Prepatellar Bursitis Workup

Updated: Nov 06, 2018
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Consuelo T Lorenzo, MD  more...
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Workup

Laboratory Studies

Laboratory studies are not usually indicated to diagnose prepatellar bursitis. However, analysis of fluid aspirated from the bursa is important in differentiating septic bursitis (SB) from nonseptic bursitis (NSB). The fluid should be sent for analysis, since the prepatellar bursa is commonly a site of infection. (See the table below.)

Table 1. Characteristics of bursal fluid in patients with septic and nonseptic prepatellar bursitis (Open Table in a new window)

Characteristic

Septic bursitis (SB)

Nonseptic bursitis (NSB)

Appearance

Purulent

Serosanguineous, straw colored, or bloody

White blood cell count per µL

1500-300,000; mean 75,000

50-10,000; usually < 3000

Differential count

Polymorphonuclear (PMN) cells

Predominantly mononuclear cells

Bursal fluid–to–serum glucose ratio

< 50%

>50%

Gram stain

Positive in 70%

Negative

Culture

Positive

Negative

Evaluate the aspirated fluid for WBC count, protein, lactate, glucose, crystals, and Gram stain results. Typical findings in septic bursitis include the following:

  • WBC count of 50,000/µL or greater

  • Elevated protein

  • Elevated lactate

  • Decreased glucose

  • Gram stain results specific to bacteria

In crystal-induced diseases causing bursitis, findings include monosodium urate crystals (gout), calcium pyrophosphate crystals (pseudogout), and cholesterol crystals (rheumatoid arthritis).

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Imaging Studies

Plain radiographs may show soft tissue swelling; however, radiographs are necessary only if other conditions are suggested (eg, fracture and/or dislocation).

CT scanning and MRI are reserved for cases that have been difficult to manage (eg, failure of initial treatment for septic prepatellar bursitis). [5, 6]

Ultrasonography may be a useful technique for evaluating synovial fluid in the knee.

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Procedures

Aspiration of prepatellar bursa fluid may be indicated because sepsis is common. Consider injection of the prepatellar bursa with corticosteroids only when infection has been excluded. Select position of maximal fullness as the site for injection. Complications of injection include, but are not limited to, the following:

  • Infection

  • Bleeding

  • Postinjection inflammation and erythema

  • Postinjection pain

  • Tendon rupture

  • Subcutaneous atrophy

A compression dressing should be worn for 24-36 hours after the procedure, with avoidance of direct pressure to the knee.

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