Prepatellar bursitis (sometimes referred to as housemaid’s knee, coal miner’s knee, carpet layer’s knee, or carpenter’s knee) occurs when the bursa positioned in front of the kneecap or patella becomes inflamed. A bursa is a fluid-filled sac responsible for cushioning areas where the bone might rub against tendons, muscles, or skin. An irritation, damage, or infection of the bursa causes the production of excess fluid, which results in swelling and tension in the knee. The swelling is typically noticeable at the front of the knee.
Types of Prepatellar Bursitis
The two primary types of prepatellar bursitis are:
Acute prepatellar bursitis: Develops suddenly, often because of trauma like a forceful impact to the knee or infection.
Chronic prepatellar bursitis: Caused by overuse or repeated pressure, usually common in individuals whose jobs or hobbies require frequent kneeling. Examples are carpenters or gardeners.
Symptoms
Symptoms of prepatellar bursitis can vary based on the severity and type. However, the common symptoms are:
Swelling: Swelling is the most noticeable symptom at the front of the knee, often occurring with a squishy sensation when pressed. The swelling is likely to worsen if not treated.
Restricted knee movement: Mild cases may not affect movement; however, more severe prepatellar bursitis can restrict bending or straightening of the knee.
Pain: Although some individuals experience little to no pain, others may feel aching or tenderness when bending or kneeling.
Causes
Prepatellar bursitis can result from:
Regular kneeling: The majority of cases stem from the pressure and irritation that comes with extended kneeling.
Direct impact: Prepatellar bursitis can arise from trauma to the knee due to a fall or a forceful impact.
Bacterial infection: Infections from cuts, scratches, or insect bites on the knee can extend to the bursa. Although less frequent, this can be rather serious and needs to be treated right away.
Medical conditions: Though less common, rheumatoid arthritis and gout can contribute to prepatellar bursitis.
Diagnosis
Prepatellar bursitis is usually diagnosed through a combination of physical examination, medical history, and imaging tests. The physical exam involves evaluating swelling, pain, and the knee’s range of motion. Imaging tests, including ultrasound or MRI, may reveal a localized fluid assembly in the subcutaneous tissue located at the front of the knee, just above the kneecap. These tests may also show hypersensitivity in the area when pressure is applied, such as from the ultrasound probe.
Treatment
At The Joint Pain Clinic, we manage most prepatellar bursitis cases with conservative measures, which include:
Rest: Avoid activities that worsen the pain, like kneeling, to allow the knee to heal.
Ice: Apply ice packs to the affected knee for at least 10 to 15 minutes at a time and several times daily.
Over-the-counter pain relievers: Medications like ibuprofen or naproxen can help alleviate pain and inflammation.
Corticosteroid injections: These may be used to reduce inflammation and provide pain relief in more severe cases.
Surgery: In rare occasions, surgical intervention may be required, especially if the bursa is too large or causes extreme pain.
Preventing Prepatellar Bursitis
You can lower your risk of developing prepatellar bursitis by:
Wearing protective gear to cushion the knees during activities involving frequent kneeling.
Keeping cuts or insect bites on knees clean and properly treated to prevent infections.
Applying ice and elevating the legs after activity if you kneel or squat often to minimize the risks.