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CONDITION/DISORDER SYNONYMS

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  • Infrapatellar bursitis

  • Housemaid’s knee

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ICD-9-CM CODE1

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  • 726.65 Prepatellar bursitis

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ICD-10-CM CODE2

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  • M70.40 Prepatellar bursitis, unspecified knee

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PREFERRED PRACTICE PATTERN3

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

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PATIENT PRESENTATION

Patient is a 58-year-old male who decided to put tile down in his bathroom. His regular job is a salesman with limited physical activity. After 2 days on his hands and knees installing floor tile, he began having knee pain. He was unable to finish the installation. He has tried to ice the knee and stay off of it. He is having difficulty bending the knee and going down the stairs as his house. The patient has tenderness just above the tibial tubercule.

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KEY FEATURES

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Description
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  • Localized inflammation of the prepatellar bursa.

  • Bursa fills with blood and serous fluid as response to either acute or repeated micro trauma.

  • Presents as pronounced, local swelling isolated to the anterior knee.

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Essentials of Diagnosis
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  • Result of single episode of trauma or repeat trauma to the anterior knee when in a flexed position.

  • Bursitis is commonly related to occupation or specific activity that causes rubbing or pressure on the anterior knee from a hard surface.

  • Swelling is contained to bursa which results in the visualization of a swollen appearance on both sides of the patella tendon.

  • Patients often note focal pain to palpation of swollen bursa, decreased range of motion, or inability to bear weight on the flexed knee.

  • Differential diagnosis is essential due to presence of infections to this area.

  • Exquisite swelling, marked tenderness, and redness or heat may be indicative of differential diagnosis.

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FIGURE 189-1

Knee bursa. (Reproduced with permission from Reichman EF, Simon RR: Emergency Medicine Procedures. © 2004.)

Graphic Jump Location
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General Considerations
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  • Full history of symptoms and medical history screening will ensure appropriate diagnosis.

  • Isolated diagnosis related to acute or chronic activity (pressure to the anterior flexed knee by a hard surface) and focal swelling/pain

  • Marked tenderness or swelling with acute onset may signal underlying fracture.

  • Redness or heat may be indicative of infection.

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Demographics
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  • No reports identifying or limiting demographics. Incidence related to activity.

  • Occurs primarily in adults but can occur in children and athletes of any age.

  • When chronic, often associated with occupation (maid) or prolonged activity (tile installer) which places flexed knee on hard surface.

  • When acute, often associated with acute blow or fall when the knee is flexed (athletes).

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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS

  • Point tenderness to the anterior knee

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