Prepatella Bursitis (House maids knee)

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Clinically Relevant Anatomy

A bursa is a small fluid filled sac designed to help soft tissue (skin, tendons,muscle and ligaments) slide easily over the underlying bone. They arise at various joints throughout the body, such as the shoulder, elbow and knee.

Prepatellar bursitis is the inflammation of the pre-patellar bursa, which lies in front of the patella or kneecap. Under normal conditions its function is to reduce the friction between the patellar tendon and overlying skin when bending the knee.

Prepatellar bursitis is the inflammation of this bursa which can either be an acute (sudden onset) injury or chronic (longer term) injury.

 

Epidemiology/aetiology

Acute prepatellar bursitis can be caused by a direct blow or fall on the knee. This ruptures blood vessels which bleed into the bursa causing swelling and triggering an inflammation reaction in the walls of the bursa. Subsequently, the walls may then thicken, causing tenderness that may remain even after the swelling has reduced. Acute bursitis can also be triggered by an infection as a result of a surface injury, such as a skin wound over the kneecap. In this case, bacteria may spread into the fluid within the pre-patellar bursa causing infection.

Chronic bursitis is a longer term problem which may recur over a period of time. Repeated damage to the knee for example from kneeling or work that involves alot of pressure on the kneecap thickens the walls of the bursa causing irritation.

Characteristics/Clinical presentation

  • Pain and tenderness on the kneecap and just below it.
  • Kneecap may be swollen and warm to the touch.
  • Difficulty kneeling.
  • An abscess or fluid filled lump may be visible over the patella.
  • For chronic Prepatellar bursitis there may be a tender lump floating underneath the skin on the patella.

 

Quick Diagnosis

History/Symptoms

  • H/o acute blow to patella.
  • Painful, focal swelling.

Objective Findings

  • Swelling and tenderness directly on the patella.

Management

Acute prepatellar bursitis is usually treated conservatively by the following methods:

  • Apply Relative rest, compression and elevation.
  • Taking NSAID’s such as Ibuprofen

 

Chronic prepatellar bursitis can be treated by:

  • Avoiding aggravating movements such as kneeling
  • If these cannot be avoided then knee pads or padded knee supports should be worn.
  • If the swelling persists then a medical professional may aspirate (suck off) some of the fluid within the bursa.
  • In cases where the bursa has become infected, anti-biotics may be prescribed
  • In more serious cases the bursa may be completely removed by surgical procedures.
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