Knee bursitis: symptoms, treatment and how long it takes to settle

Most knee bursitis that is not caused by infection settles with simple measures. Leeds Community Healthcare lists rest and avoiding kneeling on the knee, ice, simple painkillers and cushioning or knee pads for the future. The NHS adds that you can put extra cushions around the joint while you sleep to protect and support it.

Arthritis UK (formerly Versus Arthritis) suggests a pillow behind your back to stop you rolling onto the painful side, and says a physiotherapist can show you exercises to improve movement and advise on reducing friction. It also notes that anti-inflammatory painkillers such as ibuprofen, or paracetamol, can be bought from supermarkets and pharmacies and should be used according to the patient information leaflet.

The NHS says you might have bursitis if a joint is painful (usually a dull, achy pain), tender or warmer than the surrounding skin, swollen, and more painful when you move it or press on it. The area may also be red, which can be harder to see on brown or black skin.

Leeds Community Healthcare describes the typical picture for the bursa at the front of the knee: pain and swelling over the kneecap, with soft, movable swelling, tenderness to touch and difficulty kneeling or fully bending the knee. Arthritis UK adds that if the bursa is just under the skin you may be able to see its outline because of the swelling.

NHS Tayside's referral guide says swelling and tenderness over the area of the knee can come with warmth and redness, and that the range of movement of the knee is frequently preserved. Pain when kneeling points to the pre-patellar bursa, while pain on fully straightening the knee suggests a Baker's cyst, a different swelling behind the knee.

The NHS says bursitis should go away in a few weeks with home treatment. Arthritis UK says that if painkillers and anti-inflammatories work for you, pain should improve within a couple of weeks, though you may still have swelling for a while afterwards.

That is a general picture. If knee pain has not improved after 1 to 2 weeks of treating it yourself, the NHS says to see a GP. The NHS knee pain page also says to see a GP if knee pain does not improve within a few weeks.

Bursitis can come back. The NHS suggests keeping to a healthy weight, cleaning any cuts on the joints, warming up before exercise, using padding when putting pressure on joints (for example when kneeling) and taking regular breaks from activities that press on a joint.

Leeds Community Healthcare lists injury to the knee, such as a fall or a direct blow, and long periods spent on the knees. Infection can also occur inside the bursa, which may follow a cut or scratch near the knee that lets bacteria in.

Arthritis UK says bursitis can also develop if you have gout or another condition in which hard crystals gather in or around joints, an injury that keeps coming back, an infection in or near a joint, or an inflammatory condition such as rheumatoid arthritis. It also says repetitive movements in jobs and hobbies make bursitis more likely, and that bursitis in the knee commonly happens because of a problem in a tendon, in which case treatment is likely to focus on the tendon.

Most bursitis is not infected, but infection needs different treatment and is more serious. Leeds Community Healthcare says an infected bursa is more likely in children, and in people with a weakened immune system, for example if taking steroids or having chemotherapy.

NHS Tayside's referral guide says bacterial infection with systemic upset, spreading cellulitis and fever that is not responding to oral antibiotics typically needs admission for intravenous antibiotics, while early infections may settle with oral antibiotics.

• See a GP urgently or call NHS 111 if you have a fever, feel shivery, sick or unwell (Leeds Community Healthcare).

• Contact your GP if the knee is hot, red or swollen, if pain is severe or getting worse, or if the skin around the knee is broken (Leeds Community Healthcare).

• See a GP if you cannot move the joint, or have very severe, sharp or shooting pain (NHS and Arthritis UK).

• Get advice from NHS 111 now if your knee is very painful, you cannot put weight on it, it is badly swollen or has changed shape, or it locks or gives way (NHS knee pain page).

• Intense calf pain and swelling can happen if a Baker's cyst ruptures, according to NHS Tayside; get medical advice for sudden calf swelling.

The NHS says a GP will examine the affected joint, and Leeds Community Healthcare says a doctor is usually able to diagnose pre-patellar bursitis by examining the knee, asking about your job, recent injuries, other joint problems or medical conditions.

If infection is suspected, blood tests may be suggested and fluid may be taken from the bursa using a needle (aspiration) to be tested. The NHS says this fluid is sent off to test for infection and for conditions such as gout. Arthritis UK says an ultrasound scan may be used in some cases to confirm the diagnosis, and that blood tests or scans may look for other conditions such as rheumatoid arthritis, gout or damage to muscles.

The NHS knee pain page gives a rough guide to common causes of knee pain with no obvious injury. It stresses that you should not self-diagnose, and to see a GP if you are worried.

The NHS says that in many areas you can refer yourself to community musculoskeletal (MSK) services for help such as physiotherapy without a GP referral. Your GP can also refer you for physiotherapy, or to a specialist if the problem is severe or keeps coming back.

Arthritis UK says it can take a while to get an NHS physiotherapy appointment and that you may be seen sooner privately, at your own cost. Private physiotherapists are listed by the Chartered Society of Physiotherapy. For injections or surgery, a specialist musculoskeletal or orthopaedic opinion is needed in either sector.