Would a steroid shot help prepatellar bursitis?

Management of Prepatellar Bursitis: Role of Steroid Injections

Corticosteroid injections are conditionally recommended for prepatellar bursitis when conservative treatments fail, but should be avoided if infection is suspected due to risk of worsening the condition.

Understanding Prepatellar Bursitis

Prepatellar bursitis is inflammation of the bursa located between the skin and the patella (kneecap). It commonly results from:

• Chronic microtrauma (frequent kneeling)
• Acute trauma or hemorrhage
• Inflammatory disorders (gout, rheumatoid arthritis)
• Infection (septic bursitis)

Treatment Algorithm

First-Line Treatment (1-4 weeks)

• Conservative measures:
  • Rest and activity modification (avoid kneeling)
  • Ice application for 10-minute periods through a wet towel 1
  • Compression bandage
  • NSAIDs (oral or topical) 2
  • Elevation of the affected limb

Second-Line Treatment (if symptoms persist after 2-4 weeks)

• Evaluate for infection before considering steroid injection:
  • If signs of infection present (fever, significant erythema, warmth): DO NOT INJECT
  • If no signs of infection: Corticosteroid injection may be considered

Corticosteroid Injection Considerations

• Benefits:

  • May provide short-term pain relief (1-4 weeks) 2
  • More effective than oral steroids for localized inflammation 2
  • Can be useful for chronic, non-septic bursitis 3

• Risks and limitations:

  • Potential for iatrogenic septic bursitis 4
  • May inhibit healing and reduce tensile strength of tissue 1
  • Limited high-quality evidence demonstrating benefit 4
  • Should be limited to 3-4 injections per year 2

Special Considerations

When to Avoid Steroid Injections

• Suspected infection (septic bursitis)
• Break in the skin over the bursa
• Recent trauma with hemorrhagic bursitis
• Previous failed steroid injections

When to Consider Referral

• Persistent symptoms despite 4-6 weeks of conservative management 2
• Suspected septic bursitis
• Recurrent episodes despite appropriate treatment
• Significant functional limitation

Surgical Options for Refractory Cases

For cases that don't respond to conservative measures and appropriate injections:

• Endoscopic bursal resection has shown good outcomes (66-86% of patients achieve complete pain relief) 5
• Surgical excision is recommended only for recalcitrant cases 3

Important Caveats

• Bursal aspiration of microtraumatic bursitis is generally not recommended due to infection risk 4
• Ultrasound guidance improves injection accuracy (95.5% vs 77.2% with blind injection) 2
• Always rule out septic bursitis before considering steroid injection
• Addressing the underlying cause (e.g., occupational kneeling) is crucial for long-term success

By following this structured approach, steroid injections can be appropriately incorporated into the management of prepatellar bursitis when indicated, while minimizing risks and optimizing outcomes.