■ ■ ■ Description

A bursa functions like a water balloon to reduce friction and wear of the soft tissues against bone. The prepatellar bursa is a bursa between the patella (kneecap) and the overlying skin. This bursa allows the skin to glide easily and without friction over the patella. Prepatellar bursitis is characterized by inflammation and pain of this bursa.

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■ ■ ■ Common Signs and Symptoms

• Pain, tenderness, swelling, warmth, or redness over the front of the patella at the prepatellar bursa

• Limited movement in the affected area, occasionally with radiation of pain into adjacent areas

• Occasionally, severe pain with movement of the affected knee

• Crepitation (a crackling sound) when the bursa is moved or touched

• Occasionally, painless swelling of the bursa

• Fever (when infected)

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■ ■ ■ Causes

• Usually, sudden direct trauma or repetitive kneeling or knee bending

• Less commonly, overuse or strenuous, unaccustomed exercise of the knee

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■ ■ ■ Risk Increases With

• Sports that require kneeling or landing on the knees, such as volleyball or football

• Vigorous or repetitive athletic training (particularly running down hills or inclines) or sudden increase or change in activity level (weekend warriors)

• Improper warm-up or overstretching

• Poor technique

• Artificial turf

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■ ■ ■ Preventive Measures

• Avoid injuries or overuse of muscles whenever possible.

• Appropriately warm up and cool down.

• Maintain appropriate conditioning:

  • Knee flexibility

  • Muscle strength and endurance

  • Cardiovascular fitness

• Use proper technique and wear protective equipment, including knee pads.

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■ ■ ■ Expected Outcome

This condition is usually curable within 2 weeks if treated appropriately with conservative treatment and resting of the affected area.

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■ ■ ■ Possible Complications

• Prolonged healing time if not appropriately treated or if not given adequate time to heal

• Frequent recurrence of symptoms, resulting in a chronic problem

• Joint stiffness, with permanent limitation of the affected joint’s mobility

• Infection of bursa

• Chronic inflammation or scarring of bursa

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■ ■ ■ General Treatment Considerations

Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises (particularly the quadriceps and hamstring muscles), and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. For those on their knees often or for those at risk of falling and landing on the knees, knee pads should be worn to protect the bursa while the inflammation settles down. An elastic bandage may be used to help reduce swelling. If symptoms persist or recur, withdrawing fluid from the bursa, with or without injection or cortisone, may be needed. Bursae that persist in spite of conservative treatment, that recur, or that are infected may require surgical excision (removal).

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers are usually not prescribed for this condition. If your physician does prescribe pain medications, use only as directed.

• Cortisone injection into the bursa reduces inflammation and may be administered, although this is not usually recommended as a means to return to sports.

• Antibiotics may be prescribed if the bursa is infected.

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■ ■ ■ Heat and Cold

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 weeks despite treatment

• Signs of infection develop, including fever to 101°F, increased pain, redness, warmth, or purulent drainage from the bursa

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)