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What Is Prepatellar Bursitis? Symptoms, Treatment

What Is Prepatellar Bursitis?/Prepatellar Bursitis is a condition where the bursa in the front of the kneecap gets inflamed. Bursae are little, jelly-filled sacs located throughout the body providing cushioning to the bones and soft tissues. However, sometimes the bursa may become irritated and produce too much fluid. This causes it to swell and puts pressure on the adjoining knee parts.

Bursitis is an inflammation in one of the small, fluid-filled sacs (bursae) often found near joints in the body. It can be very painful and limit mobility. The inflammation can result when too much pressure is put on one of these sacs (a bursa).

Bursae are fluid-filled sac-like structures located between mobile structures of the musculoskeletal system, between skin and bone, or between the joints. There are upward of 150 superficial and deep bursae located in between bone, muscle, tendons, and skin. Small amounts of synovial fluid are produced within the bursa and reduce friction by lubrication. Inflammation of the bursa causes excess fluid production and leads to swelling and irritation, known as bursitis. This inflammation can be caused by prolonged pressure, overuse, inflammatory and crystalloid arthritis, and direct injury or trauma. Common locations of bursitis include prepatellar, olecranon, and trochanteric.[rx][rx][rx][rx]

What Is Prepatellar Bursitis?

Causes of Prepatellar Bursitis

Pressure from constantly kneeling down
Activities such as plumbing, gardening and roofing
A direct blow to the front of the knee
Direct fall on the knee in sports such as football and wrestling.
Health conditions such as Rheumatoid Arthritis or Gout
Bacterial infection through insect bite or wound
Direct trauma/blow to the anterior knee
Frequent falls on the knee
Constant friction – between the skin and the patella can be a cause of this condition. By the impact, the damaged blood vessels in the knee result in inflammation and swelling of the bursa. Actually, a bacterial seeding of the bursal sac caused by a hematoma is rare, because of the limited vascular supply of the bursal tissue.
Infection – Typically for a septic prepatellar bursitis is a break in the skin near the bursa, which leads to swelling and pain around this area. This happens when a bacteria (for example S.
Co-existing inflammatory disease– rheumatoid arthritis, gout etc.

Symptoms of Prepatellar Bursitis

Pain that increases after physical activity
Inflammation in the front of the kneecap
Difficulty in straightening or flexing the knee
Fluid and redness in the affected area
Fever
Swelling over, above or below the kneecap.
Limited motion of the knee.
Redness and warmth at the site of the bursa.
Painful movement of the knee.
Tenderness and warmth to touch
Painful and limited ROM at the knee
If the bursitis is caused by an infection, pain is associated with fever and chills.

Diagnosis of Prepatellar Bursitis

Routine blood work is somewhat unhelpful in the diagnosis and distinguishing septic bursitis versus non-infectious bursitis.

Blood count (WBC) – may not differ between infectious and non-infectious bursitis and may not even be elevated above the normal range.
C-reactive protein (CRP) – and erythrocyte sedimentation rate (ESR) usually are elevated in septic bursitis.
A uric blood acid – level should also be checked if suspicion of underlying crystal arthropathy exists.
Antinuclear antibody and rheumatoid factor – can be ordered in chronic cases or when the underlying autoimmune disease is suspected.
Ultrasound – is particularly helpful for visualizing cobblestoning of the fat overlying a bursa, which can help differentiate cellulitis from infectious bursitis. Color Doppler can likewise be used to show signs of infection, such as hyperemia of the bursa and the surrounding tissues.
X-Ray – Plain film radiography is usually performed, but it is unnecessary and unhelpful in most cases of septic bursitis. Spurs may be seen in chronic cases of bursitis, but joint effusions are not normally present.
Computed tomography (CT) and magnetic resonance imagining (MRI) – are not needed unless suspicion for osteomyelitis or septic arthritis exists, or if the physician is evaluating a severe case of septic bursitis in which surgical management may be necessary.[rx][rx][rx]

Quadriceps. femoris muscle. Tendon of. quadriceps. femoris muscle. Patella. Medial patellar. retinaculum. Lateral patellar. retinaculum. Tibial collateral. ligament. Fibular. collateral. ligament. Patellar ligament. Fibula. Tibia. (c) Anterior view of right knee. Figure 8.8c.

Treatment of Prepatellar Bursitis

Non-Surgical Treatment

The acronym P.R.I.C.E. can be used to remember an approach to treating muscle and joint injuries, especially sports-related injuries like strains and sprains. But this approach is also helpful for bursitis. P.R.I.C.E. stands for:

P as in protection _ This means protecting the affected area from pressure or bumps. A splint might be useful for this purpose. Walking aids are sometimes a good idea too, to help relieve the pressure on a leg or foot.
R as in rest – Make sure to rest the joint. Particularly if the bursitis is work-related, you may need a note from the doctor to take some time off. Physiotherapists and occupational therapists can offer more tips on what to be careful of at home or at work also in the long term, to prevent bursitis from coming back.
I as in ice – Cool packs or a moist, cooling wrap can relieve the symptoms. It’s important to wrap the ice or cool pack in a towel or cloth first. Never put it directly on your skin – it could harm the skin otherwise.
C as in compression – An elastic compression bandage that’s not too tight can prevent the inflamed area from becoming more swollen. Putting a tightly wrapped bandage or a special cuff around a joint such as an elbow or a knee will also automatically keep the joint from moving too much.
E as in elevating – If your knee or lower leg is affected, it can be helpful to put your feet up (elevate) several times a day to keep the swelling down.

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain, reduce inflammation and help keep swelling down. For this reason, some people take them in addition to following the P.R.I.C.E. treatment approach.

Antibiotics – Antibiotic therapy should initially be aimed at the most likely organisms and tailored as needed to gram-stain and culture results. Methicillin-resistant Staphylococcus aureus coverage with oral clindamycin, doxycycline, and trimethoprim-sulfamethoxazole is recommended for empiric therapy until culture results are finalized. If there is a severe local infection or in an immunocompromised patient, admission for intravenous vancomycin is most appropriate. For those patients with a penicillin allergy, the recommended treatment is ciprofloxacin and rifampin.
NSAIDs – Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed by the doctor to reduce pain and discomfort. Short-term use of an anti-inflammatory drug, such as aspirin, ibuprofen or naproxen sodium can help relieve pain.
Corticosteroid medication –Tablet form corticosteroid can be used depending on the condition of the patient, the doctor may sap the bursa with the help of a needle and inject it with corticosteroid medication. This brings down the swelling to a great extent.
Draining the bursa – The more the fluid builds up in the bursa, the more it swells up, and the more painful it becomes. A doctor can puncture the bursa with a hollow needle (cannula) to draw out the excess fluid. But this technique is usually not a permanent solution – even when repeated several times: The fluid quickly fills up again, and each time it is drained there is a risk that bacteria could infect the bursa. This procedure can also be done to find out whether bacteria are involved. The fluid that is taken is then tested for germs in a lab.
Steroid injections – If a bursa has become inflamed following overuse and doctors are certain that bacteria are not involved, steroids can be used to treat the inflammation. The drug is injected right into the bursa. Usually, these steroid injections are only given if other treatments haven’t led to improvement after about ten days. They may cause an infection or loss of tissue.

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Physiotherapy

Many patients with knee bursitis start to feel better within a few weeks of the injury. Your physiotherapy treatment will aim to

Reduce pain and inflammation, this is achieved with the application of electrical modalities, ice, therapeutic taping and education regarding activity modification
Normalize your knee joint range of motion.
Strengthen your knee muscles, quadriceps, and hamstrings.
Strengthen your lower limb, calves, hip, and pelvic muscles.
Normalize your muscle lengths.
Improve your proprioception, agility, and balance.
Improve your technique and function walking, running, squatting, hopping and landing.
Minimize your chance of re-aggravation.

Surgical Treatment

If the swelling persists, surgical removal of the bursa may be required to treat the condition. This helps the incomplete recovery of the patient from Kneecap Bursitis.

Home Remedies of Prepatellar Bursitis

Rest your knee – Discontinue the activity that caused knee bursitis and avoid movements that worsen your pain.
Apply ice – Apply an ice pack to your knee for 20 minutes at a time several times a day until the pain goes away and your knee no longer feels warm to the touch.
Apply compression – Use of a compressive wrap or knee sleeve can help reduce swelling.
Elevate your knee – Prop your affected leg on pillows to help reduce swelling in your knee.
Put ice or a cold pack on your kneecap for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
After 3 days of using ice, you may use heat on your kneecap. You can use a hot water bottle, a heating pad set on low, or a warm, moist towel.
Prop up the sore leg on a pillow when you ice it or anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.
Rest your knee. Stop any activities that cause pain. Switch to activities that do not stress your knee.
Take your medicines exactly as prescribed. Call your doctor or nurse call line if you think you are having a problem with your medicine.
To prevent and ease kneecap bursitis during work, play, and daily activities:
- Wear kneepads when kneeling on hard surfaces. Avoid kneeling for too long at a time.
- Strengthen and stretch your leg muscles.
- Avoid deep knee bends.
You can slowly return to the activity that caused the pain, but do it with less effort until you can do it without pain or swelling. Be sure to warm up before and stretch after you do the activity

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Prevention of Prepatellar Bursitis

To avoid knee bursitis or prevent its recurrence:

Wear kneepads – If you’re working on your knees or participating in sports that put your knees at risk, use padding to cushion and protect your knees. Use kneepads or supports for any sports, work, or household tasks that strain your knees.
Take breaks – If you’re on your knees for a period of time, take regular breaks to stretch your legs and rest your knees.
Avoid excessive squatting – Excessive or repetitious bending of your knees increases the force on your knee joints.
Achieve and maintain a healthy weight – This can help take the pressure off your knee joint.
Rest your knees from time to time. Stretch them so they stay limber. Don’t overdo it. If one type of exercise leaves you hurting, try something else. Ice your sore joint after activity.
Sit, don’t squat. Use a stool when you weed the garden. You’ll put less strain on your knees.
Stay at a healthy weight. Extra pounds put added pressure on your knees and could make your joint problems worse.