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]
Prepatellar bursitis.JPG
Aseptic prepatellar bursitis
Specialty Orthopedic 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.

Contents

Prepatellar bursitis is most commonly caused by trauma to the knee, either by a single acute instance or 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 clinical history and physical examination have been obtained, though determining whether or not the inflammation is septic is not as straightforward. Treatment depends on the severity of the symptoms, with mild cases possibly only requiring rest and localized icing. Options for presentations with severe sepsis include intravenous antibiotics, surgical irrigation of the bursa, and bursectomy.

Signs and symptoms

Lateral section of the knee Prepatellar bursa.png
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. [4] The area may be red (erythema), warm to the touch, or surrounded by cellulitis, particularly if infection is present, often accompanied by fever. [5] : p. 608  Unlike arthritis, except in severe cases prepatellar bursitis generally does not affect the range of motion of the knee, though it may cause some discomfort in complete 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 anatomy, a bursa is a small pouch filled with synovial fluid. Its purpose is to reduce friction between adjacent structures. The prepatellar bursa is one of several 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 trauma to the knee, or repeated minor trauma to the knee. The trauma can cause extravasation of nearby fluids into the bursa, which stimulates an inflammatory response. [2] This response occurs in two phases: The vascular phase, in which the blood flow to the surrounding area increases, and the cellular phase, in which leukocytes migrate from the blood to the affected area. [7] : p. 22  Other possible causes include gout, sarcoidosis, CREST syndrome, [6] : p. 359  diabetes mellitus, alcohol use disorder, uremia, and chronic obstructive pulmonary disease. [7] : p. 22  Some cases are idiopathic, though these may be caused by trauma that the patient does not remember. [5] : pp. 607–8 

The prepatellar bursa and the olecranon bursa are the two bursae that are most likely to become infected, or septic . [10] Septic bursitis typically occurs when the trauma to the knee causes an abrasion, though it is also possible for the infection to be caused by bacteria traveling through the blood from a pre-existing infection site. [11] In approximately 80% of septic cases, the infection is caused by Staphylococcus aureus ; other common infections are Streptococcus , Mycobacterium , and Brucella . [6] : p. 359  It is highly unusual for septic bursitis to be caused by anaerobes, 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. Left knee prepatellar bursitis.jpg
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; aspiration of the bursal fluid is often required for this, along with a cell culture and Gram stain of the aspirated fluid. [6] : p. 360  Septic prepatellar bursitis may be diagnosed if the fluid is found to have a neutrophil count above 1500 per microliter, [5] : p. 608  a threshold significantly lower than that of septic arthritis (50,000 cells per microliter). [6] : p. 360  A tuberculosis infection can be confirmed using a 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. [5] : p. 610  Protective knee pads can also help prevent prepatellar bursitis for those whose professions require frequent kneeling and for athletes who play 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. [6] : p. 360  McAfee and Smith recommend a course of oral antibiotics, usually oxacillin sodium or cephradine, and assert that surgery and drainage are unnecessary. [5] : p. 609  Wilson-MacDonald argues that oral antibiotics are "inadequate", and recommends intravenous antibiotics for managing the infection. [1] Some authors suggest surgical irrigation of the bursa by means of a subcutaneous tube. [6] : p. 360  [16] Others suggest that bursectomy may be necessary for intractable cases; the operation is an 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]

Related Research Articles

<span class="mw-page-title-main">Tenosynovitis</span> Medical condition

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<span class="mw-page-title-main">Shoulder problem</span> Medical condition

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<span class="mw-page-title-main">Septic arthritis</span> Medical condition

Acute septic arthritis, infectious arthritis, suppurative arthritis, pyogenic arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typically include redness, heat and pain in a single joint associated with a decreased ability to move the joint. Onset is usually rapid. Other symptoms may include fever, weakness and headache. Occasionally, more than one joint may be involved, especially in neonates, younger children and immunocompromised individuals. In neonates, infants during the first year of life, and toddlers, the signs and symptoms of septic arthritis can be deceptive and mimic other infectious and non-infectious disorders.

<span class="mw-page-title-main">Bursitis</span> Human disease

Bursitis is the inflammation of one or more bursae of synovial fluid in the body. They are lined with a synovial membrane that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying on the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem. Muscle can also be stiffened.

<span class="mw-page-title-main">Baker's cyst</span> Medical condition

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<span class="mw-page-title-main">Ear pain</span> Pain in the ear

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<span class="mw-page-title-main">Synovial bursa</span> Fluid-filled sacs which cushion the bones and muscles around joints

A synovial bursa, usually simply bursa, is a small fluid-filled sac lined by synovial membrane with an inner capillary layer of viscous synovial fluid. It provides a cushion between bones and tendons and/or muscles around a joint. This helps to reduce friction between the bones and allows free movement. Bursae are found around most major joints of the body.

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<span class="mw-page-title-main">Knee effusion</span> Medical condition

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<span class="mw-page-title-main">Olecranon bursitis</span> Medical condition; swelling, redness, and pain at the tip of the elbow

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<span class="mw-page-title-main">Subacromial bursitis</span> Medical condition

Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coraco-acromial ligament, acromion, and coracoid and from the deep surface of the deltoid muscle. The subacromial bursa helps the motion of the supraspinatus tendon of the rotator cuff in activities such as overhead work.

<span class="mw-page-title-main">Infrapatellar bursitis</span> Medical condition

Infrapatellar bursitis is inflammation of the superficial or deep infrapatellar bursa. Symptoms may include knee pain, swelling, and redness just below the kneecap. It may be complicated by patellar tendonitis.

<span class="mw-page-title-main">Prepatellar bursa</span>

The prepatellar bursa is a frontal bursa of the knee joint. It is a superficial bursa with a thin synovial lining located between the skin and the patella.

<span class="mw-page-title-main">Pes anserine bursitis</span> Medical condition

Pes anserine bursitis is an inflammatory condition of the medial (inner) knee at the anserine bursa, a sub muscular bursa, just below the pes anserinus.

<span class="mw-page-title-main">Joint effusion</span> Medical condition

A joint effusion is the presence of increased intra-articular fluid. It may affect any joint. Commonly it involves the knee.

<span class="mw-page-title-main">Calcific bursitis</span> Medical condition

Calcific bursitis refers to calcium deposits within the bursae. This most occurs in the shoulder area. The most common bursa for calcific bursitis to occur is the subacromial bursa. A bursa is a small, fluid-filled sac that reduces friction, and facilitates movements between its adjacent tissues. Inflammation of the bursae is called bursitis.

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References

  1. 1 2 Wilson-Macdonald, James (1987). "Management and outcome of infective prepatellar bursitis". Postgrad Med J. 63 (744): 851–853. doi:10.1136/pgmj.63.744.851. PMC   2428634 . PMID   3447109.
  2. 1 2 3 4 Madsen, James M (22 November 2004). "Prepatellar Bursitis". In Greenberg, Michael I (ed.). Greenberg's Text-Atlas of Emergency Medicine. Lippincott Williams & Wilkins. p. 922. ISBN   9780781745864.
  3. ↑ "2012 ICD-9-CM Diagnosis Code 727.2 : Specific bursitides often of occupational origin".
  4. 1 2 Biundo, Joseph J (2008). "Prepatellar Bursitis". In Klippel, John H (ed.). Primer on the Rheumatic Diseases. Springer. p. 80. ISBN   9780387356648.
  5. 1 2 3 4 5 6 7 8 9 McAfee, JH; Smith, DL (November 1988). "Olecranon and prepatellar bursitis—Diagnosis and treatment". West J Med. 149 (5): 607–610. PMC   1026560 . PMID   3074561.
  6. 1 2 3 4 5 6 7 Aaron, DL; et al. (June 2011). "Four common types of bursitis: diagnosis and management". J Am Acad Orthop Surg. 19 (6): 359–361. doi:10.5435/00124635-201106000-00006. PMID   21628647. S2CID   42187890.
  7. 1 2 3 4 Price, N (June 2008). "Prepatellar bursitis". Emergency Nurse. 16 (3): 20–24. doi:10.7748/en2008.06.16.3.20.c8183. PMID   18672851.
  8. ↑ Chatra, Priyank (January–March 2012). "Bursae around the knee joints". Indian Journal of Radiology and Imaging. 22 (1): 27–30. doi: 10.4103/0971-3026.95400 . PMC   3354353 . PMID   22623812.
  9. 1 2 Gonzales, R; Nadler, PL (2010). "Acute Knee Pain". In McPhee, SJ; Papadakis, MA (eds.). Current Medical Diagnosis & Treatment 2010. New York: McGraw-Hill Medical. p. 33. ISSN   0092-8682.
  10. ↑ Hellmann, DB; Imboden, JB (2010). "Bursitis". In McPhee, SJ; Papadakis, MA (eds.). Current Medical Diagnosis & Treatment 2010. New York: McGraw-Hill Medical. p. 743. ISSN   0092-8682.
  11. 1 2 Shiel, William C. "Bursitis of the Knee". MedicineNet. Retrieved 9 May 2012.
  12. 1 2 Schickendantz, MS; Watson, JT (September 1990). "Mycobacterial prepatellar bursitis". Clin Orthop Relat Res. 258 (258): 209–212. doi:10.1097/00003086-199009000-00026. PMID   2203571.
  13. 1 2 "Prepatellar (Kneecap) Bursitis". American Academy of Orthopaedic Surgeons. July 2007. Retrieved 10 May 2012.
  14. ↑ Mysnyk, MC; et al. (January 1986). "Prepatellar bursitis in wrestlers". Am J Sports Med. 14 (1): 46–54. doi:10.1177/036354658601400109. PMID   3752346. S2CID   45164840.
  15. ↑ Butcher JD, et al. (15 May 1996). "Lower extremity bursitis". Am Fam Physician. 53 (7): 2317–24. PMID   8638508.
  16. ↑ Hennrikus, WL; et al. (September 1989). "Treating septic prepatellar bursitis". West J Med. 151 (3): 331–332. PMC   1026890 . PMID   2627225.
  17. ↑ Huang, Y; Yeh, W (March 2011). "Endoscopic treatment of prepatellar bursitis". Int Orthop. 35 (3): 355–358. doi:10.1007/s00264-010-1033-5. PMC   3047636 . PMID   20521045.
  18. ↑ Allen, Kelly L (18 January 2012). "Prepatellar Bursitis". WebMD. Retrieved 21 May 2012.
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