INJECTION THERAPY FOR PREPATELLA BURSITIS (Housemaid's knee)

Anatomy:

The prepatella bursa is a tiny fluid-filled sac that resides beneath the skin, above the patella, on the front of the knee (kneecap). Bursitis is characterised by a swollen and painful prepatellar bursa, which is also known as Housemaid’s knee. Bursae are placed in anatomical ‘hotspots,’ where two structures move over each other in close proximity and there is a risk of undesirable friction. There are about 100 bursae in the human body.

The bursa has a dual purpose.
They are in charge of:

  • Providing a frictionless surface on which motion can take place. During knee extension, the prepatella bursa aids in smooth movement between the kneecap and the quadriceps tendon (straightening of the knee).
  • Providing a barrier of protection from direct impact or repetitive operations. The prepatella bursa’s purpose is to protect the kneecap if you fall or kneel for an extended amount of time.

Under normal circumstances, the prepatellar bursa does an excellent job. They can, however, become inflamed and uncomfortable at times. Prepatellar bursitis (also known as Housemaid’s knee) is a painful, swelling prepatellar bursa. This can happen as a result of:

  • Kneeling puts too much strain on the bursa.
  • A fall might have a direct influence on the bursa.
  • Infection 
  • As a result of a systemic inflammatory illness like gout or rheumatoid arthritis

There are two categories of Bursitis

1.Septic bursitis:

When the bursa becomes inflamed and swollen, it is known as bursitis. The pre patella bursa is prone to infection due to its shallow placement. Septic bursitis is fortunately uncommon, but it does necessitate medical attention. According to reports, it is responsible for 1-12 instances per 10,000 hospital admissions.

If your bursa is red and hot, as well as painful and swollen, you should see your doctor right away since you will need antibiotic therapy right away. You may also begin to feel ill and suffer symptoms similar to a fever.

The most commonly infected bursas are the pre-patella bursa and the olecranon bursa of the elbow. The olecranon bursa (at the elbow) is four times more prone to septic bursitis than the prepatella bursa, according to research (Baumbach et al., 2012).

2.Aseptic Bursitis 

When the bursa gets swollen and uncomfortable but is not diseased, the bursa does not turn red. This is by far the most common type of bursitis, and it’s frequently linked to one or more of the risk factors listed below:

  • Males account for 80% of all bursa cases, according to reports (Baumbach et al., 2012).
  • Bursitis can strike at any age, however the most common occurrence of pre patella bursitis occurs in the fourth and sixth decades of life.
  • Kneeling causes repetitive pressure on the bursa. Housemaids’ knee is a condition caused by excessive weight bearing on the kneecap for long periods of time. It’s common in jobs like carpet installation and construction.
  • Trauma to the tip of the kneecap as a result of a direct collision, such as landing on your knee.
  • The pre patella bursa can become inflamed as a result of rheumatological disorders including gout or rheumatoid arthritis (Sayegh et al., 2014).

How do you know if you have Prepatella Bursitis?  

Prepatella bursitis is characterised by discomfort and swelling in the front of the knee. Symptoms can appear quickly after a trauma or develop over time as a result of repetitive activity, such as working on your knees.

How to diagnose Prepatella bursitis?

It’s critical to have an accurate diagnosis of pre patella bursitis so you can get the best therapy possible. Pre-patella bursitis can be diagnosed by a doctor or physiotherapist.

Symptoms of pre-patella bursitis include:

  • Pain in the area of the kneecap
  • Swelling on the front of the knee – Swelling on the front of the knee can be severe in rare situations, resulting in a huge soft pocket of fluid lying above the kneecap.
  • Kneeling, sitting, and walking cause pain.
  • Knee flexion (bending of the knee) causes stiffness and tightness due to swelling of the prepatella bursa.

The following symptoms may also be present if the prepatella bursa is septic:

  • It’s possible that the skin above the kneecap will turn red.
  • Increased temperature – A red and hot bursa is present in between 63 and 100 percent of all patients with bursitis (Del Buono et al 2012)
  • You might feel ill in some circumstances. Fever can indicate an infected bursa in the context of bursitis (Oliveira et al., 2015)

If you encounter any of these symptoms, you should arrange an appointment with your doctor very away.

What is osteoarthritis (OA)of the knee?

The examination entails the following:

1. Medical consultation:

  • Direct inquiry is done to figure out when, how, and why your discomfort began. A complete medical history will be reviewed, and it will be crucial to rule out systemic inflammatory causes of pain such as gout or rheumatoid arthritis, as well as an infection.
  • Knee range of motion and strength testing, as well as palpation (feeling) of various structures around the knee, are all part of the physical examination. This is typically painful, but it is necessary for diagnosing the source of your symptoms. A series of function tests, such as standing on one leg or squatting, may be required of you.

2. Additional research:

Pre-patella bursitis can typically be diagnosed based on a clinical examination. However, additional tests may be required for a precise diagnosis. We will refer you to your GP or a specialist if we feel your bursitis is caused by an infection or a systemic inflammatory illness.

Blood tests and/or further investigations may be ordered by your GP or specialist. This could involve the following:

  • Tests on the blood
    -If your doctor suspects you of having septic bursitis, you may be sent for a battery of blood tests.
    -Blood tests may be performed if your clinician suspects a systemic cause of your symptoms, such as gout or rheumatoid arthritis.
  • Aspiration of the bursa
    -If a septic prepatella bursitis is suspected, a little sample of bursal fluid can be extracted with a needle and sent to a pathology lab for further analysis. Only in a hospital setting would this be done. 

3. Musculoskeletal ultrasound imaging for diagnosis:

At your initial appointment, a diagnostic ultrasound scan will be performed. For determining the existence of bursal pathology, an ultrasonic scan is considered the gold standard imaging tool. Diagnostic ultrasound has been demonstrated to be a highly effective imaging method for diagnosing pre-patella bursitis in studies (Baumbach et al., 2012). It can also detect inflammatory arthritic disorders like gout (Fernandez et al. 2017 and Villaverde et al. 2014), making it a good imaging approach to use while trying to figure out what’s causing pre patella bursitis.

Our specialists are dual-trained as physiotherapists and musculoskeletal sonographers at Joint Injections. Your doctor will be able to clinically analyse your knee and perform a diagnostic musculoskeletal ultrasound scan during your initial consultation. Your clinician will be able to provide you with the most effective and appropriate treatment when an accurate diagnosis has been obtained.

What is the best way to treat Prepatella bursitis?

Prepatella bursitis treatment is depending on a correct diagnosis and whether the bursa is aseptic or septic.

Septic Prepatella bursitis

Your GP or a hospital consultant will treat you for this. These are not treated in our clinics. Septic prepatella bursitis necessitates medical attention and antibiotic treatment. According to studies, 82 percent of all infected bursae necessitate aspiration (Sayegh et al., 2014). A needle is used to extract contaminated fluid from the bursal space during this treatment. In the unlikely event that treatment does not relieve symptoms, surgical intervention may be required.

Aseptic Prepatella bursitis
The great majority of aseptic bursitis patients react effectively to conservative treatment. Swelling and pain usually subside within 6 weeks, and symptoms may include:

  • Exacerbating activities and postures, such as weight-bearing directly on the knee, should be avoided.
  • To relieve pressure on the bursa, a padded area (knee pad) is placed above the kneecap.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help relieve the pain and inflammation associated with bursitis for a brief period of time (Kennedy et al., 2016)

What if cautious management isn’t enough to get your aseptic prepatella bursitis under control?
If conservative approaches have failed to relieve your symptoms after being diagnosed with aseptic prepatella bursitis, an ultrasound-guided aspiration and/or a corticosteroid injection may be necessary.

Your clinician will drain (also known as aspirate) the fluid from the bursa using ultrasound guidance (and local anaesthesia if necessary). To ensure that the fluid does not return, a little dosage of corticosteroid (also known as steroid) is injected if necessary. This is accomplished in a single step. The anti-inflammatory drug corticosteroid is commonly used to treat the pain and inflammation associated with bursitis.

At Joint Injections , we have a team of highly skilled clinicians who have performed pre-patellar bursitis operations using ultrasound guidance. Physiotherapists, musculoskeletal sonographers, independent prescribers, and injectable therapists are all fully qualified clinicians. Your clinician will conduct a comprehensive clinical examination as well as a diagnostic ultrasound scan during your consultation. Your doctor will be able to prescribe the most appropriate medication for you before administering an ultrasound-guided injection if one is needed. You have the option to self-refer to our same-day service. You need not need a doctor’s referral or to bring a prescription.

 

Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all knee disorders. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.