Prepatellar Bursitis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Prepatellar bursitis, also known as housemaid's knee, is an inflammation of the prepatellar bursa, which is located between the patella (kneecap) and the overlying skin. This condition commonly results from repetitive kneeling or direct trauma to the knee.

Aetiology

Prepatellar bursitis can be caused by:

• Repetitive kneeling or prolonged pressure on the knees
• Direct trauma to the knee
• Infection (septic bursitis), often caused by bacteria such as Staphylococcus aureus
• Inflammatory conditions such as gout or rheumatoid arthritis

Pathophysiology

The pathophysiology of prepatellar bursitis involves:

• Inflammation of the bursa due to mechanical irritation or infection
• Accumulation of excess fluid within the bursa, leading to swelling and pain
• In septic bursitis, bacterial infection can cause pus formation and further inflammation

Risk Factors

• Occupations or activities that involve frequent kneeling, such as cleaning, gardening, or carpentry
• Participation in sports that put stress on the knees, such as wrestling or football
• History of knee trauma
• Underlying inflammatory conditions like gout or rheumatoid arthritis
• Diabetes or compromised immune system (for increased risk of septic bursitis)

Signs and Symptoms

The signs and symptoms of prepatellar bursitis include:

• Swelling and visible lump over the kneecap
• Pain and tenderness in the affected area, especially with movement or pressure
• Redness and warmth in cases of septic bursitis
• Limited range of motion due to swelling and pain

Investigations

Specific investigations to diagnose prepatellar bursitis include:

• Clinical examination: Physical assessment of swelling, tenderness, and range of motion.
• Aspiration of bursal fluid: For analysis to rule out infection or crystal-induced inflammation (e.g., gout).
• Blood tests: To check for signs of infection or underlying inflammatory conditions.
• Imaging studies:
  • Ultrasound: To assess bursal swelling and fluid accumulation.
  • X-rays: To rule out bony abnormalities or calcifications.

Management

Primary Care Management

• Rest and activity modification: Avoiding activities that exacerbate symptoms, particularly kneeling.
• Pain management: Analgesics such as paracetamol or NSAIDs to relieve pain and inflammation.
• Ice application: Applying ice packs to the affected area to reduce swelling and pain.
• Compression: Using knee supports or compression bandages to limit swelling.
• Aspiration: Aspiration of excess fluid from the bursa may be performed in a primary care setting if indicated.
• Antibiotics: Empirical antibiotics for suspected or confirmed septic bursitis, followed by culture-specific therapy if needed.

Specialist Management

• Referral to orthopaedics: For persistent or severe cases, or when surgical intervention is considered.
• Corticosteroid injections: May be administered for severe inflammation not responsive to conservative measures.
• Surgical intervention: In rare cases, bursectomy (surgical removal of the bursa) may be required for chronic or recurrent bursitis.
• Physiotherapy: To restore knee function and strengthen surrounding muscles after resolution of acute symptoms.

References

1. NHS (2024) Prepatellar Bursitis. Available at: https://www.nhs.uk/conditions/bursitis/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Bursitis. Available at: https://cks.nice.org.uk/topics/bursitis/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Prepatellar Bursitis: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/350/bmj.h2791 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Prepatellar Bursitis (Housemaid's Knee). Available at: https://orthoinfo.aaos.org/en/diseases--conditions/prepatellar-bursitis-housemaids-knee/ (Accessed: 24 June 2024).

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