorders, etc. This type of bursitis often becomes chronic.

Symptoms of bursitis depend on the severity of the inflammation and the location of the bursa.

Classification of bursitis

According to the anatomical location of the inflamed bursa, bursitis is divided into:

Prepatellar when the bursa located in front of the kneecap becomes inflamed. This is the most common type of bursitis. The main etiological factor is trauma.
Suprapetellar. The bursa at the top of the kneecap is affected.
Infrapatellar. The bursa in the lower part of the kneecap is affected. Occurs as a result of falling on the knee.

Clinical classification distinguishes the degrees of pathological changes in the bursa:

Acute when there is severe inflammation of the bursa, sharp pain in the leg. Lasts approximately 30 days.
Subacute, during which the swelling of the knee decreases, the pain is not so severe.
Chronic, in which the disease progresses slowly, development can last for a year.
Recurrent, characterized by sudden exacerbations due to unfavorable environmental factors.

The most dangerous outcomes of bursitis are osteomyelitis(bone suppuration), and sepsis– infection with toxins in the blood and other organs.

Symptoms

There are several symptoms of knee bursitis:

severe inflammation and pain of the knee joint, especially when pressing on it with your hand;
increased body temperature;
manifestation of frequent pain at night;
development of muscle weakness, difficulty walking;
swelling of the knee compared to a healthy one by 8-10 centimeters;
redness of the skin above the knee;
difficulty moving in the joint, which also begins to hurt;
weakness, fatigue, malaise.

If you have at least one or two symptoms, you need to consult a surgeon to clarify the diagnosis and begin adequate treatment.

Diagnostics

First of all, a general examination and questioning of the patient is carried out. To clarify the diagnosis, additional diagnostic procedures must be performed, for example:

taking anamnesis;
X-ray of the knee joint;
collection and analysis of fluid in the joint using puncture;
General and biochemical analysis of blood and urine;
research using a thermal imager.

The more different examinations there are, the more accurately it will be possible to differentiate bursitis from other diseases with similar symptoms, such as osteomyelitis, arthrosis, ruptured knee ligaments, etc.

How to treat knee bursitis? In the initial stages of bursitis, doctors offer drug treatment. However, if the stage of suppuration has begun, there are sharp pains due to which a person cannot even sleep, then they resort to surgical intervention. It is important not to give it up, because... It is impossible to cure festering bursitis with medications.

In addition to taking medications, you need to follow some rules:

ensure rest of the limb with bursitis, limit movements in the joint;
in severe cases, observe complete bed rest;
do not wrap your knees with bandages;
do not use any cold or hot procedures (compresses, heating, baths, etc.) in the knee area;
use crutches when walking.

Drug treatment

Pharmacotherapy is carried out in three areas:

cessation of the inflammation process;
restoration of metabolism in the joint and tissues around it;
rehabilitation period after the main symptoms subside.

Both local and general medications are used to combat inflammation. The first are applied in the form of ointments and gels. These include:

Diclofenac;
Dolgit;
Fastum gel.

These and other medications are applied to the affected joint twice a day. First, they are gently rubbed until dry, then a gauze compress with Dimexide solution is applied for several hours. These drugs belong to NSAIDs (non-steroidal anti-inflammatory drugs). There are contraindications common to all of them:

individual intolerance and allergies;
ulcers of the stomach and duodenum;
allergic reactions;
aspirin bronchial asthma.

In some cases, the doctor may perform local therapy corticosteroid injections. The latter are divided into fast-acting (Celeston, Hydrocortisone) and long-acting (Diprospan). These drugs are well tolerated, have no side effects, and can lead to the following results:

restoration of joint functions;
preventing bursitis from becoming chronic;
reduction of inflammation in a short period of time.

The procedure should only be performed by a doctor. An anesthetic is used to prevent pain during the injection. The number of corticosteroid injections is determined individually, usually from 5 to 10.

Physiotherapy

After the main process of inflammation has subsided, trophic physiotherapy has a good effect. This method includes the following procedures:

ozokerite therapy;
laser treatment;
electrophoresis with Dimexide and other medicinal substances;
magnetic therapy;
paraffin therapy;
treatment with drugs containing aloe, fibs, solcoseryl;
consumption of B vitamins, antioxidants, nicotinic acid.

During the rehabilitation period, physical therapy, treatment at balneological resorts, and massage are used.

Surgical treatment

Surgical intervention is performed when conservative methods are ineffective, in advanced cases of knee bursitis. The main method is aspiration.

Using a special thin needle, the doctor sucks out the pus and then injects antibiotics and corticosteroids. After such an intervention, you need to wear an elastic bandage for 48 hours.

Depending on the symptoms of knee bursitis, treatment may be more radical. If aspiration does not help, proceed to removing the joint capsule in which suppuration has developed. A couple of days after this, you can already move the joint, but limited. Full restoration of all functions and discharge home occurs 2-3 weeks after surgery.

ethnoscience

Remedies from the arsenal of traditional medicine will help cure bursitis. The following are possible methods of such treatment (only in addition to drug therapy!):

Do it one by one compresses with potatoes, cabbage and beets. To do this, you need to cut them into circles and place them on a cloth and apply them to the sore knee. Wrap the top with warm cloth and cellophane and leave it overnight. Apply compresses until complete recovery.
tablespoon celery seeds pour 250 ml of boiling water and leave for two hours. Strain and drink morning and evening for two weeks.
Do compress of hammered cabbage leaves within 7 days.
Do compresses from a decoction of burdock root. To do this, take 15 grams of raw material and boil for 5 minutes. Apply this compress to your knee for two hours for 20 days.
Put it in a calico bag flax seeds, apply it to your knee for 2 weeks.
Pour 500 ml boiling water over 1 tbsp. spoon salt. Soak a woolen scarf there, then apply it to your knee for a period of 3 to 8 hours, wrapping everything in cellophane. Carry out the procedure once a day for a week.
10 grams propolis pour 150 ml of vodka, leave for 5 days. Apply as cotton pads to the swollen joint until complete recovery.
Apply at night a bag of sugar heated in a frying pan. Treat in this way until the swelling subsides.

There are contraindications, it is necessary to consult a specialist.

Rehabilitation

During this period, you need to avoid any injuries to the knee joint, engage in minor physical exercises to develop the knee, and use infusions and compresses. It must be remembered that traditional medicine is only an additional method of treating bursitis, and not the main one.

Prevention

Prevention and prevention of the disease consists of the following activities:

body weight control;
protecting the joint area from injury when there is a high risk of damaging it;
warm up before performing exercises;
avoid exposure to low temperatures;
do not engage in heavy physical activity;
treat all infections in a timely manner;
strengthen joint ligaments through exercise and physical activity.

Conclusion

Like any disease, bursitis is easier to cure in the initial stages than to deal with its consequences, which seriously impair the function of the knee joint (abscess, fistula, osteomyelitis, etc.). For this reason, if you experience any symptoms, you should not delay contacting a doctor.