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Prepatellar Bursitis

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Introduction

Prepatellar bursitis is also referred to as Housemaid’s knee or carpenter’s knee. A ‘bursa’ is a membrane with contains a substance known as synovial fluid which reduces friction in the articulating structures which move within a joint. The prepatellar bursa is one of several bursae in the knee and lies between the patella (knee cap) and the skin, making it superficial and prone to irritation. Inflammation of a bursa is called bursitis in which 30% of cases arise from infection (70% non-infectious).

Information Video

Signs & Symptoms

  • Pain at the front of the knee cap.
  • The primary symptom of prepatellar bursitis is swelling of the area around the kneecap.
  • Redness and overtly warm to the touch.
  • Reduced and painful movement of the affected knee.
  • For infectious cases, fever/chills may accompany pain.

Causes

  • Direct fall/trauma to the front of the knee.
  • Persistent and repeated rubbing between the knee cap and the skin (Huang & Yeh, 2011).
  • Infection – typically from a cut/abrasion which allows the migration and multiplication of bacteria within the bursa, causing swelling and pain (McAfee & Smith, 1988).
  • Pre-existing inflammatory condition(s) i.e. rheumatoid arthritis, gout.

Prevalence

This condition is seen more often in males with 80% of cases being males between 40-60 years of age and two thirds of cases being non-infectious. Prepatellar bursitis stemming from infection is more common in children.

Assessment & Diagnosis

At Pure Physiotherapy, you will be assessed by a musculoskeletal specialist. The Physio will take a comprehensive history of your symptoms followed by a clinical examination so that an accurate diagnosis can be established. This will mean an effective treatment and management plan can be put in to action straight away.

Self-Management

Management is dictated by the cause yet the initial focus of treatment is to reduce inflammation. Your Physiotherapy will educate you about the issue so you can understand how to help manage the symptoms yourself. The RICE protocol: rest, ice compression and elevation, is commonly utilised over the first 72 hours to treat prepatellar bursitis (van den Bekerom et al., 2012). Within this regime it is worth noting that a brief period of rest (2-4 days) is recommended to allow symptoms and irritation to settle. Also, when applying ice do not exceed 20 minutes and be sure to have something between the source and your skin to prevent any damage. Compression and elevation will assist with swelling reduction.

 

Activity modification recommendations may also be offered to help prevent further issues such as wearing knee pads if you spend time in kneeling and implementing small breaks throughout your day to change your position.

 

Your Physio may also make recommendations on pharmaceuticals in the form of non-steroidal anti-inflammatories and topical creams/sprays/gels applied to the skin in the affected area to reduce the inflammation and control pain. We advise that you consult with a Pharmacist to discuss this.

 

In cases of considerable swelling and where function is significantly reduced, the input of a GP may be necessary to drain the fluid – thus relieving pressure, and to send a sample test for infection. Should an infection be present, antibiotics will be considered. Your Physiotherapist will discuss this with you and help you make a decision about your treatment should this be applicable.

Physiotherapy

Once the inflammation and swelling has reduced, restoring normal soft tissue flexibility and increasing strength can begin which is key for this condition (McAfee & Smith, 1988). This is important so that you can return to your normal activities and will help to reduce friction on the affected structures and mitigate the likelihood of re-occurrence. Your Physiotherapist will help create a bespoke and progressive self-management and rehabilitation programme to help manage your symptoms and improve strength and function. An emphasis should be placed on increase quadriceps strength using progressive, functional exercises.

 

Regular re-assessment will help track your progress and will allow any changes to your treatment to be made by your Physio. We provide ongoing support so that you can manage independently and prevent re-occurrence.

References

Huang, Y. C. & Yeh, W. L. (2011). Endoscopic treatment of prepatellar bursitis. International orthopaedics, 35(3), 355-358.

 

McAfee, J. H. & Smith, D. L. (1988). Olecranon and prepatellar bursitis. Diagnosis and treatment. Western Journal of Medicine, 149(5), 607.

 

van den Bekerom, M. P., Struijs, P. A., Blankevoort, L., Welling, L., Van Dijk, C. N. & Kerkhoffs, G. M. (2012). What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?. Journal of athletic training, 47(4), 435-443.

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