Prepatellar bursitis
Housemaid’s knee / bursitis in the front of the knee

In case of prepatellar bursitis, the bursa at the front of the knee is inflamed. This bursa is located between the skin and the kneecap.

Prepatellar bursitis can be caused by an infection or as a result of excessive strain or a bump to the knee. Symptoms include pain, redness, warmth and swelling of the knee. Because the condition is more common in people who work on their knees a lot, prepatellar bursitis is sometimes referred to as housemaid’s knee

Description of condition

A bursa serves as a cushion to protect areas subject to friction. It is a kind of sac filled with a little bit of synovial fluid. In this case, the bursa is located on the front of the knee, between the kneecap and the skin. When it becomes inflamed, it is called prepatellar bursitis. This condition is very similar to olecranon bursitis of the elbow.

When inflamed, the bursa becomes filled with fluid and gets thicker and painful. The skin above often also feels warmer and turns red.

Cause and history

Prepatellar bursitis can develop because work activities or sports require someone to be on their knees a lot, or (repeatedly) falling on the knees. This might include pavers or people who practice judo.

An infection may also be the culprit. Bacteria may enter the bursa through a wound on the knee and cause inflammation there.

When prepatellar bursitis develops suddenly, this is referred to as acute bursitis. If the inflammation lasts a long time, or recurs (regularly), then it is referred to as chronic bursitis.

Signs & symptoms

Symptoms that may develop with prepatellar bursitis are:

• Pain that worsens when pressing or bearing weight on the bursa (tenderness of the kneecap).
  
• Local swelling of the kneecap.
  
• Redness and warmth of the knee.
  
• Limitation, in particular, in knee flexion.
  
• In case of an infection, a small wound may be visible and a fever may occur.

Diagnosis

A doctor or physiotherapist will first ask questions focused on finding out what the symptoms are and how they arose. This will be followed by a physical examination in which local inflammatory symptoms such as pain, redness, warmth and swelling are examined. Based on this, prepatellar bursitis can be diagnosed.

A suspicion of infectious bursitis is confirmed if the knee is very red and the symptoms developed following a surface wound. To confirm, some fluid may be aspirated from the bursa with a needle for testing.

Treatment

To let the bursitis heal, it is important to give the knee some rest. This means that pressure on the knee should be avoided as much as possible. Sparing the knee temporarily usually leads to spontaneous healing.

A doctor may opt to drain the bursa with a syringe. This usually gives immediate relief from the pain. Unfortunately, there is a chance that the bursa will swell up again afterwards. A painkiller and anti-inflammatory can remedy the symptoms of chronic bursitis if it does not result from an infection. However, when there is an infection, antibiotics will be prescribed.

If the above advice and treatments do not help, the bursa may be removed surgically.

Exercises

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your locality.

References
Knuistingh Neven, A. & Eekhof, J.A.H. (2005). Bursitis olecrani en bursitis prepatellaris. Huisarts & Wetenschap. 48(5):mei:2005.
Magee, D.J. (2014). Orthopedic physical assessment. Elsevier saunders: St. Louis.
Magee, D.J., Zachazewski, J.E., Quillen, W.S., Manske, R.C. (2016). Pathology and intervention in musculoskeletal rehabilitation. Elsevier, 2nd edition.