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Prepatellar Bursitis

Prepatellar bursitis is an inflammation of prepatella bursa, which is located at the top of the knee over the kneecap. Bursitis of the prepatella bursa is sometimes called carpet layer’s knee, housemaid’s knee or roofer’s knee. It can be caused by a direct blow to the knee or from being in a prolonged kneeling position. A burse is a fluid filled sac that decreases friction between two tissues.

Causes

  • A direct blow to the prepatella bursa can produce inflammation and irritation.
  • A fall onto the knee or prepatella bursa.
  • Constant pressure on the prepatella bursa from kneeling.
  • Repeated stress injury to the prepatella bursa and tendon from jumping, which can also cause tendonitis and prepatellar bursitis.
  • Complications from rheumatoid arthritis, osteoarthritis or gout.
  • Infection of the prepatella bursa or knee.
  • Prepatella bursa can become swollen as a response to other knee conditions.

Symptoms

  • Pain and tenderness over the location of the prepatella bursa
  • Swelling
  • Loss of motion of the knee
  • Pain with activities that stress the prepatella bursa like kneeling, jumping, running or activities that cause stress on the tendons that are lubricated by the prepatella bursa.

Treatment

  • Initial treatment of prepatellar bursitis includes avoiding activities that produce pain or stress of the prepatella bursa and associated tendons (jumping, running, and kneeling.)
  • The use of ice to reduce inflammation and pain.
  • NSAIDS (nonsteroidal anti-inflammatory drugs)
  • Physical Therapy
  • Drainage of the fluid in the prepatella bursa for severe cases. Fluid can be checked for possible infection.
  • Antibiotic in the case of infections of the prepatella bursa
  • Surgery may be indicated in extreme cases if the problem becomes chronic.

Physical Therapy Interventions

Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals. Physical therapy for a prepatellar bursitis must remain conservative at the onset in order to not aggravate the condition. Emphasis will be in rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has reduced a program of stretching and light strengthening will be initiated to restore full motion and improve strength to reduce stress on the tendons and knee joint.

Common Physical Therapy interventions in the treatment of Prepatellar Bursitis include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the knee. Use of mobilization techniques also help to modulate pain.
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the knee to support, stabilize, and decrease the stresses place on the prepatella bursa and tendons of the knee joint.
  • Neuromuscular Re-education (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, running, kneeling, squatting and jumping) of the involved lower extremity to reduce stress on prepatella bursa and tendons in daily activities.
  • Modalities including the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation of the prepatella bursa.
  • Home program including strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

Medical Interventions

Avoiding the activities that produce the pain or stress the prepatella bursa is the first line of treatment.

  • RICE: (Rest, Ice, Compression, Elevation) should be used to reduce the stress on the prepatella bursa.
  • NSAIDS (non steroidal anti-inflammatory drugs) to reduce pain and inflammation.
  • Needle drainage to remove excess fluid from prepatella bursa
  • Injection of steroids to reduce inflammation in prepatella bursa
  • In the case of infection antibiotics may be prescribed,
  • In severe recurrent conditions, surgery to remove the prepatella bursa may be indicated.

Prognosis

In general, patients respond well to conservative treatment of prepatellar bursitis. It is important that once the pain and inflammation is reduced and motion and strength are restored that the patient gradually returns back to full activities. Instruction in daily activities or sport performance is helpful to reduce the chance of a reoccurrence of the prepatellar bursitis. In most cases full return to activity will take from 2-6 weeks depending on the severity of the condition. As a preventive measure individuals should:

  • Make modifications in work or daily activities such and kneeling, squatting or wearing protective equipment to avoid prolonged pressure or unexpected blows on the prepatella bursa.
  • Maintain strength and flexibility to reduce stress on the prepatella bursa and tendons of the knee.
  • Avoid highly repetitive activities whenever possible.