Prepatellar Bursitis

What is prepatellar bursitis?

Prepatellar bursitis is an inflammation of a fluid-filled sac (bursa) located in front of the knee (prepatellar) that normally acts as a cushion to help reduce friction. It can be caused by prolonged kneeling, such as for work, or due to injury or infection, and can either be acute or chronic.

Symptoms of acute prepatellar bursitis include warmth, redness that may spread, swelling, and pain at the front of the knee, as well as fluid, a possible wound, and a fever if it is due to an infection. Chronic prepatellar bursitis may include symptoms such as a soft, painless lump at the front of the knee, as well as redness around the knee.

Treatments include rest, anti-inflammatory medications, antibiotics, medications for other conditions, and surgery and other procedures if needed.

You should visit your primary care physician to discuss these symptoms. Treatment is likely to include rest, icing, elevation, and anti-inflammatory medications like ibuprofen.

Symptoms of prepatellar bursitis

Prepatellar bursitis can cause either sudden symptoms ("acute") or long-term symptoms ("chronic").

Acute symptoms

Symptoms of acute prepatellar bursitis include:

• Warmth, redness, swelling, and pain in the front of the knee: The most common finding in acute prepatellar bursitis is knee redness, swelling, and pain in the front of the knee. The knee will feel warm to the touch and will cause pain when pushed.
• Fluid in front of the knee: Inflammation causes fluid to leak out of the blood vessels into the space near the joint, and it is sometimes possible to feel the fluid when pushing down on the front of the knee.
• Wound or bug bite over the skin at the front of the knee: If the prepatellar bursitis is due to an injury or an infection, there may be signs of the injury that can be seen on the skin. Examples include a wound from an injury or evidence of a bug bite.
• Fever: A fever occurs in about one-third of people with prepatellar bursitis. It's rare for anyone with prepatellar bursitis to develop a high fever or become quite ill. If this occurs, it is usually due to an infection that has spread to the bloodstream.
• Redness spreading beyond the knee: In some cases, people with acute prepatellar bursitis may develop a redness of the skin that spreads beyond the knee to the sides of the knee and up the leg. This can occur when the bursa pops, causing inflammation and possibly an infection of the skin around the knee.

Chronic symptoms

Symptoms of chronic prepatellar bursitis include:

• Soft, non-painful lump in front of the knee: People with chronic prepatellar bursitis develop a soft lump in front of the knee, but it does not hurt when you push on it. The lump may be slightly warm or cold.
• Redness around the knee: The skin on the front of the knee usually is only slightly red in people who have chronic prepatellar bursitis. Redness that spreads around the knee is rare. This is not due to the chronic prepatellar bursitis itself but is instead due to an infection associated with prepatellar bursitis.

Causes of prepatellar bursitis

The following causes can lead to either acute or chronic prepatellar bursitis. This includes prolonged kneeling, injury or infection, and other conditions.

Prolonged kneeling

The most common cause of long-term prepatellar bursitis is prolonged kneeling. The prolonged and repeated kneeling puts pressure on the knee and causes inflammation of the prepatellar bursa. This is commonly seen in people whose jobs require them to frequently kneel, such as:

• Plumbers
• Roofers
• Carpet layers
• Coal miners
• Housemaids
• Gardeners

Injury or infection

Injury or infection can lead to prepatellar bursitis and associated inflammation.

• Injury to the knee: An injury to the knee, especially one that penetrates the skin, can also cause prepatellar bursitis. The body's normal reaction to the injury can create further injury in the joint space, and this can be exacerbated if blood collects in the bursa.
• Infection of the knee: The knee can become infected by bacteria following a knee injury or a scrape or bug bite. The infection and the body's response to the infection will generate inflammation.

Other conditions

Other conditions that can be associated with the development of prepatellar bursitis include:

• Gout: Gout is a condition in which there are high uric acid levels in the blood. The uric acid can form crystals if the concentration gets too high, such as after eating a lot of meat or seafood or consuming a lot of beer. When the uric acid crystallizes in a joint, it can cause joint pain and inflammation, and inflammation of the knee can result in prepatellar bursitis.
• Rheumatoid arthritis: Rheumatoid arthritis (RA) is an inflammatory condition in which the body's immune system erroneously attacks its own tissues, including cartilage and the tissues lining joints. If rheumatoid arthritis affects the knee joint, it can result in prepatellar bursitis.

Treatment options and prevention for prepatellar bursitis

Treatments of prepatellar bursitis, both acute and chronic, can be alleviated with rest. Other remedies include anti-inflammatories, immobilization of the knee, antibiotics, medications for other conditions, and surgery.

Avoid repeated trauma and pressure to the knee

The most important way to prevent the development of prepatellar bursitis is to avoid repeated trauma and pressure on the knee. This means:

• Avoiding prolonged kneeling
• Preventing falls or injuries
• Knee braces: If your job requires prolonged kneeling, your physician can recommend protective knee braces.

Anti-inflammatory medications

If you are experiencing prepatellar bursitis that is causing some pain, your physician may recommend that you take non-prescription pain relievers that reduce inflammation without the use of a steroid.

• NSAIDs: These include ibuprofen (Advil, Motrin) or naproxen (Aleve).
• Steroids: If you do require a steroid for inflammation, your physician may recommend a prescription anti-inflammatory medication such as prednisone (Deltasone).

When to seek further consultation for prepatellar bursitis

If you have a job that requires prolonged kneeling, you can go to your physician to see if you are at risk of developing prepatellar bursitis. Your physician may recommend that you wear a knee brace to reduce the injury to your knee.

If you develop symptoms

If you develop any symptoms of prepatellar bursitis, including a lump in front of the knee, redness around the knee, or fever, you should go see your physician. He or she can examine the knee and order laboratory tests to determine if you have prepatellar bursitis and then recommend the appropriate treatments.