Although bursitis is best confirmed via procedural examination, the initial diagnosis is made by the presentation of a series of consistent symptoms and a history of trauma or injury to the knee.  A common cause of bursitis is prolonged stress on the knee throughout a long period of time.  Prepatellar Bursitis is often called the “housemaid’s knee” because it appears most in individuals that work on their knees, like maids, plumbers, and roofers.4  When the bursa is stressed, the thin tissue around the bursa begins to thicken to compensate for the added pressure.  When stressed too much, the bursa becomes inflamed and elevates to prepatellar bursitis.  Another cause of bursitis is damage to the bursa sac through trauma.  If a patient has had a recent fall or blow to the knee, they may have damaged some of the blood vessels located near the prepatellar bursa.  When this happens, blood can flood the sac causing it to swell up and become inflamed.[1]  Although the outward appearance may seem minor to the individual, the damage to the actual bursa can be damaging if not treated.  This can become a problem when patients downplay their symptoms because of what appears as a simple bruise.  In the septic form of bursitis, an infection causes the small amount of synovial fluid within the sac to be replaced with pus from the dead cells that are fighting off the ongoing infection.  Patients suffering from prepatellar bursitis may experience reoccurring knee pain followed by possible redness and swelling.5 They may also have difficulty with their range of motion in certain actions like walking, crawling, or kneeling.5  With septic bursitis, redness will be especially apparent and a fever may even occur if the infection is bad enough.  Patients with a lowered immune system may require immediate confirmation of diagnosis if they do not present the symptoms of an immune response.

The best way to begin diagnosing prepatellar bursitis is to start with a physical examination.  In doing so, you may find tenderness or inflammation above the knee.  When asked, the patient may also claim to notice a limited range of movement in the knee joint and pain during articulation.[2]  This is dependent on the amount of activity in the patient’s occupation or daily life.  The more stress that is put on the bursa, the more inflamed it will become.  Another very obvious visual indication of prepatellar bursitis includes a small or large bump above the patella.  This bump is the expanded bursa sac filled with excess fluid, blood, or pus depending on the type of bursitis.  In the instance of septic bursitis, you may notice redness and warmth on the skin.  Some patients may have healed over the cut in the skin that the infection originated from and developed a very painful abscess.6  In some more serious cases of infection, the patient may also present with symptoms of systemic problems, such as a fever or if serious enough, even tachycardia.  In which case, this can be a cause for alarm and the patient would then need emergency care.

Most patients are not greatly affected by their prepatellar bursitis.  As an aseptic inflammatory response, most people experience slight difficulty in movement and swelling that is no different than any normal injury.  The swollen bursa can cause minor pain in some patients while in others it causes no pain at all.  The amount of irritation affects people differently depending on their activity levels.6  For employees that develop bursitis through prolonged stress but have no way around occupational obligations will have greater difficulty functioning because the more they work, the worse their condition will get.  Without isolation, the patient can cause further injury to the bursa and risk lowering their ability to articulate that joint.  Patients with acute trauma usually experience an easy recovery and their condition will not greatly affect their life.  If they are able to treat the area as a normal injury, then the body will reabsorb the excess blood over time.6  This is similar to the process of fading an old bruise.  Patients with a poor immune system that have septic bursitis run a greater risk of systemic problems if their body is unable to fight off the infection.  If spread, the infection can lead to serious, sometimes life-threatening, complications.

Evaluation:

To treat prepatellar bursitis, there are two forms of action:  Surgical and Nonsurgical.  These treatments can range between medication, therapy, and excision.   In minor aseptic cases, prepatellar bursitis can be fixed with bed rest, ice, and compression wraps.[3]  For patients who have no choice but to continue stressing the bursa, physicians often suggest knee pads or cushions to relieve stress on the joint during activity along with non-steroid inflammatory pain-relievers like ibuprofen and motrin.6  After doing so, physicians may also refer patients to a physical or occupational therapist to reduce any loss in their range of motion in the knee by increasing the flexibility of their surrounding muscles.  If persistent inflammation occurs, physicians may also administer anti-inflammatory steroids such as Hydrocortisone that restricts blood flow through the capillaries and Corticosteroids that affects the body’s immune response to infection.[4]  Such infections are first treated with an antibiotic medication like penicillin.  In chronic cases, however, antibiotics must be administered through an IV if the patient experiences systemic or immune problems.7