Prepatellar bursitis is an inflammation of a fluid-filled sac (bursa) located in front of the knee that normally acts as a cushion to help reduce friction.
What is prepatellar bursitis?
Prepatellar bursitis is an inflammation of a fluid-filled sac (bursa) located in front of the knee (prepatellar) that normally acts as a cushion to help reduce friction. It can be caused by prolonged kneeling, such as for work, or due to injury or infection, and can either be acute or chronic.
Symptoms of acute prepatellar bursitis include warmth, redness that may spread, swelling, and pain at the front of the knee, as well as fluid, a possible wound, and a fever if it is due to an infection. Chronic prepatellar bursitis may include symptoms such as a soft, painless lump at the front of the knee, as well as redness around the knee.
Treatments include rest, anti-inflammatory medications, antibiotics, medications for other conditions, and surgery and other procedures if needed.
You should visit your primary care physician to discuss these symptoms. Treatment is likely to include rest, icing, elevation, and anti-inflammatory medications like ibuprofen.
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Symptoms of prepatellar bursitis
Prepatellar bursitis can cause either sudden symptoms ("acute") or long-term symptoms ("chronic").
Symptoms of acute prepatellar bursitis include:
- Warmth, redness, swelling, and pain in the front of the knee: The most common finding in acute prepatellar bursitis is knee redness, swelling, and pain in the front of the knee. The knee will feel warm to the touch and will cause pain when pushed.
- Fluid in front of the knee: Inflammation causes fluid to leak out of the blood vessels into the space near the joint, and it is sometimes possible to feel the fluid when pushing down on the front of the knee.
- Wound or bug bite over the skin at the front of the knee: If the prepatellar bursitis is due to an injury or an infection, there may be signs of the injury that can be seen on the skin. Examples include a wound from an injury or evidence of a bug bite.
- Fever: A fever occurs in about one-third of people with prepatellar bursitis. It's rare for anyone with prepatellar bursitis to develop a high fever or become quite ill. If this occurs, it is usually due to an infection that has spread to the bloodstream.
- Redness spreading beyond the knee: In some cases, people with acute prepatellar bursitis may develop a redness of the skin that spreads beyond the knee to the sides of the knee and up the leg. This can occur when the bursa pops, causing inflammation and possibly an infection of the skin around the knee.
Symptoms of chronic prepatellar bursitis include:
- Soft, non-painful lump in front of the knee: People with chronic prepatellar bursitis develop a soft lump in front of the knee, but it does not hurt when you push on it. The lump may be slightly warm or cold.
- Redness around the knee: The skin on the front of the knee usually is only slightly red in people who have chronic prepatellar bursitis. Redness that spreads around the knee is rare. This is not due to the chronic prepatellar bursitis itself but is instead due to an infection associated with prepatellar bursitis.
Causes of prepatellar bursitis
The following causes can lead to either acute or chronic prepatellar bursitis. This includes prolonged kneeling, injury or infection, and other conditions.
The most common cause of long-term prepatellar bursitis is prolonged kneeling. The prolonged and repeated kneeling puts pressure on the knee and causes inflammation of the prepatellar bursa. This is commonly seen in people whose jobs require them to frequently kneel, such as:
- Carpet layers
- Coal miners
Injury or infection
Injury or infection can lead to prepatellar bursitis and associated inflammation.
- Injury to the knee: An injury to the knee, especially one that penetrates the skin, can also cause prepatellar bursitis. The body's normal reaction to the injury can create further injury in the joint space, and this can be exacerbated if blood collects in the bursa.
- Infection of the knee: The knee can become infected by bacteria following a knee injury or a scrape or bug bite. The infection and the body's response to the infection will generate inflammation.
Other conditions that can be associated with the development of prepatellar bursitis include:
- Gout: Gout is a condition in which there are high uric acid levels in the blood. The uric acid can form crystals if the concentration gets too high, such as after eating a lot of meat or seafood or consuming a lot of beer. When the uric acid crystallizes in a joint, it can cause joint pain and inflammation, and inflammation of the knee can result in prepatellar bursitis.
- Rheumatoid arthritis: Rheumatoid arthritis (RA) is an inflammatory condition in which the body's immune system erroneously attacks its own tissues, including cartilage and the tissues lining joints. If rheumatoid arthritis affects the knee joint, it can result in prepatellar bursitis.
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Treatment options and prevention for prepatellar bursitis
Treatments of prepatellar bursitis, both acute and chronic, can be alleviated with rest. Other remedies include anti-inflammatories, immobilization of the knee, antibiotics, medications for other conditions, and surgery.
Avoid repeated trauma and pressure to the knee
The most important way to prevent the development of prepatellar bursitis is to avoid repeated trauma and pressure to the knee. This means:
- Avoiding prolonged kneeling
- Preventing falls or injuries
- Knee braces: If your job requires prolonged kneeling, your physician can recommend protective knee braces.
If you are experiencing prepatellar bursitis that is causing some pain, your physician may recommend that you take non-prescription pain relievers that reduce inflammation without the use of a steroid.
- NSAIDs: These include ibuprofen (Advil, Motrin) or naproxen (Aleve).
- Steroids: If you do require a steroid for inflammation, your physician may recommend a prescription anti-inflammatory medication such as prednisone (Deltasone).
Injection of anti-inflammatory medications
Some physicians may offer to inject triamcinolone (Kenalog), an anti-inflammatory medication, directly into the joint to reduce the inflammation. However, other physicians do not recommend this as it may increase the risk of an infection and is not proven to help.
Immobilization of the knee and antibiotics
If you have prepatellar bursitis that is associated with an infection, your physician may recommend to:
- Immobilize the knee with a brace or splints
- Take antibiotics: antibiotic medications to treat the infection.
- Remove fluid: In some cases, use a needle to remove fluid from the knee, which can help the infection resolve faster.
Medications to treat gout
If your prepatellar bursitis is caused by gout, your physician may prescribe medications to treat gout. These include: prednisone, prednisolone, colchicine (Colcrys), or indomethacin.
Surgery to remove the bursa
If your prepatellar bursitis does not respond to other treatments, your physician may recommend surgery to remove the bursa.
When to seek further consultation for prepatellar bursitis
If you have a job that requires prolonged kneeling, you can go to your physician to see if you are at risk of developing prepatellar bursitis. Your physician may recommend that you wear a knee brace to reduce the injury to your knee.
If you develop symptoms
If you develop any symptoms of prepatellar bursitis, including a lump in front of the knee, redness around the knee, or fever, you should go see your physician. He or she can examine the knee and order laboratory tests to determine if you have prepatellar bursitis and then recommend the appropriate treatments.
Questions your doctor may ask to determine prepatellar bursitis
- How severe is your knee pain?
- How would you explain the cause of your knee pain?
- Is your knee pain constant or come-and-go?
- Is your knee pain getting better or worse?
- Which of these if any make your knee hurt worse?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
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- Knee bursitis: Overview. Mayo Clinic. Published April 22, 2017. Mayo Clinic Link
- Knee bursitis: Diagnosis & treatment. Mayo Clinic. Published April 22, 2017. Mayo Clinic Link
- Wilson-MacDonald J. Management and outcome of infective prepatellar bursitis. Postgrad Med J. 1987;63(744):851-3. NCBI Link
- Huang YC, Yeh WL. Endoscopic treatment of prepatellar bursitis. Int Orthop. 2010;35(3):355-8. NCBI Link