Prepatellar bursitis

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Prepatellar bursitis
Other namesbeat knee,[1] carpet layer's knee, coal miner's knee, housemaid's knee,[2] rug cutter's knee, nun's knee[3]
Aseptic prepatellar bursitis
SpecialtyOrthopedic surgery, sports medicine, physical medicine and rehabilitation

Prepatellar bursitis is an inflammation of the prepatellar bursa at the front of the knee. It is marked by swelling at the knee, which can be tender to the touch and which generally does not restrict the knee's range of motion. It can be extremely painful and disabling as long as the underlying condition persists.

Prepatellar bursitis is most commonly caused by

chronic
trauma over time. As such, the condition commonly occurs among individuals whose professions require frequent kneeling.

A definitive diagnosis can usually be made once a

intravenous antibiotics, surgical irrigation of the bursa, and bursectomy
.

Signs and symptoms

Lateral section of the knee

The primary symptom of prepatellar bursitis is swelling of the area around the kneecap. It generally does not produce a significant amount of pain unless pressure is applied directly.

flexion of the joint.[6]: p. 360  Flexion and extension of the knee may be accompanied by crepitus, the audible grating of bones, ligaments, or particles within the excess synovial fluid.[7]
: p. 20 

Causes

In human

bursae of the knee joint, and is located between the patella and the skin.[8] Prepatellar bursitis is an inflammation of this bursa. Bursae are readily inflamed when irritated, as their walls are very thin.[7]: p. 22  Along with the pes anserine bursa, the prepatellar bursa is one of the most common bursae to cause knee pain when inflamed.[9]

Prepatellar bursitis is caused by either a single instance of acute

idiopathic, though these may be caused by trauma that the patient does not remember.[5]
: pp. 607–8 

The prepatellar bursa and the

fungi, or Gram-negative bacteria.[5]: p. 608  In very rare cases, the infection can be caused by tuberculosis.[12]

Diagnosis

Left sided aseptic prepatellar bursitis in a retired concrete finisher.

There are several types of inflammation that can cause knee pain, including sprains, bursitis, and injuries to the meniscus.[9] A diagnosis of prepatellar bursitis can be made based on a physical examination and the presence of risk factors in the person's medical history; swelling and tenderness at the front of the knee, combined with a profession that requires frequent kneeling, suggest prepatellar bursitis.[2] Swelling of multiple joints along with restricted range of motion may indicate arthritis instead.[5]: p. 608 

A physical examination and medical history are generally not enough to distinguish between infectious and non-infectious bursitis;

radiograph of the knee and urinalysis.[12]

Prevention

It is possible to prevent the onset of prepatellar bursitis, or prevent the symptoms from worsening, by avoiding trauma to the knee or frequent kneeling.

contact sports, such as American football, basketball, and wrestling.[13]

Treatment

Non-septic prepatellar bursitis can be treated with rest, the application of ice to the affected area, and

anti-inflammatory drugs, particularly ibuprofen. Elevation of the affected leg during rest may also expedite the recovery process.[13] Severe cases may require fine-needle aspiration of the bursa fluid, sometimes coupled with cortisone injections.[11] However, some studies have shown that steroid injections may not be an effective treatment option.[14] After the bursitis has been treated, rehabilitative exercise may help improve joint mechanics and reduce chronic pain.[15]
: p. 2320 

Opinions vary as to which treatment options are most effective for septic prepatellar bursitis.

outpatient procedure that can be performed in less than half an hour.[17]
: p. 357 

Epidemiology

The various nicknames associated with prepatellar bursitis arise from the fact that it commonly occurs among those individuals whose professions require frequent kneeling, such as carpenters, carpet layers, gardeners, housemaids, mechanics, miners, plumbers, and roofers.[2][4][5]: p. 607  The exact incidence of the condition is not known; it is difficult to estimate because only severe septic cases require hospital admission, and mild non-septic cases generally go unreported.[5]: p. 607  Prepatellar bursitis is more common among males than females. It affects all age groups, but is more likely to be septic when it occurs in children.[18]

References

  1. ^
    PMID 3447109
    .
  2. ^
    ISBN 9780781745864
    .
  3. ^ "2012 ICD-9-CM Diagnosis Code 727.2 : Specific bursitides often of occupational origin".
  4. ^
    ISBN 9780387356648
    .
  5. ^
    PMID 3074561
    .
  6. ^
    S2CID 42187890
    .
  7. ^
    PMID 18672851
    .
  8. PMID 22623812
    .
  9. ^
    ISSN 0092-8682
    .
  10. ISSN 0092-8682
    .
  11. ^ a b Shiel, William C. "Bursitis of the Knee". MedicineNet. Retrieved 9 May 2012.
  12. ^
    PMID 2203571
    .
  13. ^ a b "Prepatellar (Kneecap) Bursitis". American Academy of Orthopaedic Surgeons. July 2007. Retrieved 10 May 2012.
  14. S2CID 45164840
    .
  15. PMID 8638508
    .
  16. PMID 2627225
    .
  17. PMID 20521045
    .
  18. ^ Allen, Kelly L (18 January 2012). "Prepatellar Bursitis". WebMD. Retrieved 21 May 2012.

External links

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