Prepatellar Bursitis: Causes and Treatments

Prepatellar bursitis, often colloquially referred to as "housemaid's knee," is a condition characterized by inflammation of the bursa located in front of the kneecap (patella). 

The prepatellar bursa is a small, fluid-filled sac situated between the patella and the overlying skin. Its primary function is to reduce friction and facilitate smooth movement. When this bursa becomes inflamed, it leads to a condition known as prepatellar bursitis.

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Causes of Prepatellar Bursitis

Acute Trauma

Acute trauma, such as a direct blow to the knee, is one of the primary causes of prepatellar bursitis. This trauma can result from falls, sports injuries, or accidents, leading to immediate inflammation and swelling of the bursa.

Chronic Overuse

Repetitive kneeling or pressure on the knees, common in professions such as carpet laying, plumbing, and gardening, can lead to chronic overuse of the prepatellar bursa. Over time, this can cause inflammation and bursitis.

Infection

In some cases, the bursa can become infected, leading to septic bursitis. This can occur if bacteria enter the bursa through a cut, scrape, or puncture wound on the skin.

Medical Conditions

Certain medical conditions, such as gout and rheumatoid arthritis, can predispose individuals to develop prepatellar bursitis. These conditions can cause crystals to form within the bursa, leading to inflammation.

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Symptoms of Prepatellar Bursitis

Pain and Swelling

One of the hallmark symptoms of prepatellar bursitis is pain and swelling in the front of the knee. The affected area may appear red and feel warm to the touch.

Limited Range of Motion

Individuals with prepatellar bursitis may experience a limited range of motion in the knee joint. Bending or straightening the knee can be painful and difficult.

Tenderness

Tenderness and sensitivity to pressure are common symptoms. The knee may feel tender when touched or when pressure is applied, such as during kneeling.

Fluid Accumulation

In some cases, fluid may accumulate within the bursa, leading to a noticeable bulge or lump in front of the kneecap.

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Diagnosis of Prepatellar Bursitis

Physical Examination

A thorough physical examination by a healthcare professional is often the first step in diagnosing prepatellar bursitis. The doctor will assess the knee for signs of swelling, tenderness, and limited range of motion.

Imaging Studies

Imaging studies, such as X-rays, MRIs, or ultrasound, may be used to confirm the diagnosis and rule out other conditions, such as knee osteoarthritis or ligament injuries. Prepatellar bursitis ultrasound can provide detailed images of the inflamed bursa and surrounding structures.

Aspiration and Laboratory Tests

In cases where infection is suspected, the doctor may perform aspiration to extract fluid from the bursa for laboratory analysis. This can help identify the presence of bacteria or crystals and guide appropriate treatment.

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Treatment Options for Prepatellar Bursitis

Conservative Treatments

Rest and Activity Modification

In the initial stages of treatment, resting the affected knee and avoiding activities that exacerbate the symptoms are crucial. Modifying activities to reduce pressure on the knee can help alleviate symptoms.

Ice Therapy

Applying ice packs to the affected area can help reduce swelling and alleviate pain. Ice therapy is most effective when used for 15-20 minutes several times a day.

Compression and Elevation

Using a compression bandage and elevating the affected leg can help reduce swelling and promote healing.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Over-the-counter NSAIDs, such as ibuprofen and naproxen, can help reduce inflammation and alleviate pain.

Physical Therapy

Physical therapy for prepatellar bursitis can help improve range of motion, strengthen the muscles around the knee, and prevent future episodes of bursitis. A physical therapist can design a tailored exercise program to address individual needs.

Aspiration and Injection

In cases where conservative treatments are ineffective, bursa aspiration may be performed to remove excess fluid and relieve symptoms. Corticosteroid injections may also be administered to reduce inflammation.

Antibiotic Therapy

If septic bursitis is diagnosed, antibiotic therapy is essential to treat the underlying infection. The choice of antibiotics will depend on the type of bacteria identified through laboratory tests.

Surgical Intervention

Surgical intervention is rarely required but may be considered in severe or recurrent cases of prepatellar bursitis that do not respond to other treatments. Surgery may involve removing the inflamed bursa (bursectomy) to provide relief.

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Home Remedies for Prepatellar Bursitis

Rest and Protection

Resting the affected knee and protecting it from further trauma is essential for recovery. Avoid activities that put pressure on the knee and use knee pads if kneeling is unavoidable.

Ice and Compression

Applying ice packs and using a compression bandage can help reduce swelling and alleviate pain. Ensure that the ice pack is wrapped in a cloth to prevent frostbite.

Elevation

Elevating the affected leg above heart level can help reduce swelling and promote healing. Use pillows or cushions to elevate the leg while lying down.

Gentle Exercises

Engaging in gentle exercises and stretches can help improve range of motion and strengthen the muscles around the knee. Consult a physical therapist for guidance on appropriate exercises.

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Risk Factors for Prepatellar Bursitis

Occupational Risk Factors

Certain occupations, such as carpet layers, plumbers, gardeners, and athletes that involve prolonged kneeling or repetitive knee movements are associated with a higher risk of developing prepatellar bursitis.

Medical Conditions

Individuals with medical conditions such as gout, rheumatoid arthritis, and diabetes are at an increased risk of developing prepatellar bursitis, which can lead to inflammation or infection of the bursa.

Previous Knee Injuries

A history of previous knee injuries or surgeries can increase the risk of developing prepatellar bursitis. Scar tissue and altered biomechanics may contribute to the condition.

Age and Gender

Prepatellar bursitis can affect individuals of all ages, but it is more common in adults and males and less common in children and adolescents.