From the Guidelines
Prepatellar bursitis typically presents with pain, swelling, and tenderness over the front of the knee, specifically over the kneecap (patella), and is often associated with activities that involve kneeling or direct pressure on the knee. The signs and symptoms of prepatellar bursitis can be categorized into musculoskeletal symptoms, which should be initially treated with nonpharmacological approaches such as physical therapy, heat/cold, and orthotics 1. Patients with prepatellar bursitis often experience:
- Pain over the front of the knee
- Swelling and tenderness over the kneecap
- Redness and warmth of the affected area
- Increased pain with kneeling or direct pressure on the knee
- Full range of motion, unless severe swelling restricts movement
- A feeling of fluid accumulation or fullness in the anterior knee In cases of septic bursitis, additional symptoms may include:
- Fever
- Chills
- More pronounced redness and warmth The diagnosis of prepatellar bursitis is primarily clinical, based on the characteristic anterior knee swelling that is superficial to the patella, distinguishing it from conditions like arthritis or meniscal injuries where swelling occurs within the joint space 1. The treatment approach should focus on nonpharmacological methods first, with pharmacological treatments considered only if symptoms are not controlled.
From the Research
Prepatellar Bursitis Signs and Symptoms
- The signs and symptoms of prepatellar bursitis can vary depending on whether the condition is septic or non-septic 2.
- Septic prepatellar bursitis may present with fever, prebursal temperature difference, and skin lesions, as well as purulent aspirate, low fluid-to-serum glucose ratio, high white cell count, and positive Gram staining or culture 2.
- Non-septic prepatellar bursitis may present with swelling, pain, and loss of range of motion, and may not respond to conservative treatment measures such as activity modification, compression, and nonsteroidal anti-inflammatory agents 3.
- Chronic prepatellar bursitis can be treated with conservative therapy, aspiration, or corticosteroid injection, while inflamed bursae require aggressive evaluation and treatment, including aspiration, decompression, and antibiotics 4.
Diagnostic Findings
- Bursal aspirate analysis can help differentiate between septic and non-septic prepatellar bursitis, with findings such as purulent aspirate, low fluid-to-serum glucose ratio, and high white cell count indicating septic bursitis 2.
- Physical findings such as fever, prebursal temperature difference, and skin lesions can also suggest septic bursitis 2.
- Imaging studies such as ultrasound can be used to guide aspiration and injection procedures 3.
Treatment Options
- Conservative treatment measures such as bursal aspiration, nonsteroidal anti-inflammatory agents, and PRICE (protection, rest, ice, compression, and elevation) can be effective for both septic and non-septic prepatellar bursitis 2, 4.
- Intrabursal steroid injection may be performed for patients with confirmed non-septic bursitis and high athletic or occupational demands 2.
- Sclerotherapy with a sclerosing agent such as polidocanol can be used to treat recurrent non-septic prepatellar bursitis 3.
- Antibiotic therapy should be initiated for septic bursitis, and surgical treatment such as incision, drainage, or bursectomy may be necessary for severe, refractory, or chronic/recurrent cases 2, 4.