From the Research
The best treatment option for prepatellar bursitis is a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen 400-800 mg three times daily or naproxen 500 mg twice daily for 7-10 days. The patient's presentation of pain, swelling, and redness over the anterior knee following direct trauma to the patella, with pain worsening during knee flexion when the skin tightens over the patella, is classic for prepatellar bursitis. NSAIDs are the first-line treatment as they address both the inflammation and pain associated with this condition 1.
Key Considerations
- In addition to medication, the patient should be advised to:
- Rest the affected knee
- Apply ice for 15-20 minutes several times daily
- Consider compression with an elastic bandage
- If symptoms are severe or don't improve with NSAIDs within a week, the patient may need aspiration of the bursa and possibly a corticosteroid injection
- Antibiotics would only be indicated if there were signs of infection such as fever or purulent drainage, which are not present in this case
- The mechanism of injury (direct trauma to the knee) and the timing of symptom development are typical for traumatic prepatellar bursitis, making anti-inflammatory treatment the appropriate choice
Safety and Efficacy of NSAIDs
The use of NSAIDs for prepatellar bursitis is supported by their efficacy in reducing pain and inflammation, as seen in various studies, including those on osteoarthritis and sciatica 2, 3. However, it's essential to consider the potential risks associated with NSAID use, such as gastrointestinal and cardiovascular adverse effects, and to select the most suitable NSAID for each patient based on their individual risk factors 4.
Monitoring and Follow-Up
Patients taking NSAIDs should be monitored for signs of adverse effects, and their treatment should be adjusted accordingly. In cases where NSAIDs are not effective or are contraindicated, alternative treatments such as acetaminophen or opioids may be considered, although their use should be cautious and closely monitored due to their own set of potential risks 1, 2.