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Prepatellar Bursitis Treatment & Management

  • Author: Kelly L Allen, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Oct 20, 2015
 

Rehabilitation Program

Physical Therapy

After the initial period of rest, the goal of physical therapy is to regain any loss of ROM, while increasing the flexibility of the quadriceps and hamstrings. Use of therapeutic modalities can be helpful to assist stretching in this period.

Occupational Therapy

The role of the occupational therapist in this scenario is to address modifications of activities in patients diagnosed with prepatellar bursitis secondary to overuse. Emphasize patient education, avoidance of kneeling, and use of kneepads if kneeling is necessary.

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Surgical Intervention

Incision and drainage of the prepatellar bursa usually is performed when symptoms of septic bursitis have not improved significantly within 36-48 hours. Surgical removal of the bursa (ie, bursectomy) may be necessary for chronic or recurrent prepatellar bursitis.[5] Arthroscopic or endoscopic excision of the bursa has more recently been reported to have satisfactory results with less trauma than open excision.[6, 7]

Using a systematic literature review, Baumbach et al developed a treatment algorithm for olecranon and prepatellar bursitis in which they advised that septic forms of these conditions initially be treated conservatively. They recommended that incision, drainage, or bursectomy be reserved for patients with severe, refractory, or chronic/recurrent disease.[8]

A study by von Dach et al suggested that even in cases of moderate to severe septic prepatellar or olecranon bursitis, it is safe to substitute a one-stage bursectomy with primary closure for a two-stage procedure. The study, which included 168 patients, also found that the median hospital stay was 2 days shorter with the one-stage approach than with the two-stage operation.[9]

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Consultations

Request orthopedic consultation in recurrent and/or chronic prepatellar bursitis for bursectomy evaluation. Initiate consultation for septic prepatellar bursitis that fails to improve within 36-48 hours and requires incision and drainage.

Initiate infectious disease consultation within 36-48 hours in septic prepatellar bursitis that is unresponsive to treatment.

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Contributor Information and Disclosures
Author

Kelly L Allen, MD Medical Director, Medevals

Disclosure: Nothing to disclose.

Coauthor(s)

Guy W Fried, MD Professor, Department of Rehabilitation Medicine, Jefferson Medical College of Thomas Jefferson University; Chief Medical Officer, 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Milton J Klein, DO, MBA Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital and Ohio Valley General Hospital

Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

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, Texas Medical Association

Disclosure: Nothing to disclose.

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. 2008 Jun. 16(6):647-53. [Medline].

  2. Krishna R, Rathod A, Preetham. Massive pre-patellar bursitis – a case report. Indian J Orthop Surg. 2015 Apr-Jun. 2(2):124-6. [Full Text].

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

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

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

  6. Huang YC, Yeh WL. Endoscopic treatment of prepatellar bursitis. Int Orthop. 2011 Mar. 35(3):355-8. [Medline]. [Full Text].

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

  8. Baumbach SF, Lobo CM, Badyine I, et al. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg. 2014 Mar. 134(3):359-70. [Medline].

  9. von Dach E, Uckay I, Agostinho A, et al. One- versus two-stage bursectomy for septic olecranon and pre-patellar bursitis: a prospective randomized study. American Society for Microbiology. Available at http://www.asm.org/index.php/asm-newsroom/journal-tip-sheets/371-news-room/icaac-releases/93720-one-versus-two-stage-bursectomy-for-septic-olecranon-and-pre-patellar-bursitis-a-prospective-randomized-study. Sep 18, 2015; Accessed: Oct 20, 2015.

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

 
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