eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Prepatellar Bursitis

Author: Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Coauthor(s): Guy W Fried, MD, Assistant Professor, Department of Rehabilitation Medicine, Thomas Jefferson University; Outpatient Medical Director, Medical Director of Incontinence and Respiratory Care Programs, Magee Rehabilitation Hospital
Contributor Information and Disclosures

Updated: Aug 9, 2009

Introduction

Background

The prepatellar bursa is a superficial bursa with a thin synovial lining located between the skin and the patella. Normally, it does not communicate with the joint space and contains a minimal amount of fluid; however, inflammation of the prepatellar bursa results in marked increase of fluid within its space.

Pathophysiology

The prepatellar bursa is a flat round synovial-lined structure; its main function is to separate the patella from the patellar tendon and skin. This bursa is superficial, suggesting that it is undeveloped at birth. Within the first few months to years of life, the bursa arises from direct pressure and friction. The function of the bursa is to reduce friction and allow maximal range of motion (ROM).

Mortality/Morbidity

Mortality associated with prepatellar bursitis is rare. Morbidity usually is secondary to pain and limited function.1 In the case of septic prepatellar bursitis, failure to diagnose in a timely manner may lead to increased morbidity secondary to infectious etiology.

Sex

Incidence of prepatellar bursitis is greater in males than females.

Age

Prepatellar bursitis can affect all age groups; however, in the pediatric age group, it is likely to be septic and to develop in an immunocompromised host.

Clinical

History

Obtaining the patient's history is important in ascertaining the diagnosis. Common findings reported by the patient with prepatellar bursitis may include the following:

  • Knee pain
  • Swelling of the knee
  • Redness of the knee
  • Difficulty with ambulation
  • Inability to kneel on the affected side
  • Relief of pain with rest
  • History of repetitive motion
  • History of occupation requiring excessive kneeling
  • History of a fall on the knee or blunt trauma to the knee (with presentation of symptoms up to 10 d after the incident)

Physical

The physician may note any of the following signs and symptoms during physical examination:

  • Tenderness of the patella to palpation
  • Fluctuant edema over the lower pole of the patella
  • Erythema of the knee
  • Crepitation of the knee
  • Decreased knee flexion secondary to pain

Causes

Any of the following causes may be associated with development of prepatellar bursitis:

  • Direct trauma (eg, a fall on the patella or direct blow to the knee)
  • Recurrent minor injuries associated with overuse (eg, repeated kneeling)
  • Septic or pyogenic process
    • Infection common from Staphylococcus aureus (usually from a break in the skin)
    • More prevalent in children
    • Can be mistaken for pyogenic arthritis
  • Crystal deposition (eg, gout, pseudogout)
  • History of inflammatory disease
  • Occupation
    • Carpet layer
    • Coal miner
    • Roofer
    • Plumber
    • Homemaker (housemaid's knee)

More on Prepatellar Bursitis

Overview: Prepatellar Bursitis
Differential Diagnoses & Workup: Prepatellar Bursitis
Treatment & Medication: Prepatellar Bursitis
Follow-up: Prepatellar Bursitis
References
Further Reading
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References

  1. Wood LR, Peat G, Thomas E, et al. The contribution of selected non-articular conditions to knee pain severity and associated disability in older adults. Osteoarthritis Cartilage. Jun 2008;16(6):647-53. [Medline].

  2. Ciaschini M, Sundaram M. Radiologic case study. Prepatellar Morel-Lavallée lesion. Orthopedics. Jul 2008;31(7):626, 719-721. [Medline].

  3. Borrero CG, Maxwell N, Kavanagh E. MRI findings of prepatellar Morel-Lavallée effusions. Skeletal Radiol. May 2008;37(5):451-5. [Medline].

  4. Gendernalik JD, Sechriest VF 2nd. Prepatellar septic bursitis: a case report of skin necrosis associated with open bursectomy. Mil Med. Jun 2009;174(6):666-9. [Medline].

  5. Martinez-Taboada VM, Cabeza R, Cacho PM, et al. Cloxacillin-based therapy in severe septic bursitis: retrospective study of 82 cases. Joint Bone Spine. Jul 1 2009;[Medline].

  6. Bellon EM, Sacco DC, Steiger DA, Coleman PE. Magnetic resonance imaging in "housemaid''s knee" (prepatellar bursitis). Magn Reson Imaging. 1987;5(3):175-7. [Medline].

  7. Dawn B, Williams JK, Walker SE. Prepatellar bursitis: a unique presentation of tophaceous gout in an normouricemic patient. J Rheumatol. May 1997;24(5):976-8. [Medline].

  8. Donahue F, Turkel D, Mnaymneh W, Ghandur-Mnaymneh L. Hemorrhagic prepatellar bursitis. Skeletal Radiol. Apr 1996;25(3):298-301. [Medline].

  9. Garcia-Porrua C, Gonzalez-Gay MA, Ibanez D, Garcia-Pais MJ. The clinical spectrum of severe septic bursitis in northwestern Spain: a 10 year study. J Rheumatol. Mar 1999;26(3):663-7. [Medline].

  10. Kaalund S, Breddam M, Kristensen G. Endoscopic resection of the septic prepatellar bursa. Arthroscopy. Oct 1998;14(7):757-8. [Medline].

  11. Kerr DR. Prepatellar and olecranon arthroscopic bursectomy. Clin Sports Med. Jan 1993;12(1):137-42. [Medline].

  12. McAfee JH, Smith DL. Olecranon and prepatellar bursitis. Diagnosis and treatment. West J Med. Nov 1988;149(5):607-10. [Medline].

  13. Meys E, Michaux L, Lambert M, et al. Septic Streptococcus milleri prepatellar bursitis. Clin Rheumatol. Mar 1992;11(1):109-11. [Medline].

  14. Ogilvie-Harris DJ, Gilbart M. Endoscopic bursal resection: the olecranon bursa and prepatellar bursa. Arthroscopy. Apr 2000;16(3):249-53.

  15. Papadakis KA, Vartivarian SE, Vassilaki ME, Anaissie EJ. Septic prepatellar bursitis caused by Stenotrophomonas (Xanthomonas) maltophilia. Clin Infect Dis. Feb 1996;22(2):388-9. [Medline].

  16. Pien FD, Ching D, Kim E. Septic bursitis: experience in a community practice. Orthopedics. Sep 1991;14(9):981-4. [Medline].

  17. Roy DR, Greene WB, Gamble JG. Osteomyelitis of the patella in children. J Pediatr Orthop. May-Jun 1991;11(3):364-6. [Medline].

  18. Westenfeld F, Alston WK, Winn WC. Complicated soft tissue infection with prepatellar bursitis caused by Paecilomyces lilacinus in an immunocompetent host: case report and review. J Clin Microbiol. Jun 1996;34(6):1559-62. [Medline].

  19. Wilson-MacDonald J. Management and outcome of infective prepatellar bursitis. Postgrad Med J. Oct 1987;63(744):851-3. [Medline].

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Further Reading

Related eMedicine topics:
Bursitis [Emergency Medicine]
Bursitis [Orthopedic Surgery]
Cystic Lesions About the Knee
Knee, Extensor Mechanism Injuries (MRI)
Knee Injury, Soft Tissue
Pes Anserinus Bursitis

Clinical guidelines:
Knee & leg (acute & chronic). Work Loss Data Institute - Public For Profit Organization.  2003 (revised 2008 May 7).  289 pages.  NGC:006561

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Keywords

prepatellar bursitis, bursitis, bursectomy, bursitis of knee, bursitis of the knee, prepatellar bursa, housemaid's knee, carpet layer's knee, beat knee

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Contributor Information and Disclosures

Author

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Coauthor(s)

Guy W Fried, MD, Assistant Professor, Department of Rehabilitation Medicine, Thomas Jefferson University; Outpatient Medical Director, Medical Director of Incontinence and Respiratory Care Programs, Magee Rehabilitation Hospital
Guy W Fried, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM, President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine
Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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