Prepatellar Bursitis

What is Prepatellar Bursitis?

 

Prepatellar Bursitis is an inflammation of the bursa. The Bursa is a sac filled with fluid that’s situated in front of the kneecap (patella). The Bursa functions as a gliding surface to reduce friction between moving tissues of the body. One cause of painful anterior knee swelling could be due to the prepatellar bursa being swollen. This kind of knee injury can often be checked in orthopeadic specialist centres or clinics here in Singapore.

What Causes Prepatellar Bursitis?

Prepatellar bursitis often occurs because of constant pressure to the knees while kneeling. As a result, the bursa sac becomes painfully inflamed.

Trauma to the kneecap, such as a kick to the front of the kneecap or falling onto the kneecap can also result in this condition. This can occur especially in intensive contact sports such as rugby, football or hockey, where the chances of knee injuries can be high.

Occasionally it is related to gout – a condition where the uric acid level in the body is very high.

How Does this Usually Present itself?

Inflammation of the bursa will usually present itself as a painful swelling on the front of the knee.
There are some instances that this can become infected. When it does, the swelling will appear red, warm and painful with possible discharge of pus.

What are the Symptoms of Prepatellar Bursitis?

There are a number of symptoms that can be expected when a person is afflicted with Prepatellar Bursitis. These symptoms include:

• Pain experienced with activity or movement, but not usually experienced at night
• Noticeable and rapid swelling on the front of the knee (Right where you might expect your Kneecap to be)
• There will be some tenderness and warmth when the area is touched
• Versions of Bursitis that are caused by infection may produce fluid and redness. With these, you can also expect fever and chills

Diagnosis and Examination

With this condition you will be examined and interviewed by your physician. Your doctor will ask about the symptoms you have been experiencing lately and that includes the severity of pain you may be experiencing. How long you’ve been experiencing these symptoms will also be recorded.

It is also very important that you communicate every detail such as fever or chills as these can be signs of infections. Which in this case, would need a completely different treatment plan.
During this inspection, the Doctor will need to thoroughly examine your affected knee and compare it to one that is healthy. It can be your own knee as well if you still have one that is not affected. The range of motion of the knee will also be checked as well.

What are the possible Tests for Prepatellar Bursitis?

X-Ray

This procedure will be able to provide clear images of the bones under the skin and therefore can help in visualizing the possible condition and severity of the inflammation. This can be ordered by the Doctor to check if the inflammation is caused by a fracture.

Other Kinds of Imaging Tests

Besides the X-Ray there are other versions of imaging tests that can be used in order to have a better view of the insides of the affected Knee. This includes Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI). These are ordered by the Doctor if there is a need to check for tissue damage around the Knee area.

Aspiration of Fluids

If there is a general concern about the possibility of infection, the Doctor may want to recommend the aspiration of fluid. This means that there will be a procedure that will be done to draw out fluids from inside the Bursa with a needle. The sample obtained here will then be sent to their laboratory for complete analysis.

How Prepatellar Bursitis is Treated

The first step is to be able to control the inflammation. Icing the swollen bursa can help in trying to reduce the pain and swelling. Doing it three to four times a day for 20 minutes each time is good. 

Taking oral anti-inflammatory medications can also help which are usually NSAIDs. These kinds of medications will help control and relieve pain and inflammation.

Elevation of the extremity when at rest and not walking will also help a great deal
In massive swelling such as this patient, a needle is applied to the swelling to aspirate (drain) the fluid.

If the bursitis is not infected, steroids can be injected into the sac to control the inflammation. This will result in a reduction of the swelling and pain.

What if the swelling keeps coming back?

Surgical excision of the prepatellar bursa can be performed under general anaesthesia.

This will solve the problem permanently. After surgery, the patient is allowed to walk immediately but try to avoid too much bending of the knee to allow the wound to heal.

The surgical wound usually heals in 2 weeks.
Another bursa will form over time as a response to the movement of the patella against the skin during the healing phase. If the healing process goes well, the newly formed bursa will not be thick and painful.

For more information on prepatellar bursitis or other knee injuries, feel free to contact Dr. HC Chang in Singapore. Dr. Chang has over 18 years of experience in surgical and non-surgical procedures in orthopaedic sports injuries, and has received multiple awards and accolades in the orthopaedic field. Make an appointment with Dr. Chang here.