Prepatellar Bursitis

Prepatellar bursitis is inflammation of the prepatellar bursa. The prepatellar bursa is a fluid-filled sac that cushions the kneecap (patella). Prepatellar bursitis happens when fluid builds up in the this sac and causes it to get larger. The condition causes knee pain.

What are the causes?

This condition may be caused by:

• Constant pressure on the knees from kneeling.
• A hit to the knee.
• Falling on the knee.
• A bacterial infection.
• Moving the knee often in a forceful way.

What increases the risk?

This condition is more likely to develop in:

• People who play a sport that involves a risk for falls on the knee or hard hits (blows) to the knee. These sports include:
  • Football.
  • Wrestling.
  • Basketball.
  • Soccer.
• People who have to kneel for long periods of time, such as roofers, plumbers, and gardeners.
• People with another inflammatory condition, such as gout or rheumatoid arthritis.

What are the signs or symptoms?

The most common symptom of this condition is knee pain that gets better with rest. Other symptoms include:

• Swelling on the front of the kneecap.
• Warmth in the knee.
• Tenderness with activity.
• Redness in the knee.
• Inability to bend the knee or to kneel.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam. During the exam, your provider will compare your knees and check for tenderness and pain when moving your knee. Your health care provider may also use a needle to remove fluid from the bursa to help diagnose an infection.
• Tests, such as:
  • A blood test that checks for infection.
  • X-rays. These may be taken to check the structure of the patella.
  • MRI or ultrasound. These may be done to check for swelling and fluid buildup in the bursa.

How is this treated?

This condition may be treated by:

• Resting the knee.
• Applying ice to the knee.
• Medicine, such as:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These can help to reduce pain and swelling.
  • Antibiotic medicines. These may be needed if you have an infection.
  • Steroid medicines. These may be prescribed if other treatments are not helping.
• Raising (elevating) the knee while resting.
• Doing strengthening and stretching exercises (physical therapy). These may be recommended after pain and swelling improve.
• Having a procedure to remove fluid from the bursa. This may be done if other treatment is not helping.
• Having surgery to remove the bursa. This may be done if you have a severe infection or if the condition keeps coming back after treatment.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Managing pain, stiffness, and swelling

• If directed, apply ice to your knee.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Elevate your knee above the level of your heart while you are sitting or lying down.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe fpr you to drive.

Activity

• Rest your knee.
• Avoid activities that cause pain.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do not use the injured limb to support your body weight until your health care provider says that you can.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
  • Cardiovascular fitness.
  • Endurance.

Contact a health care provider if:

• Your symptoms do not improve.
• Your symptoms get worse.
• Your symptoms keep coming back after treatment.
• You develop a fever and have warmth, redness, and swelling over your knee.

Prepatellar Bursitis Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your knee. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Hamstring, standing

1. Stand with your __________ foot resting on a chair. Your __________ leg should be fully extended.
2. Arch your lower back slightly.
3. Leading with your chest, lean forward at the waist until you feel a gentle stretch in the back of your __________ knee or in your thigh. You should not need to lean far to feel a stretch.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise B: Knee flexion, active heel slides

1. Lie on your back with both knees straight. If this causes back discomfort, bend your __________ knee so your foot is flat on the floor.
2. Slowly slide your __________ heel back toward your buttocks until you feel a gentle stretch in the front of your knee or thigh.
3. Hold this position for __________ seconds.
4. Slowly slide your __________ heel back to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your knee. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Quadriceps, isometric

1. Lie on your back with your __________ leg extended and your __________ knee bent.
2. Slowly tense the muscles in the front of your __________ thigh. When you do this, you should see your kneecap slide up toward your hip or see increased dimpling just above the knee. This motion will push the back of your knee down toward the surface that is under it.
3. For __________ seconds, keep the muscle as tight as you can without increasing your pain.
4. Relax the muscles slowly and completely.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Straight leg raises (quadriceps)

1. Lie on your back with your __________ leg extended and your __________ knee bent.
2. Slowly tense the muscles in your __________ thigh. When you do this, you should see your kneecap slide up toward your hip or see increased dimpling just above the knee.
3. Keep these muscles tight as you raise your leg 4–6 inches (10–15 cm) off the floor.
4. Hold this position for __________ seconds.
5. Keep these muscles tense as you lower your leg slowly.
6. Relax your muscles slowly and completely.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Straight leg raises (hip extensors)

1. Lie on your abdomen on a bed or a firm surface. You can put a pillow under your hips if that is more comfortable.
2. Tense your buttock muscles and lift your __________ thigh. Your __________ knee can be bent or straight, but do not let your back arch.
3. Hold this position for __________ seconds.
4. Slowly lower your leg to the starting position.
5. Let your muscles relax completely.

Repeat __________ times. Complete this exercise __________ times a day.