This presentation is on bursitis specially focused on Baker's cyst and housemaid knee with Physiotherapeutic management

1. Bursitis
By Simran Shaw

2. What is Bursa?
 Bursa are flat sacs of synovial membrane in which
the inner sides of the sacs are separated by a fluid
film.
 Bursa are found where moving structures are in tight
approximation that is between tendon and bone,
bone and skin, muscle and bone or ligament and
bone.

3. Bursa around the knee joint...
 Subcutaneous bursa
 Subtendinous bursa
 Submuscular bursa
 Prepatellar Bursa
 Subpopliteal Bursa
 Suprapatellar Bursa
 Infrapatellar Bursa (Clergyman’s Knee)

4. Bursa around the knee joint...

5. Bursa around the knee joint...

6. Bursitis
 Baker’s cyst
• Also known as
Popliteal cyst.
• Named after Dr. William
Morrant Baker.
 Housemaid’s knee
• Also known as
Prepatellar Bursitis,
Miner’s knee.

7. Baker’s Cyst...
 Definition :- A Baker's cyst is a is a fluid-filled
swelling that is developed at the back of the knee in
the popliteal fossa region. The pain can get worse
when you fully flex or extend your knee or when
you're active.
 Pathology :-
 Osteoarthritis
 Trauma or cartilage injury(athletes)
 Herniation of synovial membrane – through the
posterior part of the capsule of the knee joint. (30%)
 Escape of fluid through normal communication of
bursa with the knee. (semimembranosus /medial
gastrocnemius)

8. Baker’s Cyst...

9. Baker’s Cyst...
 Clinical Features :-
 Usually asymptomatic
 Pain (worst at ext & full flexion)
 Stiffness
 Swelling
 Giving way
 Restriction of movement
 Investigations :-
• MRI
• Ultrasound
• Arthrography
• Plain radiographs (OA)

10. Baker’s cyst...
 Investigations :-

11. Baker’s cyst...
 Physiotherapeutic Treatment
 RICE Protocol
 Rest – Taping the knee in semi flexed position or
braces in severe case.
 Ice massage - 15 minutes every 4-7 hours
 Compression
 Limb elevation
 After pain reduces – Mid range Knee mobilisation.
 Joint ROM exercises
 Calf stretch
 Hamstring stretch
 Quadriceps strengthening

12. Taping Technique

13. Compression with exercise

14. Compression with exercise

15. Quads isometrics

16. Stretching and strengthening

17. Baker’s cyst...
 Surgical Treatment :-
 Baker’s cyst –
 Needle aspiration
 Excision of bursa and closure of the capsular orifice.
 Giant cyst –
 1-2 days of non-surgical treatment
 Later arthrography and cyst is excised.
 Synovectomy is done later to prevent recurrence.

18. Housemaid’s Knee…
 Definition :- Prepatellar Bursa, which occupies a
position just over the patella gets inflamed.
 Cause :-
 Sustained pressure of body weight due to frequent
kneeling – occupational or in handicapped persons
who depend on knee walking.
 Direct blow on knee.
 Clinical Features :-
 Large rounded swelling
 Red skin, rise in temperature
 Tenderness
 Quads activity may be painful

19. Housemaid’s Knee…

20. Housemaid’s Knee…
 Investigations :-
• MRI
• Ultrasound
• Arthrography
• Plain radiographs (OA)

21. Housemaid’s Knee…
 Treatment
A. Conservative
• Analgesic ant inflammatory drugs.
• Rest – crepe or pressure bandage
• Avoid – kneeling, pressure positions & movements
at knee
• Limb elevation
• Isometric quadriceps contraction – pain free range
• Relaxed knee swinging – available pain free range
• Electrical stimulation – avoid disuse atrophy
(Quads)
• Assisted SLR

22. Housemaid’s Knee…
 Treatment
B. Surgery :- If becomes chronic and painful , then
bursa is excised surgically.
C. Post operative management
• Limb elevation
• Strong movements to toes, ankle & hip
• End of 1 week- small range isometrics to
quadriceps within pain free range.
• Self assisted relaxed passive knee swinging
• Gentle passive movements – start to improve
patellar mobility

23. Housemaid’s Knee…
• Re-education in walking( tendency to walk with
flexed knee)
• Body resistive quadriceps exercise (self-resistive) –
excellent means of Quadriceps strengthening and
mobilising knee.
• Guided functional positions
• Back to normal activities by 4-6 weeks.

24. Patella mobilisation

25. Quads isometrics

26. Other strengthening

27. Body resistive quads strengthening

28. Easy to Advanced Quads strengthening

29. Bibliography
 Joint structure and function by Pamela K. Levangie
& Cynthia C. Norkin
 Essential Orthopaedics by Maheshwari & Mhaskar
 Essentials of Orthopedics for Physiotherapists by
John Ebnezer & Rakesh John
 Essentials of Orthopaedics and Applied
Physiotherapy by Jayant Joshi & Prakash Kotwal
 Orthopedic Physical Assessment by David J. Magee
 Pictures by these books only
 Physiopedia
 Videos from Youtube and my friend Basudev
Barman