Prepatellar Bursitis
Prepatellar bursitis
3.Clinically Relevant Anatomy
The kneecap is a triangular shaped bone in front of the knee. It moves up and dawn in the groove of the femur when you bend en straighten your knee. The patellar tendon is a thick structure that connects the bottom of the patella with the tibia. The upper part of the patella is connected to the quadriceps who is responsible of the knee flexion en for moving the patella upwards.
A bursa is a small fluid filled sac that decreases friction between two tissues. This can be between skin an a tendon but also between bony structures. There are a lot of bursa around the knee. For example the semimembranosus bursa, the subsartorial bursa, the deep infrapatellar bursa, the subcutaneous infrapatellar bursa, the suprapatellar bursa and the prepatellar bursa.
The prepatellar bursitis is the most commonly injured bursa.
4.Epidemology/Etiology
Prepatellar bursitis is a also called housemaid knee or carpenters knee, this is because prepatellar bursitis is often coursed by sitting on the knees for a long time. Housemaids en carpenters do this a lot and are therefore more likely to develop a prepatellar bursitis.
The prepatellar bursitis is caused due to a lot a friction between the skin and the patella. This results in swelling and inflammation of the bursa.
A second cause of a prepatellar bursitis is a blow on the knee. This damages blood vessels in the knee and that blood causes inflammation and swelling of the bursa.
The last cause of a prepatellar bursitis can be a wound on the front of the knee or kneecap. The bacteria can enter the bursa due to the wound and can infect the bursa.
Chronic prepatellar bursitis is caused by repeated blows or friction on the knee.
5.Characteristics/Clinical Presentation
Prepatellar bursitis can be recognized by swelling of the knee, especially on the kneecap the can occur after an hour after a blow and can build up over weeks when there is daily friction on the knee. The knee can also feel warm and the knee will feel painful while bending and stretching.
7.Diagnostic Procedures
To make sure that the injury is a prepatellar bursitis a x-ray, MRI an CAT-scan can be taken. To make sure that the patalla isn’t broken or that there are tears in the tendons in and around the knee.
A arthogram, aspiration or blood test can be used to rule out other injuries.
10.Medical Management
If the prepatellar bursitis is persistent anti-inflammatory medication is often used.
If the anti-inflammatory medication has no effect a injection of cortisone into the affected area is possible.
The bursa can also be drained. This can be done by a doctor with the use of a needle and a string. The fluid can then be analyzed for infection.
If no treatmant of the bursitis works surgery may be used to remove the prepatella bursitis. Over time a new bursa will grow back.
11. Physical Therapy Management
The most common used treatment against a prepatellar bursitis is the R.I.C.E method. Stretching the quadriceps is also used as treatment of a prepatellar bursitis to reduce the friction between the skin and the patella tendon. When the patella tendon is mare flexible there is less friction.
A treatment that is not often used is applying ultrasound on the prepatellar bursitis. The ultrasound is a diagnostic technique that uses high frequency sound waves. This increases the normal resolution time of mastcels ,increases the blood flow and stimulates the production of collagen. The ultrasound is produced by a little machine. You put some gel on the injured tendon or muscle and afterwards you put on the end of the machine that produces the ultrasound. Without the gel the ultrasound isn’t transferred in the tissue of the patient and is then useless. Then you make circular movement on and around the injured area. This is also important. If you keep the ultrasound on the same place then it will injure the tissue of the patient.
Prevention
Avoid injury or overuse of muscles. Before doing sport do an appropriate warm up and afterward a cool dawn.
See that the flexibility of the knee stays optimal and also the strength and endurance of the muscles of the leg.
Prevent blows on the kneecap.
Use proper equipment, including kneepads when you spent of lot of your time one your knees.
6.Differential Diagnoses
Medial Collateral and Lateral Collateral Ligament Injury, Osteoarthritis, Pes Anserinus ,Bursitis ,Posterior Cruciate Ligament Injury, Rheumatoid Arthritis, Patellar tendon rupture , Chondromalacia patella ,Patellofemoral pain
15.Recent related Research(From PubMed)
Endoscopic treatment of prepatellar bursitis.
Closed bursotomy for chronic prepatellar bursitis: a self-described case.
Prepatellar septic bursitis: a case report of skin necrosis associated with open bursectomy.
Chronic posttraumatic bursitis of the medial collateral ligament: surgical treatment in 2 high-level professional athletes.
Images in clinical medicine. Infrapatellar [corrected] bursitis.
Painful suprapatellar swelling: diagnosis and discussion.
Patellar osteomyelitis presenting as prepatellar bursitis.
Massive prepatellar bursitis in cerebral palsy.
From Web of knowledge
Infectious olecranon and patellar bursitis: short-course adjuvant antibiotic therapy is not a risk factor for recurrence in adult hospitalized patients
http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do?product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=2&colname=WOS
Cloxacillin-based therapy in severe septic bursitis: Retrospective study of 82 cases
http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do?product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=3&colname=WOS
Ossifying Bursitis Praepatellaris of the Knee Joint
http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do?product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=4&colname=WOS
Hemorrhagic prepatellar bursitis: a rare case report and review of the literature
http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do?product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=8&colname=WOS
Prepatellar Septic Bursitis: A Case Report of Skin Necrosis Associated With Open Bursectomy
http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do?product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=7&colname=WOS
Olecranon and prepatellar bursitis - Treating acute, chronic, and inflamed
http://apps.isiknowledge.com.ezproxy.vub.ac.be:2048/full_record.do?product=UA&search_mode=GeneralSearch&qid=1&SID=S24LCBd8ahiI4bB3hJ7&page=1&doc=30&colname=WOS
References .
Reid, d.c, Injury Assesment and Rehabilitation, New York, 1992, p 416-438, Cuchil Levington Inc(C)
Goroll, Allan H.; Mulley, Albert G.. Primary Care Medicine: Office Evaluation and Management of the Adult Patient. Lippincott Williams & Wilkins. p. 1058. ISBN 9-7807-8177-5137
Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.
Babak Shadgan, Bernard J. Feldman, and Siavash Jafari, Wrestling Injuries During the 2008 Beijing Olympic Games, Am J Sports Med September 2010 38 1870-1876; published online before print June 3, 2010, doi:10.1177/0363546510369291
Kelley's Textbook of Rheumatology, W B Saunders Co, edited by Shaun Ruddy, et al., 2000.
Allen KL, Fried GW; Prepatellar Bursitis. eMedicine. Article dated 2009.
Rennie, WJ, Saifuddin, A. Pes anserine bursitis: incidence in symptomatic knees and clinical presentation. Skeletal Radiol 2005; 34:395.
