Knee bursitis

　　Common causes of knee bursitis include: acute or chronic trauma; acute or chronic suppurative infection; low-toxic inflammation such as gout, tuberculosis, rheumatoid arthritis, etc. Generally, it is divided into infectious and non-infectious inflammation according to clinical manifestations and the characteristics of synovial fluid. Traumatic injury is considered to be the main pathogenic factor of non-infectious bursitis. It is divided into acute trauma and chronic injury. Chronic injury is more common, caused by long-term, continuous, repeated, concentrated, and slightly stronger friction. It is also common in some professional athletes, such as wrestlers. Direct compression and friction is the main pathogenic factor. In the early stage of chronic traumatic bursitis, the bursa swells due to hemorrhagic exudate. Later, acute inflammatory changes appear, with edema, congestion, thickening, or villous changes of the bursa, thickening and fibrosis of the bursal wall, a large amount of fibrin clots attached, and some calcification deposits in the bottom of the bursa or tendons. Under the microscope, neutrophils and lymphocytes can be seen. There are two situations of acute injury: one is the acute exacerbation caused by chronic injury, with edema of the bursa and acute traumatic inflammatory changes, with pale yellow and transparent effusion along the synovial membrane. The other is due to an accidental acute trauma, with the synovial effusion often being bloody and light red. Infectious bursitis is relatively rare, but it is easy to involve the prepatellar bursa. The main pathogenic bacteria include Staphylococcus aureus, Streptococcus, and Streptococcus pneumoniae. Potential risk factors for purulent bursitis include trauma, long-term mechanical stimulation, hormone therapy, alcoholism, gout, and rheumatoid arthritis.

　　After repeated attacks or repeated trauma of knee bursitis, it can develop into chronic bursitis. Attacks can last for several days to several weeks and may recur multiple times. Acute symptoms can appear after abnormal movement or overexertion. Due to synovial hyperplasia, the bursal wall becomes thick, and the bursa eventually develops adhesions, villi, exostoses, and calcifications. Due to pain, swelling, and tenderness, muscle atrophy and limited activity can occur.

　　Patients with knee bursitis often have no clear cause and gradually develop a round or elliptical mass at the joint or bony prominence, which grows slowly with superficial tenderness and can be palpated with clear edges and fluctuation sensation, without skin inflammation; deeper locations have unclear boundaries and may be mistaken for solid tumors. After being subjected to a large external force, the mass can increase rapidly with severe pain, and the skin may be red and hot without edema. The mass may be punctured in the chronic stage to produce clear mucous fluid, in the acute stage to produce bloody mucous fluid, and occasionally secondary infection may lead to purulent inflammation.

　　1. Pay attention to rest: Rest is the primary method to solve any joint pain, so the joints should be well rested.

　　2. Pay attention to hygiene; strengthen labor protection, and develop the habit of washing hands with warm water after work.

　　3. Swing arms: If the painful area is at the elbow or shoulder, it is recommended to swing the arms freely to relieve pain. 4. Alternate ice and heat: If the acute swelling and pain weaken and the heat has been eliminated, the method of alternating ice and heat can be used for treatment, that is, ice therapy for 10 minutes followed by heat therapy for 10 minutes, and so on.

　　5. Ice敷: If the joint feels very hot, ice therapy can be used. Alternate with 10 minutes of ice therapy and 10 minutes of rest. Do not use heat therapy as long as the joint is still hot.

　　6. Other: Pointed toe European-style shoes have a narrow upper, and wearing such shoes for a long time can cause the feet to be squeezed and rubbed, easily leading to diseases such as bursitis and hallux valgus deformity in women. Severe patients may have joint dislocation and require surgical treatment. However, this disease may not manifest in the short term. For example, patellar bursitis in kneeling workers, sitting bone tubercle bursitis in thin elderly women after sitting for a long time; heel bursitis caused by tight shoes, etc.

　　During the examination, it is necessary to identify localized tenderness on a bursa, and for superficial bursae (such as olecranon, prepatellar), check for swelling and lack of synovial fluid. If the patient has obvious pain, redness, fever, and swelling, infection should be ruled out. It is necessary to exclude injuries to tendons or muscles around the joint, suppurative bursitis, intra-bursal hemorrhage, synovitis, osteomyelitis, cellulitis, and other pathological processes that can simultaneously affect communicating bursae and joints. For some cases, when puncturing the bursa, it is possible to aspirate mucous or bloody mucous fluid.

　　Patients with knee bursitis should eat the following foods:

　　1. Eat more fresh vegetables, fruits, and beans. Apples, pears, soybeans, etc.

　　2. It is advisable to eat foods that activate blood circulation and resolve stasis, and open the orifices, such as Panax notoginseng, hawthorn, polemonium, allium fistulosum, shepherd's purse, etc.

　　3. In the later stage of the disease, it is advisable to eat nutritious foods that tonify Qi and nourish the liver and kidney, such as grapes, black beans, wolfberry, longan, turtle meat, etc.

　　Foods that knee bursitis patients should not eat:

　　1. Avoid foods such as fried, grilled, overly salty, or overly sweet foods.

　　2. Avoid spicy, greasy and other heavy flavors, as well as stimulants such as cigarettes and alcohol.

　　Deficiency-Cold Type: Swelling of the knee joint, fluctuation, unchanged skin color, cold sensation when touched, mild restriction of movement, pain exacerbated with weather changes, accompanied by lumbago, headache, frequent night urination, bland taste, pale and bloated tongue, teeth marks on the edges, slippery and greasy tongue coating, wiry and fine pulse, slow pulse especially. Medication: Aconitum carmichaelii prepared 20 grams, Atractylodes macrocephala 20 grams, Aconitum napellus 20 grams, Elaphe carinata 20 grams, Eucommia ulmoides 20 grams, Rehmannia glutinosa 30 grams, Foeniculum vulgare 12 grams, Polygonatum odoratum 20 grams, Cinnamomum cassia 20 grams, Licorice 12 grams, Poria 20 grams, Clematis 20 grams. Decocted for internal use, one dose per day.

　　Damp-heat Type: Swelling of the knee joint, with obvious fluctuation, burning sensation when touched, pain during flexion and extension of the joint. Red tongue, thin yellow tongue coating, wiry and rapid pulse. Medication: Bovine horn 20 grams, Morus alba 30 grams, Imperata cylindrica 20 grams, Periploca sepium 20 grams, Gypsum 30 grams, Coix seed 30 grams, Rhizoma Polygonati 30 grams, Scolopendra 1 (ground and taken). Decocted for internal use, one dose per day.

　　Cold and Damp Type: Swelling of the knee joint, palpable cystic fluctuation, not hot to the touch, with obvious tenderness, mild restriction of movement, symptoms worsen in cold weather, pale and bloated tongue, deep and wiry pulse. Medication: Aconitum carmichaelii prepared 20 grams, Astragalus 30 grams, Rehmannia glutinosa 30 grams, Bubalia 6 grams, Saposhnikovia divaricata 20 grams, Cinnamomum cassia 20 grams, Licorice 6 grams. Decocted for internal use, one dose per day.

　　Blood Heat Type: Swelling of the knee joint, with obvious fluctuation, positive floating patella test, burning sensation when touched, tenderness, thin white tongue coating, wiry and slippery pulse. Medication: Lonicera japonica 30 grams, Forsythia 10 grams, Angelica sinensis 10 grams, Adzuki bean 30 grams, Stephania tetrandra 12 grams, Uncaria tomentosa 20 grams, Achyranthes bidentata 15 grams, Plantago asiatica 20 grams. Decocted for internal use, one dose per day.